Potential for Further Mismanagement of Fever During COVID-19 Pandemic: Possible Causes and Impacts.

Rakesh K Singh,Dhiraj Kishore,Samer Singh

doi:10.3389/fmed.2022.751929

Abstract

Fever remains an integral part of acute infectious diseases management, especially for those without effective therapeutics, but the widespread myths about “fevers” and the presence of confusing guidelines from different agencies, which have heightened during the coronavirus disease 2019 (COVID-19) pandemic and are open to alternate interpretation, could deny whole populations the benefits of fever. Guidelines suggesting antipyresis for 37.8–39°C fever are concerning as 39°C boosts the protective heat-shock and immune response (humoral, cell-mediated, and nutritional) whereas ≥40°C initiates/enhances the antiviral responses and restricts high-temperature adapted pathogens, e.g., severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), strains of influenza, and measles. Urgent attention is accordingly needed to address the situation because of the potential public health consequences of the existence of conflicting guidelines in the public domain. We have in this article attempted to restate the benefits of fever in disease resolution, dispel myths, and underline the need for alignment of national treatment guidelines with that of the WHO, to promote appropriate practices and reduce the morbidity and mortality from infectious diseases, such as COVID-19.

Highlights

Fever is integral to our natural defense against acute clinical infections, especially those without effective therapeutics, e.g., common cold, measles, and influenza [1–9]
The term “fever(s)” in the manuscript narrowly applies to the elevation of body temperature in response to an infection, unlike its broader usage in the literature for any temperature elevation
Reserving the usage of “hyperpyrexia” or more explanatory term “pathogen-hyperpyrexia” for the fevers of infectious disease origin while “hyperthermia” for non-braincontrolled fever is suggested to reduce the prevalent confusion among clinicians and public concerning their management

Summary

INTRODUCTION

Fever is integral to our natural defense against acute clinical infections, especially those without effective therapeutics, e.g., common cold, measles, and influenza [1–9]. The phobia of fever remains extensive among the general public, nursing staff, and clinicians, despite the body of theoretical and practical/experimental evidence to the contrary [14–22, 36, 72, 82] It has been gradually increasing over the years and promoting the continuation of non-evidencebased irrational management practices [16–25, 72, 82]. Inability to differentiate fever by type and terminology mess: The inability to differentiate the common “hyperpyrexia” from “hyperthermia” is widespread The former beneficial one results from the brain-controlled incremental increase in temperature during infection, while the latter concerning one results from uncontrolled temperature elevation on the failure of thermoregulatory mechanism as observed in heat shock [15]. Reserving the usage of “hyperpyrexia” or more explanatory term “pathogen-hyperpyrexia” for the fevers of infectious disease origin while “hyperthermia” for non-braincontrolled fever is suggested to reduce the prevalent confusion among clinicians and public concerning their management. The prescription of antipyretics for diseases without effective therapeutics makes it a risky proposition (e.g., COVID-19, influenzae, and measles)

Fear of Brain Damage From High Fever

CONCLUSION

Findings

DATA AVAILABILITY STATEMENT