Americans at High Risk From Coronavirus Urged to Stay Home

By Pat Anson, PNN Editor

A senior U.S. health official warned Sunday that Americans with underlying health conditions should avoid large crowds and not board airplanes or cruise ships because of the coronavirus outbreak. Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, also said quarantines of infected areas in the U.S. may become necessary.

"It's possible," Fauci told host Chris Wallace on Fox News Sunday. "You don't want to alarm people, but given the spread we've seen, anything is possible, and that’s the reason we have got to be prepared to take whatever action is appropriate to contain and mitigate the outbreak."

Italy’s Prime Minister on Sunday ordered a quarantine of northern Italy, after a spike of over a thousand new coronavirus cases was reported.  Italy has recorded nearly 6,000 cases and 233 deaths, the most fatalities outside of mainland China. About 16 million people live inside the quarantine area.

"We have to be realistic," said Fauci, when asked if similar travel bans could be imposed in the U.S. "I don't think it would be as draconian as nobody in and nobody out, but if we continue to get cases like this, particularly at the community level, there will be what we call mitigation, when you'll have to do essentially social distancing: keep people out of crowded places, take a look at seriousness -- do you really need to travel? And I think it particularly important among the most vulnerable.”

Fauci says elderly people with heart disease, chronic lung disease and diabetes should avoid high-risk situations, such “crowded places, getting on airplanes, and absolutely don’t get on a cruise ship.”

‘You’re Going to See More Deaths’

The comments from Fauci and other leading health officials signaled the U.S. was shifting from a failed effort to contain the virus to mitigation, such as closing schools and cancelling large gatherings.

"Initially, we had a posture of containment so that we could give people time to prepare for where we are right now. We're shifting into a mitigation phase, which means that we're helping communities understand you're going to see more cases. Unfortunately, you're going to see more deaths. But that doesn't mean that we should panic," U.S. Surgeon General Jerome Adams said CNN's State of the Union.

“We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country. We’ll get through this, but it’s going to be a hard period. We’re looking at two months, probably, of difficulty,” Dr. Scott Gottlieb, former commissioner of the Food and Drug Administration said on CBS’ Face the Nation.

As of today, there are 21 deaths and 521 confirmed cases of coronavirus in at least 33 states, although the actual number is likely to be higher because testing for the virus in the U.S. has been limited. There are over 109,000 cases worldwide and 3,799 deaths.

Early information out of China suggested the chances of a coronavirus patient dying were about 2.3 percent. But last week the World Health Organization raised the fatality rate to 3.4 percent, which is far higher than seasonal flu, which kills about 0.1% of those infected.

While symptoms are mild for most coronavirus patients, the elderly and those with chronic health conditions are most at risk. A study done by the Chinese Center for Disease Control and Prevention found that people over the age of 80 have the highest fatality rate of all age groups at 14.8 percent, followed by people in their seventies (8%) and sixties (3.6%).

People with the following health conditions also have a higher risk of dying:

• 10.5% Cardiovascular disease

•   7.3% Diabetes

•   6.3% Chronic respiratory disease

•   6.0% Hypertension

•   5.6% Cancer    

According to the CDC, people at higher risk from the COVID-19 virus should stay home and “avoid crowds as much as possible.”

Overuse of Acetaminophen Increases During Flu Season

By Pat Anson, Editor

Acetaminophen is a key ingredient in hundreds of over-the-counter pain relievers and cough, cold and flu medicines – from Excedrin and Tylenol to Theraflu and Alka-Seltzer Plus.

Recent guidelines released by the UK’s National Institute for Health Care Excellence (NICE) even recommend acetaminophen (paracetamol) for treating sore throat pain.

But a large new study warns that too many cold and flu sufferers take too much acetaminophen – which has long been associated with liver damage and allergic reactions such as skin rash.

Researchers at the University of Pittsburgh and Boston’s University’s Slone Epidemiology Center surveyed nearly 14,500 U.S. adults about their use of acetaminophen in the preceding 30 days. The study, which was sponsored by Johnson & Johnson, was conducted over a five-year period, from 2011 to 2016.

Investigators found that 6.3% of acetaminophen users exceeded the recommended maximum adult daily dose of 4,000 mg on at least one day during a week that they used acetaminophen.

Usage patterns grew during the cold and flu season. The odds of taking more than 4,000 mg of acetaminophen increased to 6.5% compared to 5.3% during the off-season.

This was primarily due to increased use of over-the-counter medications designed to treat upper respiratory cold and flu symptoms.

