Science Vs - Coronavirus: Unmasking the Facts and Ibuprofen Scares

Episode Date: March 24, 2020

Healthcare workers across the U.S. are saying they don’t have enough protective gear to keep them safe against the coronavirus. They’re having to reuse masks, and they’re worried that they may have to resort to homemade cloth masks. Is all this safe? Plus, reports are saying that ibuprofen, the stuff in Advil, is making people with coronavirus sicker. But what does the science say? To find out we spoke to infectious disease expert Professor Raina MacIntyre, industrial hygienist Dr. Rachael Jones, public health researcher Professor Carlos Del Rio, and cardiologist Dr. Yogendra Kanthi.  UPDATE 4/23/20: An earlier version of this episode said that health care workers using N95 masks had roughly half the infection rate of workers using classic surgical masks. We’ve updated the episode to clarify that the study only compared the infection rates to a control group, not each other. Here’s a link to our transcript: https://bit.ly/3agVF4i Selected References The best study we could find on cloth masks: https://bit.ly/3bmRHaI  Study showing that N95 masks are best for healthcare workers: https://bit.ly/2xfvKLT  The Lancet letter theorizing about why ibuprofen might be risky: https://bit.ly/2QEDFt6    This episode was produced by Meryl Horn, Wendy Zukerman, Rose Rimler, Michelle Dang, Laura Morris and Sinduja Srinivasan. We’re edited by Blythe Terrell and Caitlin Kenney. Fact checking by Lexi Krupp. Mix and sound design by Catherine Anderson. Music written by Peter Leonard, Emma Munger, and Bobby Lord. A big thanks to all the researchers and healthcare workers that we got in touch with for this episode, including Professor Paul Little, Dr Kirsty Short, Siyab Panhwar, and Ayman Saeyeldin. And special thanks to Meg Driscoll, the Zukerman family and Joseph Lavelle Wilson. Learn more about your ad choices. Visit podcastchoices.com/adchoices

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It's been a week of social distancing for me. I finished a puzzle I cooked for the first time in a million years. Well, I put more than three ingredients into a bowl for some overnight oats. I was pretty proud of myself. And, like a lot of us, I was glued to news about this coronavirus. And I kept coming across questions around two specific things, ibuprofen and masks. So that's what we're diving into today. Some reports are saying that ibuprofen, the stuff in Advil, is making people with coronavirus sicker and that they should steer clear of the drug. So what's going on there?

But first, we want to talk about masks. We're hearing a lot about shortages for healthcare workers, that they don't have enough masks and other gear to keep them safe. In Italy, more than 3,500 healthcare workers have already gotten the virus. And in the US, we heard from those who were worried they would be next. Here's what a few of them told us. They've told us that they're only going to give us one mask every five days. What they're having us do is re-wear the same dirty mask over and over and over again. And if we need a new mask, we have to go and show the old one to our supervisor to prove why it needs to be thrown away. We get handed N95 masks and we're supposed to keep them in bags and put our names on them and

reuse them throughout the day. At this moment, we are already rationing. As of a few days ago, you know, got to a point where we were almost completely out and we had to start reusing some of our masks and gowns. It's horrifying. We're all completely horrified. We feel like we are soldiers being sent to war without the protective equipment that we need. A lot of people are scared to go to work. All this is starting to sound awful. So how important are these masks for healthcare workers? And is it that bad to reuse them? For this, we called up Professor Raina McIntyre,

an infectious disease expert at the University of New South Wales in Australia. Hello. Hello. Raina has led several clinical trials looking at how masks protect healthcare workers from respiratory viruses. And she has found that the best kind, the one that healthcare workers need, are the N95s. You might have heard of these. Raina calls them respirator masks. They're the ones that look like they're kind of moulded over your nose and mouth. And how they fit is actually part of their magic.

