Amusing COVID-19 patients to death with fever suppressing drugs

19 April, 2021

Look up any collection of witticisms penned by the French Enlightenment writer, historian and philosopher Voltaire, and you will find this gem:

“The art of medicine consists in amusing the patient while nature cures the disease.”

Sadly for fan’s of Voltaire’s rapier wit, the attribution is probably false – there are several earlier versions of the quote. That in itself speaks to the dubious regard in which medical doctors were held throughout the eighteenth century.

In Voltaire’s day, the ‘amusements’ employed by doctors included cupping, blood letting, purging with powerful herbs, and massive, often fatal, doses of mercury. It’s a testimony to the curative power of nature that any patients survived their doctors’ ministrations.

But is modern medical practice, for all of its pretensions to ‘following the science’, really any less misdirected than this eighteenth century voodoo medicine?

According to Stephen A Hoption Cann, Clinical Professor at the School of Population & Public Health, University of British Columbia in Vancouver, Canada, when it comes to the treatment of fever, twenty first century medicine is as irrational as eighteenth century medicine. And this irrational form of medical ‘amusement’ is potentially deadly.

In an article published in April 2021, titled ‘Fever: Could A Cardinal Sign of COVID-19 Infection Reduce Mortality?’ Cann points out that fever is “a highly conserved physiological response to infection that occurs in all mammal and bird species”.

Coldblooded animals such as reptiles, amphibians, fish and insects evolved too early to benefit from this gift of nature. Lacking the ability to internally raise their body temperature, when they become infected with viruses or bacteria, they instead seek out warmer environments to simulate the febrile response.

Furthermore, while young warm-blooded animals – including humans – throw robust fevers as a rapid response to infection, older animals have difficulty mounting adequate fever responses.

Non-human animals have no desire to be amused by doctors when ill, which allows their instinctive drives to kick in. Cann cites an experiment in which both young and old rats were injected with bacterial lipopolyasccharide (LPS), a component of bacterial cell walls which triggers a defensive response by the immune system.

The rats were then placed in a thermal gradient – a long enclosure in which the floor temperature ranged from 10°C at one end, to 40°C at the other. Very soon after being injected with LPS, the young rats all threw impressive fevers, which subsided quite rapidly after their immune systems cleared the bacterial toxin.

The old rats’ responses ranged from low fever, to no fever, to a drop in core temperature. But when placed in the thermal gradient, they all spontaneously moved to warmer positions than the young rats. The old rats leveraged the external warmth to eventually achieve a similar febrile response as their younger counterparts were able to produce under their own steam. In other words, old rats were guided by nature to work smarter, rather than harder, in order to receive the benefits of fever.

Fever is metabolically costly: 1°C of rise in temperature may require a 13% increase in metabolic rate. Nature would long since have discarded this energy-expensive physiological response unless it served a useful purpose; as the American painter William Morris Hunt astutely observed,

“Nature is economical. She puts her lights and darks only where she needs them.”

Fever, as Cann points out, puts bacteria and viruses at a thermal disadvantage. For starters, the replication of many types of infectious bug is inhibited at higher temperatures. Lower replication rates mean less opportunities to establish an infection in their unwilling host.

Furthermore, an arsenal of cytokines and interferons – potent compounds produced by the innate immune system – is unleashed by fever, bombarding the invading bug with chemical warfare.

Studies on both humans and non-human animals have repeatedly shown that both reducing ambient temperature (e.g. the air-conditioned cool temperatures typical of hospital environments) and suppressing infected individuals’ fever with antipyretic agents (e.g. aspirin, paracetamol [Panadol] and ibuprofen [Nurofen]) lead to increased sickness and death.

Thwarting the fever response leads to:

• Increased viral replication
• Higher viral titres (quantity of virus in a given volume of fluid such as sputum or blood plasma)
• Greater viral shedding (expulsion and release of virus progeny from the infected host) and therefore higher infectiousness
• Reduced immune responses
• Increased duration of illness
• Higher rate of complications (e.g. bronchitis, laryngitis, pneumonia)
• Reduced survival rate of infected individuals.

None of this information on the benefits of fevers, and the harms that result from their suppression, is new. The seminal studies on these benefits and harms date back to the 1940s, 50s and 60s.

Moreover, as Cann points out, physicians of ancient times recognised the beneficial effects of fevers, and sought to provide supportive care for the febrile patient rather than aggressive suppression of nature’s cure for infection.

For example, the Roman medical historian Aulus Cornelius Celsus (c. 25 BC−50 AD), in his medical text De Medicina, discussed the three key ‘F’s’ in the management of acute diseases: fever, fluid and food.

Fever

Fever, Celsus cautioned, should never be suppressed. Instead, the febrile patient should be covered with ample warm bed-clothes to conserve the energy their body would otherwise be obliged to expend in shivering, which is a temperature-raising mechanism. Once the infection is overcome and the fever breaks, covers should be removed and the person should be allowed to cool down naturally through the temperature-lowering mechanism of sweating.

Fortunately, observation of patients in the pre-antibiotic era clearly demonstrates that rationally supported fevers almost never reach a level at which they endanger the infected individual’s health. Nature is not stupid, although humans – who fancy themselves as inhabiting the very top of the evolutionary tree – frequently are.

Parents often worry that their child may suffer a febrile convulsion if his or her temperature goes ‘too high’. As Cann points out, it has been known for decades that febrile seizures are almost always benign, and there is next to no risk that a child who experiences a febrile seizure will go on to develop epilepsy.

