Note: The Pregistry website includes expert reports on more than 2000 medications, 300 diseases, and 150 common exposures during pregnancy and lactation. For the topic Coronavirus, go here. These expert reports are free of charge and can be saved and shared.
According to a UK study, fever is the most frequent symptom of mild and moderate COVID-19. Fever or pyrexia is an immune response. When a harmful pathogen is introduced into your bloodstream, the hypothalamus of the brain is activated. It releases chemicals that cause heat generating effects by two mechanisms. The first mechanism is prevention of heat loss by constriction of blood vessels on the skin surface. If less blood is flowing near the skin surface, less heat will be emanated into the environment.
The second mechanism is to increase heat production. This is done by increasing the metabolic rate by making muscles in the body contract. The purpose of these intricate mechanisms is to raise the body’s temperature thereby creating an unsuitable environment that will make it hard for the pathogens to survive. Fever occurs when the body temperature is above 38°C. When you have a fever, you will feel hotness of the body and shivering which is caused by contracting muscles.
Treatment of fever is still controversial as it serves an immunological role. Even so, treating fever does not worsen disease outcomes and serves to make the patient less uncomfortable.
Scientists are still searching for the cure of COVID-19. The search is promising as there are a number of drugs under study with some showing promising results already. Even so, it may take time for these drugs to be approved as their safety, as well as efficiency, is a major concern.
Thus, the current management of mild to moderate cases is supportive. Supportive management is the treatment of symptoms with the goal of making the patient as comfortable as possible. The current mainstay is providing oxygen when needed and treating any fever.
If you are currently pregnant, it may be useful to know the drugs available for fever and how they interact with your pregnancy. This is because treatment of fever in pregnancy is crucial and delicate; crucial because fever in pregnancy has been associated with increased birth defects to the baby, especially if the mother is not taking folic acid supplements, and delicate because most antipyretics have side effects and their use in pregnancy frowned upon. Thus, fever in pregnancy can present a damned if you do or damned if you don’t situation. Here are the commonly available antipyretics and their safety profiles in pregnancy:
Acetaminophen or paracetamol is one of the most commonly prescribed drugs in the United States and Europe. It is on the World Health Organization’s list of essential medicines. It is cheap and commonly prescribed for fever and mild to moderate pain. It is broken down in the liver to produce a compound that selectively inhibits pain mediators in the brain. It can be taken orally, rectally or as an intravenous infusion. Its effect lasts two to four hours. Acetaminophen is safe for use in pregnancy.
Ibuprofen is used to relieve pain and fever. It is a member of a class of drugs known as Non-Steroidal Anti-inflammatory Drugs (NSAIDs). Ibuprofen can be taken orally or as an intravenous infusion. It works within one hour to relieve pain and fever. In early pregnancy, ibuprofen can be used with caution if benefits outweigh the risks. However, at and after 30 weeks of gestation, ibuprofen is only recommended in life threatening emergencies where there are no other alternatives. This means that ibuprofen, particularly in late pregnancy, poses a real threat to the unborn baby. Thus, it should not be used over the counter and even in a hospital setting, should only be used if there are no safer alternatives. All in all, the use of ibuprofen in pregnancy is not recommended.
Aspirin or acetyl salicylic acid is a powerful anti-inflammatory drug that reduces pain and fever in thirty minutes. It is a special type of NSAID as it can irreversibly inactive pain mediators. Other NSAIDs work in a similar fashion but their effects are reversible. Because of this feature, aspirin has a host of other uses including prevention of stroke and blood clots, and treatment of inflammatory conditions such as pericarditis. It has side effects, most significantly, the risk of bleeding stomach ulcers. The use of aspirin in pregnancy is not recommended especially in the third trimester as it can lead to heart defects in the unborn baby.
With the current pandemic, temperature checks in countries and cities that are not on lock down are common. This is because fever is a common sign of COVID-19 and is easily and non-invasively detected using a thermometer. Chances are you will have your temperature checked now more than ever if you have not already purchased your own thermometer and are keeping tabs yourself. Hence, when you find yourself or are found with a fever, do not panic. Not all fevers are due to COVID-19. Secondly, do not self-medicate with antipyretics or worse, antibiotics. Call your doctor, or book an appointment if possible. They will do the necessary tests and prescribe the safest drug.