Debunking harmful myths about fever: the antidote to “fever phobia” and what to do instead
Misconceptions around fever and the best way to handle it are SO common, and they may be keeping you sick longer than you need to be. What are these myths, why are they so common, and what should we be doing when our child has a fever?
It is imperative that we set the record straight about fevers in the time of COVID-19.
With fever being such a common symptom of the novel coronavirus, in even milder cases, it becomes all the more urgent that we dispel a few misconceptions about what a fever’s purpose is, whether they’re harmful or helpful (spoiler alert: they’re actually really helpful), and what we should be doing when we or one of our kiddos is running a fever.
If we don’t dispel these myths, more folks will wind up in the already overburdened hospital system.
As I watch the work of those on the front lines of this crisis, I feel compelled to do what I can as an alternative medicine practitioner to help mitigate some of the load our healthcare system (with all its many flaws) is facing. One of the best ways for me to contribute right now is to help educate the public in such a way that it keeps people (namely, worried parents with feverish kiddos and misinformed adults with non-serious fevers) from visiting hospitals unnecessarily.
If we continue to mishandle and misunderstand fevers, two things will happen:
Concerned and well-meaning folks will take themselves (or their children/loved ones) to the doctor when there’s really no need, causing unnecessary exposure to COVID19 or other things floating around in the hospital air, and
Folks who might have kicked the coronavirus or other infection will end up in the hospital, when they might have otherwise gotten away with having a mild case if they had handled their fever differently
Both of these things will A) cause more people to be exposed and B) place more strain on the already overburdened medical system. Not to mention, the fear of (unnecessary) Tylenol shortages will cause more panic buying and take resources away from folks who really do need the NSAIDS (non-steroidal anti-inflammatory drugs) for other things.
Fever phobia is a real and present concern worldwide.
Parents, this article is especially for you. “Fever-phobia” in parents is a well-documented phenomenon in the literature, regardless of level of education or socioeconomic status, and it leads to overly aggressive treatment of fevers in kiddos. But don’t think I’m pointing fingers, it can be scary when your little one is all hot and achey. We’ve all been taught to fear fevers, and many of our pediatricians feed “fever phobia” by giving parents mixed messages about how to handle their child’s fever, and failing to educate them about proper treatment. Wow, that was a lot of F’s. This phobia persists worldwide to this day among both parents and healthcare providers.
Herbalists and other traditional healing systems have a very different take on fevers, and have known for thousands of years that a fever is an important and beneficial part of the body’s normal response to infection. It has long been a tenet of healing systems like Ayurveda, TCM, and European Herbalism to support a robust febrile response while mitigating discomfort. That means doing what is indicated by the person’s individual symptom presentation, whether that’s stoking the fire, opening the peripheral blood vessels to encourage the person to sweat, or applying moistening remedies to keep the tissues from drying out. This is often entirely the opposite of how fever is handled within conventional medicine, where lowering someone’s temperature is often the main goal of treatment.
Mainstream medicine’s standard approach of “treating” a fever is somewhat mind-boggling when you consider that many authoritative organizations like the American Academy of Pediatrics have reiterated again and again the benefit of fevers and the uselessness of treating a fever just because it’s there, emphasizing that the priority should be making the kiddo as comfortable as possible while they ride it out (assuming the CAUSE of the fever is non-serious, of course). Note: that advice doesn’t really apply to infants (6 weeks - 3 months), in whom fever is often cause to seek medical attention promptly.
Pop quiz! What is a normal adult human’s temperature supposed to be?
How many of you said 98.6°F? Yep, all of you (unless you skimmed the next line of course, ya cheater…) We all learned it somewhere growing up, but sorry folks, that’s just not how it is.
The “normal” human body temperature is NOT 98.6°F
It never has been. The person who put this notion forward *at best* used crappy measurement equipment and, at worst, just made shit up. Either way, the 98.6° F myth has been debunked, repeatedly, but has persisted amongst healthcare practitioners and laypeople alike. While the average normal body temperature is 97.7°F (36.5°C), the *range that is considered normal* runs from 91.8°F (33.2° C) all the way up to 100.8°F (38.2°C). It also fluctuates throughout the day, starting lower in the morning and peaking in early evening, so make a mental note of that when taking a temperature. If you have a menstrual cycle, your basal body temperature (the lowest temp your body reaches in a 24-hour period, usually measured upon waking before getting out of bed), will be 0.5-1.0 degree lower in the first half of your cycle, and higher in the second half. This is the idea behind measuring basal body temperature to track when you ovulate.
