Coronavirus and Fever Part II: What Medical Research says about Fever Ibuprofen and Acetaminophen

The Coronavirus has thrust fever into the international medical debate. Specifically, how and if we should be using Advil, Tylenol, or other fever reducing drugs for treatment. The French health minister Olivier Veran came out against use of Ibuprofen for Coronavirus treatment; the World Health Organization contradicted that recommendation. I have found the soundest judgment to have come from Anthony Fauci, MD, the director of the National Institute of Allergy and Infectious Diseases who’s been leading the U.S. response: “Bottom line is, I have not seen any firm data (on Ibuprofen) to indicate there’s a problem or to prove that there’s not a problem.”

I am a Naturopathic Doctor versed in incorporating both the timeless wisdom of nature as well as modern medical research to guide my medical decisions. I will investigate fever and use of antipyretics – a class of fever reducing drugs that includes Tylenol and Advil – through both of those lenses. My first article in the series explored this topic philosophically. This second article will answer frequently asked questions (FAQs) about fever and antipyretics based on what we know from medical research studies.

This article is for information purposes and should not be interpreted as medical advice. Please contact a medical provider for treatment and follow CDC guidelines.

FAQs: Safety of Fevers and the use of Fever Lowering Drugs

1. Fever from infection is not dangerous

I quote from the guidelines from The American Journal of Pediatrics:

“Fever, however, is not the primary illness but is a physiologic mechanism that has beneficial effects in fighting infection. There is no evidence that fever itself worsens the course of an illness or that it causes long-term neurologic complications. Thus, the primary goal of treating the febrile child should be to improve the child’s overall comfort rather than focus on the normalization of body temperature.”

The main concern for parents of children with high fevers are seizures. There is no evidence that antipyretics reduces incidence of febrile seizures. Treatment should focus on keeping the patient comfortable. I introduce Naturopathic fever therapies in my next article geared towards keeping the patient as comfortable as possible while not interfering with the immune supporting fever process.

3. Is there a temperature threshold in which a fever is considered dangerous?

No, there is no absolute dangerous temperature for fever due to infection. Again I quote from the American Journal of Pediatrics: “Studies of health care workers, including physicians, have revealed that most believe that the risk of heat-related adverse outcomes is increased with temperatures above 40°C (104°F), although this belief is not justified.”

At 104°F and above, there are concerns surrounding the stress such a high temperature puts on the body, particularly if the patient is not a child and has compromised kidney or liver function. Infectious fever reaching that temperature in adults is very rare. The body is unlikely to mount a response it cannot sustain.

4. So even if I have a very high fever and severe symptoms I can ride the illness out at home?

No, no, no, no, no and one more NO!  If you are for example experiencing neck rigidity, confusion, mottled red skin, and a rapidly spiking fever, you may have meningitis, a rapidly developing deadly inflammation in the spinal cord. You need emergency treatment for the underlying infection that is causing the fever, not for the fever itself.

5. What do you mean by fever from infection? Do other types of fevers exist and are they more dangerous?

Fever is one of the effects in the body from inflammation. We learn the four signs of inflammation in medical school as: rubor, calor, tumor, and dolor, which translate from latin as: redness, heat, swelling, and pain. Any irritant can initiate inflammation in the body. 50% of fevers are not caused by infections. Some of those other causes of fever can cause dangerous body temperatures. Heat stroke and head injury for example may lead to dangerous body temperatures exceeding 106°F and 107°F, which overheat the brain, because they can interfere with the body’s ability to self-regulate. Heat stroke is due to an external temperature rise for which the body cannot compensate. Head injuries that affect the hypothalamus, the center of the brain that controls temperature, disrupt the body’s ability to control runaway temperatures.

6. Fever lowering drugs do not save the lives of those being treated for infectious disease

There are no studies that show antipyretics improve the course of infectious disease. In fact, there are small studies that show improved survival rate for critically ill patients of infectious disease not treated with antipyretics. This is due to the fact that sepsis – the end stage of deadly infectious diseases where the infection enters the blood stream – is compromised by lowering body temperature. A team of microbiologist studying Neisseria Meningitidis, the most common bacteria responsible for meningitis, found that the concentrations of the bacteria reduced 90% after several hours incubating at fever temperature compared to average body temperature. Fever is a natural antibiotic for some disease causing organisms.

7. What are antipyretics good for?

They are palliative medications. They reduce the discomfort and sweating, the dolor one experiences during febrile infectious disease.

8. Less pain while I’m dealing with this annoying infection, what’s wrong with that?

Besides the increased death-rate for septic patients already discussed above, there are at least three other issues with using antipyretics for the treatment of infectious disease:

1. They are toxic drugs
   1. Acetaminophen (Tylenol) is the most common drug overdose in the world. It has a narrow therapeutic index, meaning the dosage between what is prescribed and what causes acute liver failure is dangerously small.
2. They Increased spread of infections
   1. Since individual feel better with antipyretic treatment, they are more likely to increase social contact while they are still actively infected. This makes social distancing measures to flatten the curve harder to implement.
3. They lead to chronic disease
   1. There was a large population study tracking over 200,000 children worldwide that showed a correlation between Tylenol use during their first year of life and the development of allergic diseases including asthma, eczema, and allergies at 6-7 years of age. The correlation is stronger for children that were heavier users of Tylenol. Intuitively, it makes sense that taking a medication that dampens your immune system could leave you vulnerable to the dysregulated immune response of allergic disease later in life.

We need to be having the discussion around ibuprofen and acetaminophen for management of infectious disease during this coronavirus pandemic. The medical research shows that fever reducing drugs are effective for reducing pain and discomfort, but not for saving lives; furthermore, they are problematic because they correlate with increased: death rates for critically ill individuals, spread of infections, susceptibility to chronic disease, and they lead to drug overdoses.

One trend that I came across in the medical literature is that the onus of proof for safety and efficacy is placed upon the fever rather than the drugs. There were many studies that concluded that there was not sufficient evidence to prove that acetaminophen was unsafe or that fever improved disease outcomes. You may refine your perspective from reading medical studies, but your conclusions will at some point return to your biases. Check in with yourself as to who you are more willing trust: the cow or the chemist?

Other articles in the Coronavirus and Fever series include:

• Part I: Naturopathic philosophy of fever: directing versus shutting down the fever process
• Part III: Naturopathic treatments for fever: directing instead of shutting down the fever process.