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Compiled by Crystal Howell, PharmD, BCIDP, BCPS, Assistant Professor of Pharmacotherapy, UNT System College of Pharmacy

MYTH 1: If I don’t have a fever, I don’t have COVID-19.

A fever is roughly 100.4° F sustained over an hour, or greater than 100.9° F. Patients who are found to have SARS-CoV-2, which causes coronavirus disease 2019 (COVID-19) can have different symptoms. Some studies have shown that only 44 – 65% of patients initially have a fever, though it may develop later in the infection.

Conclusion: Busted!

MYTH 2: I should stop taking my blood pressure medication to keep from getting COVID-19?

There has been a theoretical debate about the role of a specific class of high blood pressure medication called an ACE inhibitor. There is no data indicating help or harm of this class of medication in the setting of COVID-19. However, a recent study found a possible association between patients on ACE inhibitors and a lower risk of death from COVID-19. In addition, there is clear harm possible if the medication is discontinued without physician supervision. The American Heart Association recommends that patients do NOT discontinue their chronic ACE inhibitor medication.

Conclusion: Not enough data, but don’t stop your medications! 

MYTH 3: I should avoid NSAIDS like Ibuprofen if I think I have COVID-19.

The FDA has announced they are not aware of any scientific evidence supporting the need to avoid non-steroidal anti- inflammatory drugs (NSAIDs) such as ibuprofen. The WHO originally advised avoiding the use of NSAIDs until they could investigate. They have since reversed their decision and agree with the FDA that there is not enough scientific literature to support that NSAIDs should be avoided. If you use an NSAID, be aware that it can mask symptoms of an infection such as a fever.

Conclusion: Not enough data

MYTH 4: Everyone should take hydroxychloroquine for COVID-19. What do you have to lose?

Hydroxychloroquine has a long list of possible side effects and has limited science to support that it works against SARS-CoV-2. This medication should only be taken in the setting of a clinical trial for COVID-19 to ensure appropriate monitoring for side effects such as life threatening abnormal heart rhythms and irreversible vision loss. Do not start this medication without a discussion of side effects with your healthcare provider.

Conclusion: Busted!

Download a copy of the handout here.

MYTH 1: REFERENCES

1. Protsiv M, Ley C, Lankester J, Hastie T, Parsonnet J. Decreasing human body temperature in the United States since the Industrial Revolution eLife. URL: https://elifesciences.org/articles/49555 . Published January 7, 2020. Accessed April 9, 2020.
2. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical Practice Guideline for the Use of Antimicrobial Agents in Neutropenic Patients with Cancer:2010 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93. DOI: 10.1093/cid/cir073
3. Jain V, Yuan JM. Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection. medRxiv. [Epub ahead of print March 16, 2020]. DOI: 10.1101/2020.03.15.20035360
4. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. [Epub ahead of print on February 28, 2020].DOI: 10.1056/NEJMoa2002032
5. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a singlecentered, retrospective, observational study. Lancet Respir Med. [Epub ahead of print on February 24, 2020]. DOI: 10.1016/S22132600(20)30079-5
6. Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COIVD-19 in Wuhan, China: a retrospective cohort study. Lancet. [Epub ahead of print on March 28, 2020]. DOI: 10.1016/S0140-6736(20)30566-3
7. Mo P, Xing Y, Xiao Y, et al. Clinical characteristics of refractory COVID-19 pneumonia in Wuhan, China. Clin Infect Dis. [Epub ahead of print on March 16, 2020]. DOI: 10.1093/cid/ciaa270

MYTH 2 REFERENCES:

1. Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension. 2017;71(6):e13-e115. DOI: 10.1161/HYP.0000000000000065
2. Centers for Disease Control and Prevention (CDC). Groups at Higher Risk for Severe Illness. URL: https://www.cdc.gov/ coronavirus/2019-ncov/need-extra-precautions/groups-at-higher-risk.html Updated: April 2, 2020. Accessed April 9, 2020.
3. Guan W, Ni Z, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. [Epub ahead of print on February 28, 2020].DOI: 10.1056/NEJMoa2002032
4. Jain V, Yuan JM. Systematic review and meta-analysis of predictive symptoms and comorbidities for severe COVID-19 infection. medRxiv. [Epub ahead of print March 16, 2020]. DOI: 10.1101/2020.03.15.20035360
5. Hoffman M, Keine-Weber H, Schroeder S, et al. SARS-CoV-2 Entry Depends on ACE2 and TMPRSS2 and IS Blocked by a Clinically Proven\Protease Inhibitor. Cell. [Epub ahead of print on March 4, 2020]. DOI: 10.1016/j.cell.2020.02.052
6. Li H, Zhou Y, Zhang M, Wang H, Zhao Q, Li J. Updated approaches against SARS-CoV-2. Antimicrob Agents Chemother. [Epub ahead of print March 23, 2020]. DOI: 10.1128/AAC.00483-20
7. Hanff TC, Harhay MO, Brown TS, Cohen JB, Mohareb AM. Is There an Association Between COVID-19 Mortality and the Renin-Angiotensin System-a Call for Epidemiologic Investigations. Clin Infect Dis. [Epub ahead of print March 26, 2020]. DOI: 10.1093/cid/ciaa329
8. Bavishi C, Maddox TM, Messerlie FH. Coronavirus Disease 2019 (COVID-19) Infection and Renin Angiotensin System Blockers. JAMA Cardiol. [Epub ahead of print April 3, 2020]. DOI: 10.1001/jamacardio.2020.1282
9. HFSA/ACC/AHA. HFSA/ACC/AHA Statement Addresses Concerns Re: Using RAAS Antagonists in COIVD-19. American College of Cardiology. URL: https://www.acc.org/latest-in-cardiology/articles/2020/03/17/08/59/hfsa-acc-aha-statement-addresses-concernsre-using-raas antagonists-in-covid-19 . Published: March 17, 2020. Accessed: April 1, 2020.
10. Zhang P, Zhu L, Cai J, et al. Association of Inpatient Use of Angiotensin Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers with Mortality Among Patients with Hypertension Hospitalized with COVID-19. Circulation [Epub ahead of print on April 2020]. DOI: DOI: 10.1161/CIRCRESAHA.120.317134

MYTH 3 REFERENCES:

1. Fang L, Karakiulakis G, Roth M. Are patients with hypertension and diabetes mellitus at increased risk for COVID-19 infection? Lancet Respir Med. 2020;8(4):e21.DOI: 10.1016/S2213-2600(20)30116-8
2. U.S. Food and Drug Administration (FDA). FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19. https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-patients-use-non-steroidal-anti-inflammatorydrugs-nsaids-covid-19 Published: March 19, 2020. Accessed: April 9, 2020.
3. Updated: WHO Now Doesn’t Recommend Avoiding Ibuprofen for COVID-19 Symptoms. Science Alert. https://www.sciencealert.com/ who recommends-to-avoid-taking-ibuprofen-for-covid-19-symptoms Published: March 17, 2020. Accessed: April 9, 2020.

MYTH 4 REFERENCES:

1. Wang M, Cao R, Zhang L, et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019 – nCoV) in vitro. Cell Res. 2020;30(3):269-271. DOI: 10.1038/s41422-020-0282-0
2. U.S. Food and Drug Administration (FDA). Fact sheet for health care providers emergency use authorization (EUA) of hydroxychloroquine sulfate supplied from the strategic national stockpile for treatment of covid-19 in certain hospitalized patients. https://www.fda.gov media/136537/download . Published March 28, 2020. Accessed April 1, 2020.
3. Plaquenil® [Package Insert]. Concordia Pharmaceuticals Inc. Revised January 2017. Accessed April 8, 2020.
4. Hydroxychloroquine. In: Lexi-Drugs Online. Hudson, OH: Lexi-Comp, Inc.; [Updated April 8, 2020]. Accessed April 8, 2020.
5. Simpson TG, Kobacs RJ, Stecker EC. Ventricular arrhythmia risk due to hydroxychloroquine-azithromycin treatment for COVID-19. American College of Cardiology. https://www.acc.org/latest-in-cardiology/articles/2020/03/27/14/00/ventricular-arrhythmia-riskdue-to hydroxychloroquine-azithromycintreatment-for-covid-19 Published March 29, 2020. Accessed April 8, 2020.
6. Marmor MG, Kellner U, Lai TYY, Melles RB, Mieler WF. American Academy of Ophthalmology Statement Recommendation on Screening for Chloroquine and Hydroxychloroquine Retinopathy (2016 Revision). Ophthalmology 206;123:1386-1394. DOI: 10.1016/j. ophtha.2016.01.058
7. Texas State Board of Pharmacy (TSBP). 291.30 Medication Limitations. https://www.pharmacy.texas.gov/files_pdf/291.30.pdf Published March 20, 2020. Accessed March 20, 2020.

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