The way you can tell is a respirator fits tightly around the face. It doesn't allow moulded over your nose and mouth. And how they fit is actually part of their magic. The way you can tell is a respirator fits tightly around the face, so it doesn't allow the leakage of air. And healthcare workers should wear a respirator. And Raina, she has the data to show how good these puppies are. In one of her studies, she looked at more than 3,000 healthcare workers in Beijing and found that after a month, only those who wore their N95 masks all the time had lower infection rates. While those who wore classic surgical masks,

like you might see at the dentist, they didn't have less infections. Now, not all studies have found this, but Reiner's are some of the largest and best in this space. So, what healthcare workers really need in this pandemic are those N95 respirator-style masks. But as we heard from healthcare workers, in some places, there aren't enough to go around.

There's been a lot of talk of healthcare workers having to reuse masks, sometimes for multiple days in a row. How risky is that? It probably carries some risk because the masks get contaminated, they get moist, and that's not good because bacteria can grow in a more moist environment. But if they've got no choice, that's a really difficult dilemma. One solution to this shortage is to not only reuse masks, but to disinfect them. So to find out what might work, producer Rose Rimler and I called up an expert in this very field. My name is Rachel Jones, and my specialty area is actually around the exposures of healthcare workers to viral respiratory infections.

Oh, that's handy. It is. Rachel, who's at the University of Utah, told us that she'd been hearing of all kinds of things that doctors and nurses were using to disinfect their respirators. There was alcohol sprays and bleach, which we know can kill the virus, but you have to be careful

so you don't breathe in a face full of bleach. Other places have been experimenting with UV radiation. That can be used to disinfect respirators. And so you can disinfect them? Yes. Oh, that's great. I'm kind of surprised. The challenge is that they haven't all been, I think, proven to work as robustly as we'd like them to work. And it's not clear that, you know, all the health care facilities would have the processes in place. Studies in the lab using special machinery have found that viruses can be killed with UV radiation. But Rachel says that a lot of hospitals in the US, they aren't set up for this kind of thing at the moment. And so another idea has been popping up. Making masks out of

cloth, like sometimes t-shirt material. Yes, crafting is joining the war movement. Some hospitals are even calling on DIY crafters to sew masks to shore up the supply. But can cloth stop a virus? Well, Rachel says, put down your needles and thread. A lot of materials just aren't made to stop viruses. Like, think of T-shirt material. We like T-shirts because they're airy and they don't make us sweat too much. And viruses can roll right through them.

All of those properties that we like in our T-shirt make them problematic to use as a mask because small particles have been demonstrated in experimental studies to move readily through cloth that is used in a mask like a bandana or a t-shirt. The only clinical trial that we have on cloth masks, which had around 1,000 doctors and nurses, found that they didn't work. And in that study, it actually increased their risk of viral infections. We don't know exactly why. It's so interesting that the CDC has recommendations that say, okay, in dire straits, it's like their last resort.

Like if it's really dire straits, it's a crisis, there's nothing else. You can wear a cloth mask as a health care worker. Is that good advice? I don't think that's a good advice. And I was really surprised that that came out as a recommendation, as were some of my colleagues. What were you guys saying to each other? Well, mostly kind of smacking our foreheads and going, oh no. Mostly we were just surprised because there really is no scientific evidence that using a cloth mask

offers any benefit. To suggest a cloth mask is not based on science. And so it's important to separate out what is the science-based type of controls and what is the shortage-based type of controls. So what do you, and what do you mean by that? Like that they're saying this just to make healthcare workers feel better? I think so. So in my understanding of how respiratory viruses are transmitted and the limited ability of cloth masks to filter out viruses from the air suggests to me that they are mostly offering comfort rather than actual protection. That is kind of heartbreaking. Yes. And to be clear, the CDC said that this was something during the crisis phase when other options were not available. And we are not at crisis phase yet. I would think, I do not think that we're at the point of using cloth masks yet. So, I mean, how did we get here that we're at a shortage? Yeah. I mean, I've been reading all these papers about masks and how well they work or don't work and

all these pandemic planning strategies. And there's plenty of papers from years ago. I mean, I'm looking at the dates and it's like 2000, 2005. And it's like, we need to plan for masks. And so like, I'm reading this and I'm like, what the hell? Absolutely. The idea that we need 300 million masks is not new news. This is something that was anticipated years ago. And we just have not been able to, as a public health system, been able to actually implement that preparation. Who can we blame? as a public health system, been able to actually implement that preparation.

