How to manage a fever

The proper management of fever is a basic self-care skill that everyone should possess, pandemic or no pandemic. All you need is a few common herbs, a good thermometer, a nice cosy bed with lots of blankets and a week or two off work.

In this article, I go through what exactly fever is, how to monitor it, and how to manage each stage properly. Notice I say ‘monitor’ and ‘manage’ – not ‘suppress’ – which brings me to the most important point of all.

Aspirin, paracetamol, NSAIDs and fever
Some things you won’t be needing during your fever are aspirin, paracetamol, ibuprofen or any other non-steroidal anti-inflammatory drugs (NSAIDs). These medicines, whilst constituting the basis of the conventional approach to fever, have been shown repeatedly in clinical trials to prolong and worsen viral infections, increase viral shedding and suppress immune resistance.

In fact, the most reliable online source of medical information on COVID-19, the Internet Book of Critical Care (IBCC), has updated its chapter on COVID-19 to advise physicians to avoid all non-steroidal anti-inflammatory drugs in COVID-19 infection due to their capacity to upregulate virus-binding receptors on cells, worsen infection and cause kidney toxicity.

What is fever?
So, back to fever. Fever can be defined as a beneficial rise in body temperature and metabolism which aids the body’s immune reaction to invading bacteria and viruses. Along with it comes a boost in blood circulation, increased white blood cell and antibody production, and increased elimination via the skin and urine.

In terms of the latest evidence relating to COVID-19, a high fever is more likely to indicate severe infection. The most common presentation, however, is said to be that of a ‘low-grade’ fever, which has specific implications for the individual patient.

Normal body temperature
Contrary to popular belief, not every single person on the planet has a constant body temperature of 37°C!

In fact, average body temperature tends to be around 36.8°C, with variations of up to 0.5°C throughout the day. Older people also tend to have lower body temperatures – a temperature of 36.6°C can indicate low-grade fever in an elder in some cases. This is important to be aware of considering that elders are high-risk patients when it comes to COVID-19.

Check your body temperature on rising and between 4-6pm for a few days to get a feel for what your normal temperature is. A rise of 0.25°C above normal at a specific time of day can be constituted as a low-grade fever.

Management of fever
▪ Stage 1
Initial signs are chills, shivering, and pallor. The body’s ‘set point’ or internal thermostat has been elevated, and you’ve got some catching up to do.

Hot, warming ‘diaphoretic’ (sweat-inducing) herbs are indicated here. Think ginger, chilli, clove. I make my ginger tea so strong it’s completely opaque – almost milky in appearance.

However, the key aspect of initial fever management is fasting. Your body only produces a certain amount of protein each day, and during acute illness you need all the protein you can get for making white blood cells and immune peptides. You don’t want to be bothered with making digestive enzymes or regenerating your gut lining. Sticking to a water fast until the fever drops below 37.2°C reduces fever duration and improves overall outcomes.

▪ Stage 2
Once the fever has reached 38-39°C, the skin will be hot and dry, but moisture is lost through the skin all the while making hydration critical at this stage.

Drink warm, soothing drinks with lots of ‘demulcent’ herbs like mallow, plantain, marshmallow and slippery elm. These contain mucilage – gooey polysaccharides that nourish and moisten the mucous membranes which become inflamed and damaged during influenza infections, producing the dry cough.

Moistening the membranes will also improve local immune activity and help prevent the spread of infection to the lungs.

Put a handful of the herb (fresh or dry) in a 1.5 litre bottle of water and sip throughout the day. Other herbs to use here are the cooling, relaxant diaphoretics – elderberry and elderflower are good examples. These herbs relax the capillaries and increase heat lost by radiation through the skin.

▪ Stage 3
Characterised by alternating fever and chills, the body’s set point is fluctuating at this stage, with ‘cytokine surges’ – waves of inflammation which make you feel rubbish – coming and going in between periods of relief.

A simple tea formula made of stimulating and relaxant diaphoretics, such as the traditional yarrow, elderflower and peppermint combo, is great here. Other useful gentle diaphoretic herbs for this stage include lemon balm, catmint and lime flowers.

It is also common to develop food cravings during this time – it is important to not give in to these and stick with your fast until your fever drops.

▪ Stage 4
The set point falls, and you ‘sweat it out’.

The most important thing here is to stay in bed. Continue to hydrate, keep warm, and be patient. In COVID-19, symptoms can return after periods of respite, and a crisis point is often seen around day 10 in severe illness. This does not mean you need to fast for 10 days – the fever itself should not last for more than a few days, following which you can start to eat soups, stews, fruits and other light nourishing meals.

▪ Stage 5
This is the recovery stage. Continue to rest as much as possible and don’t go back to work unless you really need to.

Adaptogens may be useful here as you’ll be feeling pretty run down still. Liquorice is a good demulcent ‘qi tonic’ (Chinese medicine terminology) which puts a bit of spring in your step. Other nourishing adaptogens include ashwagandha and shatavari.

It is normal to still feel a little tired in the weeks following a fever, but if this develops into long-term fatigue, you may need to see a natural health practitioner about it. Poorly managed fevers can develop into complex symptom pictures like Chronic Fatigue Syndrome, so it’s important that you give your fever the attention it deserves in the initial stages, to prevent this from happening.

By Poppy Burr
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Poppy is a UK-trained medical herbalist practising in Praia da Luz. She offers consultations and treatment in Western Herbal Medicine, incorporating Functional Medicine testing and nutritional strategies where appropriate. For more information, visit