All of this should be factored into a person’s assessment of their temperature. In other words, don’t just go by the number on the thermometer. Know where your temperature falls on the spectrum of normal temps, measure multiple times in a day (upon waking and around 4-6pm is a good strategy), and factor in any temperature shifts that may be the result of your menstrual cycle.
Ok, so you’ve factored all that in, and yep, you definitely still have a fever. It’s 1° or more higher than your normal baseline and you’ve got other symptoms too (chills, body aches, fatigue, etc). You’re starting to feel a little worried. You may now be asking yourself (on your way to laying down in bed, hint hint), should I be worried that I have a fever, even though my other symptoms aren’t serious? In short, no.
Fevers themselves are NOT a threat to health
A fever is NOT an illness in itself. It is not something to be feared or suppressed and, as you’ll see below, there is NO benefit to medicating it. In fact, it is your body’s natural, helpful, and appropriate physiological response to an invader. Fevers are a crucial part of the immune response that hasten recovery and cause other elements of your immune system to operate more effectively, conversing your body’s valuable resources. Your T-cells function more efficiently at the elevated temperatures associated with fever, for example. The Influenza virus simply DIES in the lungs, without ANY help from white blood cells, when the temperature reaches 99 -100°F (remember that the lungs are cooler than the rest of the body).
Ok, but some fevers are hazardous, right? What about the rule that you shouldn’t let your child’s fever climb above 104°, or they risk neurological damage? That’s got to be a serious risk we have to watch out for, doesn’t it?
Not so much.
Fevers above 104°F are not inherently dangerous, nor can they cause brain damage
I remember my mom reaching for the thermometer after a casual brush on my forehead left her with a furrowed brow. Being 7 or 8 years old, I feared that meant what it had earlier in my short life (thermometer up the bum, eek!), and I remember being weak-kneed grateful that I’d graduated to the pokey-cold-metal-thing-under-the-tongue method. As she turned away, I heard her mutter worriedly about how she hoped it wasn’t higher than 104… How many times have we heard that rule: that you can’t let a fever get above 104°F, or you risk brain damage? It’s one of those things that’s repeated and repeated until it enters the collective unconscious and no one knows where it came from, like gum staying in your GI tract for 7 years after you swallow it (another spoiler alert: also not true).
It is an unfortunately widespread myth that fevers above 104 degrees are dangerous and can cause brain damage. This is simply. not. true. Only body temperatures above 108° F (42° C) can cause brain damage, and, because every human brain comes with a built-in thermostat, really the only way a person’s body temp can climb that high is with the help of extreme, external environmental temperatures (for example, being confined to a closed car in hot weather). The fevers that come from infection don't cause brain damage and there is no arbitrary level of fever where the prospect of letting the fever run its course becomes “too risky.”
To decide how serious someone’s condition is, you must look at the individual, at their other symptoms (as well as activity level, appetite, and behavioral changes in kiddos) and look for other signs that the CAUSE of the fever is serious (meningitis, a worsening of COVID19, appendicitis, etc), rather than looking at just the number on the thermometer. A higher fever does NOT necessarily equate to a more serious infection.
But even if it’s a non-serious infection, you should still give the person medication to bring the fever down, right?
Wrong.
Not all fevers need to be treated with antipyretics (temperature-lowering drugs).
Just because we have drugs that will bring a fever down, doesn’t mean that all fevers need to be treated with fever medicine. Don’t get me wrong, it’s sometimes okay to give medications to lower fever if the person or kiddo is really uncomfortable. The point here is that fevers shouldn’t be treated BY DEFAULT, just because they exist. We only need to force the temperature down if the fever is causing excess discomfort, which usually doesn’t happen until they go above 102° or 103° F (39° or 39.5° C).
“One trial found that people infected with Influenza or Shigella who were given fever-lowering medications were sick for 3.5 days longer than those who didn’t receive such medications.”
