COVID-19 pandemic is posing an unprecedented sanitary threat:
antiviral and host-directed medications to treat the disease are urgently needed. A great effort has been paid to find drugs and treatments for hospitalized, severely ill patients. However, medications used for the domiciliary management of early symptoms, notwithstanding their importance, have not been and are not presently regarded with the same attention and seriousness. In analogy with other airways
viral infections,
COVID-19 patients in the early phase require specific
antivirals (still lacking) and non-etiotropic drugs to lower
pain,
fever, and control
inflammation. Non-steroidal anti-inflammatory drugs (
NSAIDs) and
paracetamol (PAC) are widely used as non-etiotropic agents in common airways
viral infections and hence are both theoretically repurposable for
COVID-19. However, a warning from some research reports and National Authorities raised
NSAIDs safety concerns because of the supposed induction of
angiotensin-converting enzyme 2 (ACE2) levels (the receptor used by SARS-CoV2 to enter host airways cells), the increased risk of bacterial
superinfections and masking of disease symptoms. As a consequence, the use of
NSAIDs was, and is still, discouraged while the alternative adoption of
paracetamol is still preferred. On the basis of novel data and hypothesis on the possible role of scarce
glutathione (GSH) levels in the exacerbation of
COVID-19 and of the GSH depleting activity of PAC, this commentary raises the question of whether PAC may be the better choice.