Furthermore, there is no evidence that antipyretics (paracetamol/acetaminophen, diclofenac, or ibuprofen) prevent febrile convulsions, and some may increase the risk of convulsions by reducing urine output.

Fluid

Contrary to popular opinion and medical advice, providing extra fluids to a person battling a viral or bacterial respiratory infection is counterproductive, and potentially lethal.

As the infection-fighting mechanisms that nature equips us with kick in, hormonal changes are triggered that result in fluid conservation. Pushing fluids into our bodies at this time increases the risk of hyponatraemia (low blood sodium levels), which is associated with worse outcomes of infection, and the pooling of fluid in the lungs, which impairs breathing.

Again, Celsus indicates that ancient physicians were way ahead of us:

“There is sufficient agreement that for all who are feverish an excess of fluid is unsuitable”.

De Medicina

Cann points out that COVID-19 treatment guidelines recommend paracetamol/acetaminophen as the first line antipyretic to counteract fever in patients with COVID-19. Yet this drug is known to reduce blood pressure, which in a hospital setting is frequently countered with fluids (given orally and/or intravenously) and/or blood pressure-raising drugs. The resulting flurry of tail-chasing medical activity might be amusing if its results were not so detrimental to patients’ health, and even their chances of survival:

“Thus, a vicious cycle ensues as we desperately work against the normal physiology of the body to maintain blood pressure, but as total body water stores increase, oxygenation in the lungs then becomes compromised, inducing unnecessary harm.”

Fever: Could A Cardinal Sign of COVID-19 Infection Reduce Mortality?

Food

Pet parents have long observed that a sick dog or cat will stop eating, often for many days, and seek a warm place to rest while nature’s curative mechanisms take their course. Young children exhibit the same behaviour, often to their parents’ alarm. As it turns out, the instincts of non-human animals and children demonstrate far greater innate intelligence than the supposed wisdom of adults – including those subjected to medical ‘education’.

Celsus noted that sick adults who either ate lightly or abstained from food entirely during their illness, suffered less and recovered faster than those who continued to eat their accustomed amount of food.

His astute observations are confirmed by scientific research. The gastrointestinal tract is effectively shut down during infection, with both secretion of digestive fluids and motility (movement of food and waste through the digestive tract) grinding to a halt as the fever mechanism kicks in.

This shutdown conserves substantial energy, which can then be redirected to fighting off the infection. When we thwart this energy conservation mechanism by continuing to eat while acutely ill, not only will we take longer to recover, but our risk of complications is heightened.

As Cann notes,

“Overfeeding or hyperalimentation in intensive care has been associated with hyperglycemia, fatty liver, sepsis, and increased inflammation and mortality.”

Fever: Could A Cardinal Sign of COVID-19 Infection Reduce Mortality?

“COVID-19 death” or iatrogenic death?

With the death toll attributed to COVID-19 now nearing 3 million, it’s time to ask ourselves how many people are truly dying of SARS-CoV-2 infection, and how many are dying from the medical treatments they are receiving – the phenomenon known as iatrogenic, or doctor-induced, death.

As Cann points out, current treatment guidelines for those diagnosed with SARS-CoV-2 infection or COVID-19 advise liberal use of antipyretics as soon as fever appears.

Particularly in elderly and/or metabolically unhealthy individuals, this irrational, non-evidence based advice often sets in motion an ominous chain of events: worsening illness, hospitalisation, further aggressive use of medications which leads to development of complications for which even more medication is prescribed, sometimes resulting in intubation which requires prolonged sedation and carries a high risk of either permanent lung damage or death.

Cann quotes T.C. Brackeen, who stated during the 1918 flu pandemic,

“In the future we will look back on this epidemic of influenza with wonder and surprise; yes, in spite of our vaunted advancement, we have utterly failed in the recent crisis.”

Spanish Influenza

Over one hundred years later, medicine is still failing. One of the reasons for this failure was identified by Brackeen in 1918:

“The cause of this failure of the medical profession is our ignorance of preventive medicine. Our medical schools have taught diagnosis and treatment, but not prevention of disease.”

Spanish Influenza

The other is perceptively articulated by Cann: rather than understanding, respecting and supporting our natural barriers to infection – especially our evolutionarily conserved fever response – modern medicine thwarts them at every turn.

The full impact of this catastrophic mismanagement has not yet been quantified, because very few doctors have the independence of mind to question established medical practices, such as fever suppression, and to design studies that test the outcomes of fever suppression vs thermal support of fevers.

I would not advise waiting until Cann’s advice to seize the opportunity presented by COVID-19 to study the role of fever in overcoming SARS-CoV-2 infection is heeded; I strongly suspect that hell will freeze over first.

Rather than allowing ourselves to be amused to death by non-evidence-based medical treatments, it’s up to us to take responsibility for our own health. Our ancient ancestors acknowledged the inherent wisdom of natural processes. Instead of seeking cures for our symptoms, we need to recognise, as they did, that the symptoms are the cure.

Fever, and the accompanying loss of appetite, thirst and energy, are your body’s intelligent response to infection. Exercise your own intelligence by obeying these internal cues: if you develop symptoms of respiratory infection, you should lie down, keep yourself warm until the fever breaks, abstain from food, drink only enough water to satisfy your thirst… and avoid fever-suppressing medication like the plague that it is.

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