What is best to reduce fever
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