Who can we blame? Oh, my goodness. You know, ultimately, I'm not sure exactly who is to blame. I mean, there is a national stockpile that's managed by the federal government and that stockpile clearly is inadequate. Now, Raina, who you heard from at the beginning of the show, she did have a slightly different opinion. She thought that cloth masks might stop people from touching their face with their grubby hands, which could put virus particles right into your mouth. So maybe they aren't entirely useless. Okay. But what do all these mask facts mean for you and me? Joe Schmoes, walking around, going to the grocery shop. Should we ever mask up? Well, given that there aren't

enough masks to go around, for now, we need to be saving them for healthcare workers. So don't go stockpiling. If you do have some N95s or surgical masks lying around, there is some good evidence to suggest that if you're in a high-risk area, around lots of people who are sick, then these masks can reduce your risk of infection. After the break, Advil.

This little pill is one of the first things that many of us reach for when we get a fever and feel achy. But when it comes to this coronavirus, is that stuff dangerous? welcome back we've just talked about how our healthcare workers need good protective gear and all these diy approaches they don't work like we need them to. Next up, ibuprofen. Advil and other drugs that have ibuprofen in them are so common that many of us don't even think twice before we pop one. But there was a lot of news this week that ibuprofen could make people with coronavirus even sicker. We've got new evidence that suggests that an anti-inflammatory like ibuprofen could be potentially harmful.

The World Health Organization is now recommending that anyone suffering COVID-19 symptoms avoid taking ibuprofen. This comes after French Health Minister Olivier Varane warned that such drugs could worsen the effects of the coronavirus. This whole thing really got going with this tweet from the French health minister warning that people with fevers shouldn't use these kinds of drugs, which are also called non-steroidal anti-inflammatories or NSAIDs. Now, as you just heard, some news reports said that the WHO backed up the French on this. But that's not actually what they said. And the confusion might have been fueled by one of the biggest gripes that grammar narcs have. Double negatives.

The WHO responded to all of this with a tweet saying, quote, WHO does not recommend against the use of of ibuprofen, end quote. Yeah, so does not recommend against the use of ibuprofen. And they also repeated the of in their tweet. Is there any wonder there's any confusion here? So to find out more, I called up Dr. Carlos Del Rio, a doctor and public health researcher at Emory University in Atlanta. I'm already recording, so let's just jump right in. I'm guessing you're very busy. You have no idea.

So what I wanted to talk to you about was this ibuprofen thing that really blew up in the news recently. So I guess it all started when the health minister of France tweeted that taking anti-inflammatory drugs such as ibuprofen could be an aggravating factor of the infection. What did you think when you heard about it? Well, you know, I mean, I think I immediately, I tell you, I contact a friend of mine who's an infectious disease physician in Paris

who I have the utmost respect to. And I said, hey, what's going on? What is going on with your French health minister, you know, mandating us not to use ibuprofen? Is there any data? And he responded, he said, is that a few young COVID patients who were otherwise healthy had started developing serious symptoms after being given an NSAID. And this story has actually been going around, but it seems super anecdotal.

And Carlos's friend noted that he really didn't have much to go on here. But I do not think this data has been published, so very limited evidence. But there do not think this data has been published, so very limited evidence. But there's another piece to this puzzle, something that's also been making the headlines. A letter in The Lancet, a very fancy journal, which could explain how this drug might cause problems for people with COVID. To understand more about this, I called up this guy. I'm Jürgen Kampi. I'm Jogan Kampi. I'm a cardiologist at the University of Michigan.

Jogan says that to understand the theory here, why ibuprofen might be bad for COVID patients, we first have to know how viruses, any viruses, make us sick. Okay, so after little viral particles get into our body, they then have to get into our cells. And that's not easy. Think of each cell as a fortress. A fortress.

