Scientific Rationale for a Bottom-Up Approach to Target the Host Response in Order to Try and Reduce the Numbers Presenting With Adult Respiratory Distress Syndrome Associated With COVID-19. Is There a Role for Statins and COX-2 Inhibitors in the Prevention and Early Treatment of the Disease?

Front Immunol. 2020 Sep 2;11:2167. doi: 10.3389/fimmu.2020.02167. eCollection 2020.


The inflammatory response to and the subsequent development of Adult Respiratory Distress Syndrome (ARDS) is considered to underpin COVID-19 pathogenesis. With a developing world catastrophe, we need to examine our known therapeutic stocks, to assess suitability for prevention and/or treatment of this pro-inflammatory virus. Analyzing commonly available and inexpensive immunomodulatory and anti-inflammatory medications to assess their possible effectiveness in improving the host response to COVID-19, this paper recommends the following: (1) optimize current health-cease (reduce) smoking, ensure adequate hypertension and diabetes control, continue exercising; (2) start on an HMG CoA reductase inhibitor "statin" for its immunomodulatory and anti-inflammatory properties, which may reduce the mortality associated with ARDS; and (3) consider using Diclofenac (or other COX-2 inhibition medications) for its anti-inflammatory and virus toxicity properties. For purposes of effectiveness, this needs to be in the early course of the disease (post infection and/or symptom presentation) and given in a high dose. The downsides to these recommended interventions are considered manageable at this stage of the pandemic.

Keywords: COVID-19; COX-2 inhibitors; Diclofenac; immunomodulatory; statins.

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use
  • Animals
  • Anti-Inflammatory Agents, Non-Steroidal / adverse effects
  • Anti-Inflammatory Agents, Non-Steroidal / therapeutic use
  • Antiviral Agents / adverse effects
  • Antiviral Agents / therapeutic use
  • Betacoronavirus*
  • COVID-19
  • COVID-19 Drug Treatment
  • Coronavirus Infections / complications*
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / prevention & control
  • Coronavirus Infections / virology
  • Cyclooxygenase 2 Inhibitors / adverse effects
  • Cyclooxygenase 2 Inhibitors / therapeutic use*
  • Diclofenac / adverse effects
  • Diclofenac / therapeutic use
  • Host-Pathogen Interactions / drug effects
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / adverse effects
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Pandemics / prevention & control
  • Pneumonia, Viral / complications*
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / prevention & control
  • Pneumonia, Viral / virology
  • Respiratory Distress Syndrome / complications*
  • Respiratory Distress Syndrome / drug therapy*
  • Respiratory Distress Syndrome / prevention & control
  • Respiratory Distress Syndrome / virology
  • SARS-CoV-2
  • Virus Internalization / drug effects


  • Adrenal Cortex Hormones
  • Anti-Inflammatory Agents, Non-Steroidal
  • Antiviral Agents
  • Cyclooxygenase 2 Inhibitors
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Diclofenac