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COVID-19: Fever Reduction Facts

dr. Jonathan Chimel i'ma emergency

physician and medical toxicologist at

the Mount Sinai Hospital so today we're

going to be talking a little bit about

fever and the use of ibuprofen for fever

and specifically for kovat 19 so before

we speak about the use of ibuprofen for

Kobe 19 let's talk about fever in

general and what is a fever so fever is

the body's response to an infection

this actually wastes a lot of precious

energy by the body and so why are we

actually doing this to generate a fever

the thought is that a fever is actually

beneficial to our body in many ways and

our grain actually increases the

temperature setpoint that directs the

rest of the body to be at when we have

an infection physicians generally

consider a fever to be a temperature of

100 point 4 degrees Fahrenheit or

greater with a few exceptions and so

that's what a fever is there's a lot of

anxiety surrounding fevers as the number

itself

now as physicians will we carry much

more about is what's causing the

underlying infection as far as the type

of virus the type of bacteria work

fungus etc and then what are the body's

other effects from that infection but

the actual number itself the fever that

we're talking about is potentially a

beneficial response by the body to fight

off the infection so before we get into

Cova 19 let's talk very briefly about

some of the research that's been done in

the past on fevers in general and the

use of fever reducing medicine which is

called an antipyretic drug the two main

types of antipyretic drugs are

acetaminophen which has a brand name of

Tylenol and in much of the world is

called paracetamol or ibuprofen which

has a brand name of motrin or Advil

another one is naproxen which has a

brand name of a leaf in the United

States so these are all antipyretic

medicines that reduce fevers so some of

the past research that's been done

looking at the potential benefits of

fevers and the use of antipyretic or

fever reducing drugs includes

evolutionary studies and several others

so evolutionarily the fever response by

the body is actually conserved across a

huge number of species including in cold

blooded animals that will actually move

into the Sun to help increase their body

temperature when they have an infection

and so the thought is well if our body

is wasting its precious energy and this

has been conserved by evolution across

so many types of species this fever

response that there must be some use of

the fever response for the immune

response to the infection there have

been several studies trying to have

animals with infections at a higher

temperature or lower temperature or

giving them a fever reducing medicines

and the studies generally show although

they're mixed they generally show that

the fever response can actually be

helpful to finding an infection there

have also been some human studies

looking at fevers and whether they're

beneficial these human studies have been

published in prestigious journals and

and there are enough of them that there

are actually larger studies called meta

analyses and review articles that gather

all this research together to look at it

at the end of the day what these studies

tend to show is that fevers may be

beneficial for humans to fight off

infections that taking fever reducing

medicines may potentially harm the

body's ability to fight off an infection

however at the end of the day a lot of

these studies do not show a big effect

from it

either direction whether benefit or harm

and so at the end of the day it probably

does not make an enormous difference

so that's beginning a little bit about

fevers in general now let's get into the

concern about ibuprofen and kovat 19:00

so where does this concern actually come

from things are moving rapidly when it

comes to kovat 19and research that's

being published so on March 11th which

is just eight days ago a letter was

published in the lancet respiratory

medicine and this letter was merely

suggesting the possibility that

ibuprofen could potentially make Koba 19

worse the letter actually was focusing

on blood pressure and diabetes medicines

and there was a sentence that mentioned

ibuprofen

so after this letter Frances Health

Minister announced that people should

really have a lot of caution in taking

ibuprofen for Koba 19:00 although there

was no actual data this was just

suggested in a letter based on some

hypothetical mechanisms and then the

World Health Organization tweeted out

that they said based on currently

available information the World Health

Organization does not recommend really

ibuprofen then subsequently they tweeted

that they were consulting with

physicians they are not aware of any

evidence and that they do not recommend

against the ibuprofen at this time so

everything is kind of rapidly changing

at this point what are the hypothetical

concerns just to dig into the science

for a moment Koga 19:00 one of the ways

that it attacks the body is when it

enters the lungs it binds a molecule on

our cells called East to there is some

suggestion that ibuprofen may increase

the level of East two and theoretically

if that happens then could there be eat

more of this molecule on our cells for

the virus to bind

- that's a theoretical concern as of

right now there is no actual human or

animal data to suggest that's true for

Koba 19 and the use of ibuprofen so that

gets us into our next question when is a

fever reducer appropriate for treating

the symptoms of Cova 19 at the end of

the day probably if you're if you are

suspected to potentially have koban 19

and you are uncomfortable from a fever

it is probably okay to take a fever

reducing medicine if you feel like you

can ride out the fever so to speak then

it's reasonable to skip taking the fever

reducing medicine so witch fever

reducing medicine if you are going to

take one is best for Cova 19 well this

whole discussion really surrounds the

use of ibuprofen and NSAIDs

non-steroidal anti-inflammatory drugs

this discussion does not concern

acetaminophen which is known as

paracetamol or Tylenol and in fact the

French Health Minister suggested that

people take acetaminophen instead of

ibuprofen

so witch fever reducing medicine is best

for Koba 19 we really don't know at this

point probably either one is okay but if

you're going to take one it's reasonable

to potentially lean more towards

acetaminophen instead of ibuprofen

now who should avoid taking ibuprofen

well anybody with a known allergy to

medicines should avoid taking that

medicine that's true for any medicine

and then people should speak with their

doctor before taking ibuprofen if they

have any diagnosis of kidney disease

inflammatory bowel disease if they have

a history of stomach surgery or if

they're on any blood thinning medicines

so what are really the take-home points

here the primary reason to treat a fever

with a fever reducing medicine is to

reduce discomfort the actual fever

number itself does not concern us so

much and there is some evidence that

fevers are actually beneficial for the

body to help fight off an infection so

do not feel like if you have a fever

that you automatically need to take a

fever reducing medicine the real

indication to take one of these

medicines is if you're feeling

uncomfortable and if you are feeling

uncomfortable from a fever is whether

there is harm or not we really don't

have good evidence there probably is not

a large either benefit or harm so if you

are feeling really uncomfortable from a

fever it's probably reasonable to take

one of these medicines

does it matter or whether you take

ibuprofen naproxen acetaminophen it

probably does not make a big difference

but if you have acetaminophen it's

reasonable to lean more towards

acetaminophen at this point until we

have more data if you have any questions

please speak with your physician and I

hope that everyone out there does well

with this and if you're feeling sick I

hope that you feel better