Prospective role of NSAIDs with antiviral properties for pharmacological management of postsurgical procedures during COVID-19

Almost 3 years since its first case report, coronavirus disease 2019 (COVID-19) remains one of the most discussed topics in the world. Severe acute respiratory syndrome coronavirus 2 (SARS- CoV-2), the causative agent of COVID-19, infects host cells, mainly in the respiratory tracts, via immediate attachment to the angiotensin-converting enzyme type 2 receptor at the surface of host cells[1]. SARS-CoV-2-infected patients may then develop several symptoms, including fever, body pain, and malaise[2,3]. Some of these symptoms can also develop after patients undergo surgical procedures[4]. Indeed, during the early times of COVID-19 and even until now, surgical procedures face great challenges due to the high number of COVID-19 cases and possible viral trans- mission before, during, and after surgical procedures were taken[5]. To manage fever and inflammatory-related symptoms, anti- pyretics, and analgesics, classified as NSAIDs, are commonly used[6]. NSAID drugs act via the inhibition of arachidonic acid conversion to prostaglandins. This mechanism of action has been suggested to play a major role in the inhibition of pain sensation and resolution of inflammation[7]. Apart from their desired pharmacological effects, some NSAIDs have been suggested to cause immunosuppression, and this has been a subject of scien- tific debate[8]. In this correspondence piece, we would like to raise the awareness about the immunosuppressive effect of NSAIDs, which is quite debatable, as well as their documented antiviral activity against major viruses, including SARS-CoV-2. Evidence on these two seemingly unrelated pharmacological effects shall be critically assessed and carefully managed to achieve the best use of NSAIDs in the postsurgical management amid the emerging and re-emerging of viral infectious diseases.