Fever and Covid 19

Fever I believe could be a savior in COVID-19. 

Not all get fever when they get COVID-19. But for those who do what I have written below maybe life-saving. Please read it and if I can help in anyway let me know. 

130 years ago doctors got the first pill that gave them power to reduce fever when Bayer of Germany synthesized aspirin in 1890. 

Since then all have been treating fever first with aspirin then with Tylenol , ibuprofen etc. 

Since the time of Hippocrates it had been widely believed that fever was beneficial. Aspirin was new and it magically relieved fever AND pain. A firm conviction(without any specific research basis) soon took hold in doctors nurses and all humans that fever always needs to be reduced. Tylenol/Crocin also a fever and pain reducer was heavily marketed on TV and added to it. 

I have always believed reducing fever in infection routinely at the outset is almost always wrong. See my blog post from 2013 on this topic. Only for those with quite serious heart or lung or neurological disease and in infants is reducing fever warranted.

Fever is an ancient (600 million years) evolutionary response found in living beings that clearly helps fight infections. New research suggests that it also modulates the duration of the inflammatory response helping to turn it off. This latter becomes increasingly critical in a disease such as COVID-19.

I believe that not treating fever very well might be the difference between recovery from Covid-19 or it’s serious progression.

For myself in the first week of my own COVID19 illness. I have done the same for my 3 seasonal febrile flu like illnesses over the years. 

I would not take ANY fever reducing medication in the first 7 days of illness presuming all fever to be due to COVID-19 in this pandemic era.

Usual infections need to be kept in mind. Causes such as infections of skin, soft tissue, joints, bladder, lungs and acute abdominal heart or CNS infections come with symptoms and signs and labs that distinguish them from COVID 19. 

Benefits from high fever expected in COVID19 are

1) sustained fever of 102F increases production of INTERFERON the primary antiviral chemical our body makes. Fever ALSO helps turn off inflammation by modulating the HSR (heat shock response) a more recently understood part of our immune response. Ref available. 

2) FEVER helps ALL body systems fight infection by enhancing innate immunity. 

3)duration and degree of fever is a guide as to how illness is progressing. Lowering fever gives a false sense of security things have improved.

4) Fever makes us rest so reduces family and community spread. Ref available. 

5) PERSISTENCE of fever more than 100.4° F beyond 7 days in COVID 19 is of concern needing further evaluation. 

Other symptoms of concern can occur too. Please make sure you’re aware of details of Covid19 symptoms from the CDC or other sources.

When you leave fever in COVID19 alone in this way it generally stays continuously high 101 -104°. There is no reason to let the fever go above 103°F. Try to keep fever between 102 and 103°F with wet compresses as needed. This temperature is safe. Do not panic.

Take temperature frequently at least 4 -6 x day and night. RECORD. Trust me you will not remember what your temperature was the night before neither will your family. The daily highest fever level guides you as to your condition. 

Leaving fever alone is more comfortable than bringing temperature down with any agent (Tylenol or paracetamol Ibuprofen Crocin Aspirin etc etc ). It only goes up again and drains physically. You actually dehydrate more as you sweat profusely. The fever goes back up again and again as these pills wear off.

Cool compresses on forehead for comfort can be used. When the temperatures are high wet your skin from head to toe thoroughly with lukewarm water and lower your temperature easily. Do not use cool water so as to avoid shivering. 

Stay hydrated with fluid of your choice. I use water, coconut water or salted lime or lemon water. Keep track of fluid intake by counting of glasses/ bottles consumed.

Protocols for aspects of outpatient management other than fever are available from COVID-19 sites from various reputable medical institutions. I humbly but firmly disagree with the recommendation to reduce fever routinely that most sites state.

Stay safe.

If I can help in anyway please reach out to me. 

🙏🏽

Vinod Seth 

PS

Did you know that the Nobel prize for medicine in 1927 was given to an Austrian physician for fever therapy of an infection. This was prior to the availability of penicillin and fever therapy stayed the primary mode of treatment for dementia from generalized paralysis of the insane (neurosyphilis) for 20 years till penicillin.

PSS 

In the preantibiotic era fever was used as treatment in cases of pneumococcal meningitis in 3 patients. While no one survived dramatic reductions in CSF organism count was achieved. This paper was published in 1938. Reference available.