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Let fever do its job

Wrotek et al., Evolution, Medicine, and Public Health, doi:10.1093/emph/eoaa044
Nov 2020  
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Review of fever focusing on COVID-19. Authors note that fever is a key component of the acute phase response to infection. Fever enhances immune cell performance, induces cellular stress on pathogens, and acts synergistically with other stressors like iron deprivation. Observational studies associate higher temperatures with improved survival in infections including COVID-19. Randomized trials do not show improved outcomes from fever reduction, while aggressive cooling increased mortality in some cases. Public health considerations like fever screening and transmission linked to antipyretic use are discussed. Authors find that, with no definitive evidence of harm, the precautionary principle suggests allowing fever in this life-threatening infection to support this likely beneficial host defense.
Wrotek et al., 23 Nov 2020, peer-reviewed, 4 authors. Contact:
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Let fever do its job
Sylwia Wrotek, Edmund K Legrand, Artur Dzialuk, Joe Alcock
Evolution, Medicine, and Public Health, doi:10.1093/emph/eoaa044
Although fever is one of the main presenting symptoms of COVID-19 infection, little public attention has been given to fever as an evolved defense. Fever, the regulated increase in the body temperature, is part of the evolved systemic reaction to infection known as the acute phase response. The heat of fever augments the performance of immune cells, induces stress on pathogens and infected cells directly, and combines with other stressors to provide a nonspecific immune defense. Observational trials in humans suggest a survival benefit from fever, and randomized trials published before COVID-19 do not support fever reduction in patients with infection. Like public health measures that seem burdensome and excessive, fevers involve costly trade-offs but they can prevent infection from getting out of control. For infections with novel SARS-CoV-2, the precautionary principle applies: unless evidence suggests otherwise, we advise that fever should be allowed to run its course.
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