*Fever in Covid- How to treat difficult cases?*.

*Covid Update-149*

Fever is seen in about 78% cases of Covid. *Most patients (45%)will have intermittent fever in range of 100.5 to 102°F* especially young

*About one-third patients may have low grade fever upto 100.4°F especially in old age*

In only 15% cases fever crosses 102°F.

About 15% cases can have fever with chills.

Fever is indicative of ongoing inflammation in disease process. It may often be difficult to treat fever in some patients.

*How to treat Fever in Covid 19*

Use Paracetamol ®️ brands Crocin, Calpol, Dolo 650.

In my opinion using 650mg of paracetamol offers no extra advantage over 500mg.

Prefer giving paracetamol in case of fever more than 100 F on SOS(as and when required). Giving it three times a day can be troublesome in few people as it may cause profuse sweating 2 to 3 hours after intake.

*If fever doesn’t subside in covid –What to do?*

1.Adding some non steroidal antiinflammatory drug like *Nimesulide, Meftal, Piroxicam etc once/twice a day supplemented by paracetamol* sos upto 3 to 4 times in a day is safe in most patients except those with compromised kidney function.

2.For *fever persisting beyond 5 days* AIIMS Covid protocol *recommends adding Budicort inhalation/Nabulization 800ug twice a day*.

3.If fevers persists *beyond seven days*, the treating doctor may decide to add *low-dose oral steroids eg. Methyl prednisolone 4 to 8 mg twice a day or Prednisolone 5 to 10mg twice a day*.

4. Reappearance of fever or increase in *peaks of fever in second week of illness could a sign of impending Cytokine storm* warranting full dose steroids 40mg Prednisone/8mg Dexona/32mg Methyl prednisolone.

5. Don’t forget to advise *plenty of water and liquids* to patients having fever.

6. *Taking bath during fever is not harmful*. Rather taking bath with fresh water may be helpful bring down fever.

7. *Fever may come down by taking rest in AC cooled rooms*. Those who experience chills in AC may prefer Fan.

8. *Bed Rest* helps to bring down fever.

🌹 *Recurrent Low grade Fever in Covid. What to do?*

It is important to understand that it is *not uncommon to have low grade fever of 99 to 100 F in covid patients for more than 2 weeks* despite various medications. Possibly, raised Basal metabolic rate (BMR) could be the reason. BMR comes down with Rest. Important to stay assured.

🌹 *Resurgence of fever after recovery*

After recovery from Covid it is *not uncommon to see resurgence of episodes of fever lasting few hours to days, especially after heavy physical activity*. Such patients usually don’t land up into serious complications. Rest, paracetamol and short 3 to 5 day course of Non steroidal anti inflammatory drugs like Nimesulide Meftal Neprosyn Piroxicam may be helpful.

*About 40% percent patients report off and on fever even after 3 months of recovery*. *It is called Long Covid*. Such patients may require low dose of Non steroidal Anti inflammatory drugs for 4 to 8 weeks. However, it may be important to monitor Kidney function in such cases.

🌹🌹 *Why some people don’t have fever at all while others have prolonged fever in Covid?*

Note : One of the most perplexing aspects of coronavirus is why it strikes people so differently. Why do some people sail through without a symptom, while others — even some who are otherwise healthy and relatively young — get extremely sick or even die? It seems to do something with immunity of the person.

drskgupta@gmail.com

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