"This is the first multi-year, year-round study that includes detailed data on how consumers used acetaminophen medications," said Saul Shiffman, PhD, of Pinney Associates and the University of Pittsburgh. "The study findings suggest the importance of educating consumers about acetaminophen and counseling them about appropriate use and safe dosages of these medications.

"Getting this message out is especially important during cold/flu season, when people may be more likely to treat illness symptoms with acetaminophen combination products, sometimes without even realizing they contain acetaminophen."

The use of acetaminophen (paracetamol) is even more pronounced in France, according to a new study published in the British Journal of Clinical Pharmacology.

There was a 53% increase in the use of paracetamol in France between 2006 and 2015, and 1000 mg tablets of paracetamol (which are not available in the United States) are now the most-used drug among French adults. There is also a trend towards larger doses. Consumption of 1000 mg tablets increased by 140 percent in France over the ten-year study; while consumption of 500 mg tablets decreased by 20 percent.

Compared to other countries in Europe, France ranked first in paracetamol usage and third in the consumption of mild opioids such as tramadol and codeine. The French use of strong opioids such as morphine was among the lowest in Europe.

"To our knowledge, this is the first published study analysing consumption trends for both non-opioids and opioids over the last decade in France. Long-term surveillance over the past 10 years has highlighted quantitative and qualitative changes in analgesic consumption patterns in France," said study co-author Philippe Cavalié, PhD, of the French National Agency for Medicines and Health Products Safety.

"The very widespread analgesics consumption that we have documented raises the concern of overuse and misuse, as well as addiction to opioids."

The U.S. Food and Drug Administration asked drug makers in 2011 to limit acetaminophen doses to 325 mg per tablet or capsule. The FDA also requires a “Boxed Warning” label – the agency’s strongest warning – to call attention to serious risks.

Over 50 million people in the U.S. use acetaminophen each week for pain and fever – many unaware of the risk of liver injury and allergic reactions. Over 50,000 emergency room visits each year in the U.S. are blamed on acetaminophen overdoses, including 25,000 hospitalizations and 450 deaths.

For more information about acetaminophen and how to avoid overdosing, visit KnowYourDose.org.

Flu and NSAIDs Increase Heart Attack Risk

By Pat Anson, Editor

With the cold and flu season in full swing, many people take over-the-counter pain relievers like Advil and Aleve to ease their aches and pains, and to help them sleep.

What many don’t know is that they may be increasing their risk of a heart attack.

In a study of nearly 10,000 people hospitalized in Taiwan after a heart attack, researchers found that patients who took non-steroidal anti-inflammatory drugs (NSAIDs) during an acute respiratory infection tripled their risk of an acute myocardial infarction (heart attack).  The study was published in the Journal of Infectious Diseases.

Respiratory infections and NSAIDs were both already known to raise the risk of cardiovascular problems, but this was the first time they were studied together.  

"Physicians should be aware that the use of NSAIDs during an acute respiratory infection might further increase the risk of a heart attack," said lead author Cheng-Chung Fang, MD, of National Taiwan University Hospital.

“This approach should raise clinical concern because NSAIDs use during ARI (acute respiratory infection) episodes is highly common in real-world practice.”

Fang and his colleagues found that using NSAIDs while having a respiratory infection was associated with a 3.4-fold increased risk for a heart attack. The risk was 7.2 times higher when patients received NSAIDs intravenously in the hospital.

Another commonly used pain reliever, acetaminophen, which eases pain in a different way than NSAIDs do, was not evaluated in the study. But researchers say it may be a safer alternative, at least in terms of cardiac risk, for relief from cold and flu symptoms.

NSAIDs are widely used to treat everything from fever and headache to low back pain and arthritis. They are found in so many different over-the-counter products -- such as ibuprofen, Advil and Motrin -- that many consumers may not be aware how often they use NSAIDs. 

In 2015, the U.S. Food and Drug Administration ordered warning labels for all NSAIDs to be strengthened to indicate they increase the risk of a fatal heart attack or stroke. The revised warning does not apply to aspirin. The FDA said people who have a history of heart disease, particularly those who recently had a heart attack or cardiac bypass surgery, are at the greatest risk.

European researchers released an even stronger warning last year, saying there was no solid evidence that NSAIDs are safe.

Exactly how the pain relievers damage the heart is unclear, but a recent study on animals at the University of California, Davis found that NSAIDs reduced the activity of cardiac cells and caused some cells to die.