Nor is it true that fevers will “keep getting higher” unless they’re treated. That’s not how the body works! The brain has a thermostat, and it won’t usually allow fevers from infection to go above 103° or 104° F (39.5° - 40° C). They will *rarely* get up to 105°F or 106°F (40.6° or 41.1° C), which is considered a “high” fever. Such a fever will probably be uncomfortable, but in and of itself is still harmless. Treat the fever if you need to make the person (or little one) more comfortable, but take solace in the fact that you’re doing so for their comfort, not because the fever is dangerous.
It’s important to note that, in giving fever-suppressing medications, we are inherently suppressing the immune response. So we need to be judicious in our use of NSAID medications (ibuprofen, Tylenol, etc), now more than ever. There’s strong reason to believe that that some of these medications may worsen viral infections, including COVID19, by negatively affecting the severity, duration and spreadability of viral infections. We don’t yet have data showing their effects on COVID specifically, but we have plenty of data to show that NSAIDS obstruct our body’s anti-viral defenses. Taking NSAIDS to arbitrarily lower a fever also lowers antibody production, and reduces the number of competent B-lymphocytes. One trial found that people infected with Influenza or Shigella who were given fever-lowering medications were sick for 3.5 days longer than those who didn’t receive such medications. 3.5 days!
Ok, so hopefully by now I’ve convinced you to use your judgement when deciding to take or give someone medication to bring their non-serious fever down. Now you’re probably asking:
So what should I do instead?
In short: help your fever along while making yourself more comfortable
Just to reiterate here real quick: while the fever itself is not an illness, that doesn’t mean that we should just let a fever run without discovering WHY the person has a fever. The CAUSE of the fever should always be investigated and addressed - a fever resulting from a viral infection needs to be handled VERY DIFFERENTLY than one resulting from peritonitis. If you come to me with a fever resulting from a ruptured appendix, I’m not going to give you yarrow, I’m going to give you a ride to the hospital.
A feverish person should be made as comfortable as possible. Sometimes that means treating the fever with NSAIDS! But a lot of the time it doesn’t, and there are other ways to make the person more comfortable. And know this as well: treating a fever probably won’t bring temperature back to normal, but rather will bring their temperature down 2 or 3 degrees (1-1.5 degrees celsius). When the medication wears off, the fever will return for the 2-3 days it usually lasts for viral infections.
So, after you tuck yourself into bed to binge-watch that Tiger show and cancel all your commitments, what can you do to help support your fever and get it gone as soon as humanly possible?
Drink water! Take measures against dehydration
The old adage of “feed a cold, starve a fever” is complete horse shit and downright harmful. Your body has just cranked up the thermostat, burning more fuel in order to keep your core temp elevated, and that means you may be hungry. If you are, feed yourself! It will help.
The biggest thing, however, is to hydrate, hydrate, hydrate! Those with fevers (especially children) need to be encouraged to drink extra fluids - water, juice, coconut water, Pedialyte. Don’t pump them full of sugary drinks, but some watered-down juice is a-okay. Since fevers cause the body to lose fluids through sweating and breathing, we want to be on the lookout for, and guarding against, dehydration.
Herbally, “diaphoretics” and “demulcents” are your best fever allies
If you have studied herbalism for any extended period of time, you’ve probably noticed a strong overarching theme to how a skilled herbalist utilizes the medicines at her disposal: she uses them to support the proper functioning of this or that body system. Now, yes, symptom control (pain relief, bringing the swelling down, etc) are often part of the larger mosaic of an herbal protocol, but the priority is always to address the root cause and help beneficial processes of healing to do their job. This is the idea behind fever as well, and can be summed up thusly (if you remember NOTHING else from reading this article, remember this): your mission is to help the fever do its thing while making yourself as comfortable as possible.
How do herbs help you do that? Well, that’s where it gets a bit more complicated, because “helping the fever along” can mean one or a combination of several different things, but it most always involves a category of herbs called “diaphoretics.” Diaphoretics come in several flavors, which we’ll discuss in more detail in a second, but the short version is that diaphoretics have long been used to address colds, flus and fevers by helping to direct the circulation in a certain way and/or to help “ventilate” a fever by encouraging sweating (thank you to the ever-helpful jim mcdonald of herbcraft.org for this language and for his extensive write-ups on fevers and other topics). You must look at how the person’s fever is presenting, and do what is indicated to elicit a robust febrile response, all while mitigating discomfort.
