Several people have contacted me over the last few weeks asking for my opinions on hydroxychloroquine. I’ve invariably answered that I don’t know, since I haven’t looked at the data myself. I felt that it was time to rectify that situation.
Most of us probably take fever lowering drugs, like paracetamol (a.k.a. acetaminophen, tylenol, panadol, alvedon), aspirin, or ibuprofen (a.k.a. advil, motrin, ipren), when we get a high temperature. The technical term for these drugs is antipyretics. After half an hour or so, we start to feel better and maybe don’t have to spend the whole day in bed. But it is well understood among researchers studying the immune system that the fever is in itself an important part of the body’s defence against infection. Our immune system works better at a higher temperature, and many pathogens have trouble replicating at a higher temperature. So, does taking antipyretics increase the risk of a more severe infection, or even of dying? And does it delay recovery?
“Try to cut down on the salt.”
I’m sure many people have gotten this well-meaning piece of advice from their doctor, especially if their blood pressure is a little bit high. It ranks up there with not smoking or drinking alcohol and avoiding red meat, saturated fat, and sugary drinks as one of those things we’re told to do if we don’t want to die prematurely. It is actively promulgated by government health authorities all over the world, including the NHS in the UK and the FDA in the US.
In my previous post on the covid pandemic I mentioned that the body’s main defence against viruses is T-cells, not antibodies, and that the only reason we test for antibodies instead in clinicial practice is because it is easier and cheaper. I also ventured a hypothesis that the levels of population immunity are much higher than is being found in the antibody tests, and that this is because lots of people who don’t have antibodies do have covid specific T-cells. It turns out that this hypothesis is supported by new evidence.
A new study has just been published in JAMA (the Journal of the American Medical Association) that seeks to answer this question definitively. This subject has been somewhat controversial, because observational studies have tended to show a positive effect, while randomised clinical trials have failed to show any effect. Usually you would trust the trial data more than the observational data, but these trials were all relatively short (generally a year or less), had relatively small study groups, and often used quite low doses of vitamin D.
Ok, I want to preface this article by stating that it is entirely anecdotal and based on my experience working as a doctor in the emergency room of one of the big hospitals in Stockholm, Sweden, and of living as a citizen in Sweden. As many people know, Sweden is perhaps the country that has taken the most relaxed attitude of any towards the covid pandemic. Unlike other countries, Sweden never went in to complete lockdown. Non-essential businesses have remained open, people have continued to go to cafés and restaurants, children have remained in school, and very few people have bothered with face masks in public.