COVID-19 • “I’ve Got The Fever!”

COVID-19:  “I’ve Got The Fever!”

March 18, 2020

No; really, I don’t.

But you’ve got that song in your head for the rest of  the day.  You’re welcome.

There have been a lot of question regarding fever management in this time of COVID-19 that I’d like to cover as best as I can.

So I don’t bury the lead: Acetaminophen (tylenol) vs. Ibuprofen (motrin).

It has been suggested that Acetaminophen is better for this disease and Ibuprofen may cause other problems.  I do not think that is conclusive, however, information is ‘leaning’ that way.  

COVID-19, being a novel (completely new) virus, we are still learning how, specifically, it works.  This nasty dude is only 4 months old so most answers are: ‘we do not know’ or  ‘we have preliminary studies that say…’ or ‘we have strong evidence’.  It’s like a being a new parent of a 4 month old – just trying to figure it all out.  In the meantime, we do what worked well in the past and learn from it.

Given that the information points to Acetaminophen (Tylenol) being better, and both are good at lowering a fever, I will be using Acetaminophen to treat any fever coming to this house.  And that is a change for us.

To fever or not to fever?

Next I’d like to introduce you to my friend Dr. Campbell who makes a very compelling argument for leaving your fever alone.  Try hanging in there with this video, because it is spot on science as I know it: https://www.youtube.com/watch?v=nt2CBtukxtE.

(He’s not really my friend, I just listen to him a lot and he seems really friendly.)

First, Dr. Campbell narrows the scope of who should be OK to not take fever medicines.  He DOES NOT apply this method to kids and he implies that a temperature of 39°C (102.2°F) is as high as it should go.  That is reasonable.

His argument, in my view, however, has several flaws in it.  He says; ‘if you are healthy’, even into your later years, a fever will defeat the virus more quickly.

“If you are healthy.”  is just the issue.  COVID-19 is hardest on those compromised with respiratory systems (asthma, COPD, etc.) and chronic illnesses like diabetes.  So, people with this type of compromise are NOT good candidates for leaving a fever to run its course.

Also, as a fever rises, so does heart rate and a lot of other issues in the cardiovascular system.  So those folks with cardiovascular disease are also NOT good candidates for leaving a fever to run its course.

And fever chews up energy – sugars.  So anyone with diabetes, again, letting a fever run its course is NOT a good strategy.

If you are still in the category of, “I’m good, got none of that, I’ll let it ride.”  You will still be increasing the ‘spewing goo’ problem.  Dr. Campbell doesn’t mention it directly, but it will be the result of all those pictures he was drawing.  And that certainly will increase the possibility of spread and increase cleaning chores.

Finally, Dr. Campbell says that if you do take the fever reducing medicines, your normal immune response will be slower, you will be sicker for longer, and increase your chances of pneumonia.

Here I totally disagree with him.  A nice theory, but bad practice.  People with fevers don’t move much.  They pile blankets on and hunker down.  Fluids that accumulate in the lungs tend to ‘pool’ in the lowest areas and make for a good home for bacteria; ie. Pneumonia.

If you give folks some fever reducing medicine (Acetaminophen or Ibuprofen), activity levels improve so fluids cannot ‘pool’ in the lungs.  That allows for much better air exchange in the lungs.  It also keeps folks from sweating-out all their fluids and improves the ability to replace the losses that do happen.  All good in preventing ‘add on’ illnesses like pneumonia.

Remember, “Flatten the Curve”?  It is the same here.  If you do not take the medicine, you may have a shorter course of illness, but you will feel a lot worse.  And if you have other problems, you could make them much worse.

If you take the fever reducing medicines, it is possible you’ll be sick for a couple days longer, but you’ll actually feel somewhat OK for that time, be modestly functional, keep any other medical problems from getting worse and, in my opinion, will be more likely will not to need a hospital.

In the end, you and your health care provider should make the call as to how to manage a fever in you; and specifically at this time.

I hope this was helpful.