April 20, 2020

COVID-19: Fatalities exceed 160,000 globally; No evidence of severe adverse events in COVID-19 patients due to use of NSAIDs

ECDC case count update

According to the European Centre for Disease Prevention and Control (ECDC), since 31 December 2019 and as of 20 April 2020, 2 355 853 cases of COVID-19 have been reported, including 164 656 deaths.

Cases have been reported from:

Africa: 22 303 cases; the five countries reporting most cases are South Africa (3 158), Egypt (3 144), Morocco (2 855), Algeria (2 629) and Ghana (1 042).

Asia: 378 985 cases; the five countries reporting most cases are Turkey (86 306), China (83 817), Iran (82 211), India (17 265) and Israel (13 491).

America: 899 051 cases; the five countries reporting most cases are United States (759 687), Brazil (38 654), Canada (34 777), Peru (15 628) and Chile (10 088).

Europe: 1 046 854 cases; the five countries reporting most cases are Spain (195 944), Italy (178 972), Germany (141 672), United Kingdom (120 067) and France (112 606).

Oceania: 7 964 cases; the five countries reporting most cases are Australia (6 612), New Zealand (1 105), Guam (136), French Polynesia (55) and New Caledonia (18).

Other: 696 cases have been reported from an international conveyance in Japan.

Deaths have been reported from:

Africa: 1 120 deaths; the five countries reporting most deaths are Algeria (375), Egypt (239), Morocco (141), South Africa (54) and Cameroon (42).

Asia: 14 663 deaths; the five countries reporting most deaths are Iran (5 118), China (4 636), Turkey (2 017), Indonesia (582) and India (543).

America: 47 369 deaths; the five countries reporting most deaths are United States (40 682), Brazil (2 462), Canada (1 580), Mexico (686) and Ecuador (474).

Europe: 101 408 deaths; the five countries reporting most deaths are Italy (23 660), Spain (20 453), France (19 718), United Kingdom (16 060) and Belgium (5 683).

Oceania: 89 deaths; the four countries reporting most deaths are Australia (70), New Zealand (12), Guam (5) and Northern Mariana Islands (2).

Other: 7 deaths have been reported from an international conveyance in Japan.

[Note from ECDC: The data presented have been collected between 6:00 and 10:00 CET, 20 April.]

NSAIDs and COVID-19

On 19 April, WHO published on its site a Scientific Brief , which concluded that at present there is no evidence of severe adverse events, acute health care utilization, long-term survival, or quality of life in patients with COVID-19, as a result of the use of non-steroidal anti-inflammatory drugs (NSAIDs).

According to the report, concerns have been raised that NSAIDs may be associated with an increased risk of adverse effects when used in patients with acute viral respiratory infections, including COVID-19.

A rapid systematic review was carried out on 20 March 2020 on NSAIDs and viral respiratory infections using MEDLINE, EMBASE, and WHO Global Database. The review included studies conducted in humans of any age with viral respiratory infections exposed to systemic NSAIDs of any kind.

"All studies on COVID-19, the Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS) were included irrespective of their sample size", the Scientific Brief stated.

The objective of the review was reportedly to assess the effects of prior and current use of NSAIDs in patients with acute viral respiratory infections on acute severe adverse events (including mortality, the acute respiratory distress syndrome (ARDS), acute organ failure, and opportunistic infections) on acute health care utilization (including hospitalization, intensive care unit (ICU) admission, supplemental oxygen therapy, and mechanical ventilation) as well as on quality of life and long-term survival.

A total of 73 studies were included. All studies were concerned with acute viral respiratory infections or conditions commonly caused by respiratory viruses, but none specifically addressed COVID-19, SARS, or MERS.

Findings from the review included the following:

  • very low certainty evidence on mortality among adults and children
  • effects of NSAIDs on the risk for ischemic and haemorrhagic stroke and myocardial infarction in adults with acute respiratory infections are unclear
  • moderate to high certainty evidence showed little or no difference between ibuprofen and acetaminophen (paracetamol) among children with fever with regard to effects on death from all causes, hospitalization for any cause, acute renal failure, and acute gastrointestinal bleeding
  • most studies report that no severe adverse events occurred, or that only mild or moderate adverse events were observed
  • there was no evidence regarding the effects of NSAID use on acute health care utilization, explicit quality of life measures, or long-term survival.

The report noted several limitations of the review, including that no direct evidence from patients with COVID-19, SARS, or MERS was available and therefore all evidence included should be considered indirect evidence with respect to the use of NSAIDs prior to or during the management of COVID-19. Further, the studies included not only patients with confirmed viral respiratory infections and known pathogens, but also those with conditions commonly caused by respiratory viruses, such as upper respiratory tract infections and fever in children. "It is likely that not all participants had viral respiratory infections", it noted further.

SOURCE: ECDC; WHO
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