And each virus has to break into that fortress. We think the way that this coronavirus breaks in is by binding to a receptor called ACE2. ACE2. ACE2. ACE2 may be a gate to the fortress. Okay, so to bring this back to ibuprofen and that letter in The Lancet, those researchers said that drugs like ibuprofen

can ramp up the production of ACE2, leaving more for the virus to latch onto. The theoretical risk is that ibuprofen could increase the level of ACE2, which may then present more binding sites or more docks on cells for the coronavirus to attach to. And if you have more gates, there is more room for invaders to come in. So then, just even from a theoretical perspective, so do we know for sure that having more ACE2 receptors or having more of these gates in the fortress

actually increases someone's risk of infection? No, we don't know that. The problem with this theory is that there's actually not great evidence that ibuprofen actually does increase ACE2 production. The science we have mostly comes from animal studies. And then there's a bigger issue. We don't know that having more of these receptors lets more viral particles in. It's all pretty speculative.

I also reached out to a few doctors in China where they've been dealing with this disease for months to see if they'd been having bad experiences with ibuprofen. One told me that they're regularly giving patients ibuprofen. He hadn't heard anything about this. Another said, quote, maybe, but there's no clear evidence, end quote. But in the research cupboard, we did find something curious, something that might suggest steering clear of ibuprofen could be the right move. It comes from research done into influenza, which also attacks the lungs. You see, some early research is suggesting that for a small group of people, taking high dose NSAIDs while you have respiratory infections

can increase your risk of getting a heart attack. And that could be because these kinds of drugs can interfere with a bunch of stuff related to your heart. Now, we know that quite a few people dying of coronavirus are dying from heart failure. But again, this is early research, and it wasn't specifically into ibuprofen. And that all means that the available evidence

that ibuprofen causes big problems for people with coronavirus is pretty limited. Both the FDA and the European Union's similar body have said there's no clear link here. We may hear more out of France about what they're saying, and then things could change. But in the meantime, if you have a fever and a nasty headache, and you think you have coronavirus, what should you do? Here's Jürgen. If you're taking ibuprofen, we'd probably suggest you don't take it anyway, if you can change it and

use acetaminophen. Acetaminophen, that's what Tylenol or take it anyway if you can change it and use acetaminophen. Acetaminophen, that's what Tylenol or paracetamol is. So if you have a fever, we generally would recommend you take acetaminophen before you take a non-steroidal anti-inflammatory agent. I don't think that changes in the setting of COVID. And why is that? L-azepamophen can have other side effects on patients if you take it in either large doses or long periods of time. And other academics are on the Tylenol train too, including Carlos, who you heard from before.

Exactly. You know, my recommendation would be exactly that. I mean, we are, I feel like we're going down a, we're in uncharted territory, right? We are fighting an enemy we don't understand. And as we're getting little bits of information, if ibuprofen was the only drug available to treat fever, I would say, well, we're stuck.

We have to use it. But because we have other options, let's just pause and say, okay, while we get more information, let's use ibuprofen, let's use other things. And in the off chance that there may be something in this association. And now we want to change gears for just a minute.

Because, hey, let's just take a moment and forget about the coronavirus. Just for a moment. And let me tell you about this. Scientists recently discovered the oldest known scorpion. It's fossilised and it's more than 430 million years old. It was found in the wilds of Waukesha, Wisconsin. And the amazing thing about this little critter is that researchers think that it might have been

one of the very first creatures to move from water to land. They think this because some parts of this beastie look really similar to horseshoe crabs, which can go back and forth between land and sea. How cool is that? Scorpions. OK, back to social distancing. Maybe another puzzle.

And we'll be back on Thursday with more Science Verses. And if you're new to the show, welcome. You should know that everything we say on this show is furiously fact-checked. And if you're ever curious and you want more information, you should follow the links in our show notes to click on our transcript and you'll see all of our citations there. Have fun.

This episode was produced by Meryl Horne, me, Wendy Zuckerman, Rose Rimler, Michelle Dang, Laura Morris and Sindhuja Srinivasan. We're edited by Blythe Terrell and Caitlin Kenny. Fact-checking by Lexi Krupp. Mix and sound design by Catherine Anderson. Music written by Peter Leonard, Emma Munger and Bobby Lord. A big thanks to all the researchers and healthcare workers

that we got in touch with for this episode, including Professor Paul Little, Dr Kirsty Short, Saihab Panwha and Ayman Sayyaldin. A special thanks to Meg Driscoll, the Zuckerman family, and Joseph Lavelle-Wilson. I'm Wendy Zuckerman. Back to you next time.