Sometimes that means stoking the fire with stimulating diaphoretics. These herbs drive circulation outwards towards the periphery, by quite literally, getting your blood pumping. Many of these are spices - ginger, cayenne, cardamom, cinnamon, pepper. Think of a time you accidentally ordered the spicy version at an Indian or Mexican restaurant and found yourself hot, sweat-stained and out of breath by the end of the meal. That’s what stimulating diaphoretics feel like. People whose fevers can’t seem to get started or who feel cold and clammy at their onset benefit from the use of this type of diaphoretic, but you must be careful, as these warming herbs can also be very drying (see below).
Sometimes it means opening the peripheral blood vessels to encourage the person to sweat using relaxing diaphoretics. You know when you get a fever, and you realize that your muscles are all locked up from shivering, and you’re holding a ton of tension all over? That tension is inhibiting you from getting a good sweat on, and from getting good blood blow out to the periphery. Relaxing diaphoretics to the rescue. Think peppermint, spearmint, elderflower and, the ultimate remedy for all us stiff-necked overachieving list-makers out there who are so type-A we can’t even relax enough to sweat, *blue vervain*. Use her with more caution than you’d use with peppermint or elderflower, as she’s also an emetic in large doses (take too much and you’ll throw up).
Most times, using herbs for fevers means applying moistening remedies to keep the tissues from drying out. In addition to keeping fluid intake high, that means DEMULCENTS. All the demulcents, all the time. Since the person’s core temp is being temporarily elevated, we need to take extra care to coat and soothe any mucous membranes or other tissues (think dry, cracked lips) that may be at risk of drying out. Why do we care if our mucous membranes dry out while we have a respiratory infection? See my article on staying healthy during COVID19 for an explanation of what demulcents are and examples of easy-to-find demulcent plants and foods (and a delicious recipe for demulcent oatmeal courtesy of the Eclectic School of Herbal Medicine).
The most skillful and effective way to make use of demulcents and diaphoretics is to combine them into a tea formula, so you get the benefit of a well-stoked fire combined with “opening the windows” to the periphery (thanks again for the metaphors, jim) while also not drying the person’s mucous membranes out with all that fire-stoking and sweating.
But Alyssa, how do I know which herbs I should take to help me sweat out the fever?
Well, it depends (I know, I hate it when people say that…but it’s true. Damn you, nuance.).
Which herbs are best for you depends on a complex weave of factors, so seeking the advice of a clinical herbalist is best.
When people hear I’m an herbalist, their next question is often, “oh cool! So, what herb should I take for [insert health condition here]?” I’m not hating on that, I’m thrilled they’re interested in calling on plant medicine to cure what ails them. However, as with many aspects of herbal care (or any healthcare, for that matter), it’s rarely a question of “plug-and-play.” Which plant (or combination of plants) you need depends not only on the nature of the issue itself, but also on your constitution and the presentation of the affliction (i.e., how it’s showing up in YOU individually). There isn’t a blog post in the world with the scope to equip you with all the information you need about herbal energetics to choose the right herb in any given scenario. That’s what professional herbalists are for, whether they be multigenerational folk herbalists, European phytotherapists, TCM practitioners, or myself. I’d be happy to help you figure out which herbs would be best to help your fever along and keep you comfy - I’m available during this time for 30-minute tele-health appointments for fevers, coughs, colds, etc. A free 2 oz tincture is included with the cost of your appointment, btw.
As I’ve said before, it’s not the fever you need to worry about, it’s the CAUSE of the fever you need to investigate. A fever could be a viral infection you can breeze through, or it could be more serious. Pay attention to the other symptoms, and if they point towards something that needs a hospital or tell you that your immune system is not coping well with fighting off a virus (COVID19 or otherwise), please don’t hesitate to get the help you need.
If you have a fever plus any of the following, you need to seek medical attention right away:
If your fever has been towards the high end (above 104-105°F depending on your baseline) for more than 4 days despite herbal or hydrotherapy treatments
dry cough with fever and difficulty breathing
shortness of breath at rest
chest pain
drastic changes in mental status such as sudden confusion, extreme sleepiness or inability to waken
blue lips or face
severe sore throat with a muffled voice (sometimes known as “hot-potato voice”) and/or feeling of airway being constricted or blocked
your respiratory infection came on rapidly and is accompanied by neck pain and trouble/discomfort/pain when you try to tilt your chin up
severe abdominal, low back, or genital pain