43. Risk and Benefits of Treating Fever in the Age of COVID-19

The administration of medications like acetaminophen and ibuprofen is frequently an automatic response to fever. But a mountain of scientific evidence suggests that lowering fever could potentially do more harm than good. As we’re coping with the COVID-19 outbreak, these issues bear consideration.

Across a diverse number of species, including reptiles, fever is an evolutionary response that inhibits the replication of bacteria and viruses. The activity of our B-cells, T-cells, and immune modulators is enhanced at higher temperatures. Not surprisingly, studies have demonstrated that treating fever can result in a prolonged or more severe course of illness.

When my own children were younger, I tended to give them Motrin or Tylenol at the first sign of fever. Instantly the kids felt better and resumed normal activities—instead of resting while they were sick. I began to wonder if the antipyretics might be harmful, promoting overexertion in ill children. A plethora of scientific studies now suggest these medications have potential negative side effects, both on a macroscopic and microscopic level.

Many parents worry that a high fever could be dangerous or damaging to children. When addressing this concern, it’s important to keep in mind that fever is a physiologic response to illness. The hypothalamus raises core temperature in an effort to fight infections, but not indefinitely. This contrasts with non-physiologic hyperthermia, in which temperatures can rise to dangerously high levels—think dehydrated football player wearing heavy equipment on a hot day.

Are there some situations in which antipyretics should be given? In the setting of pain, dehydration, or difficulty sleeping, antipyretics are useful. Children who are vulnerable to the increased metabolic demands of fever, such as those with asthma and rapid breathing, might also benefit from fever reducers. In the ICU setting, studies have demonstrated that antipyretics are useful for treating patients with brain injuries; they may also be indicated in the setting of septic shock.

However, in the case of febrile children who aren’t in pain or in danger of dehydration, antipyretics aren’t indicated. This holds true for children with a history of febrile seizures. Overwhelmingly, the evidence suggests that administration of antipyretics has no effect on the recurrence of febrile seizures, a frightening but benign condition.

In summary, fever is a natural response to infection that helps fight bacteria and viruses. In the face of COVID-19 or other infectious illnesses, not treating fever might be the best course of action.