STOP THE TYLENOL!!!!!

We are in the midst of this season's COVID outbreak, and just coming off the latest seasonal RSV. Yes, it's highly odd to have an RSV outbreak in summer instead of winter months, but it is what it is. As a clinician, I'm treating scores of sick patients right now. I'm observing a commonality -- those who are trying to suppress a fever, particularly with Tylenol, tend to do much worse.

We have known for a couple of decades that acetaminophen (the generic active ingredient in Tylenol) can have some adverse effects on a body trying to overcome an infection. Acetaminophen is known to deplete glutathione, and acetaminophen has been shown to be a potential risk factor for poor outcomes with asthma. In recent times we have also dubbed a term called "fever phobia" for people who haven't yet learned that fever is a good thing. Yes, febrile seizures are still a concern, and yes fevers make us feel terrible, but fevers serve an important function for our immune system. And we NEED glutathione!

Let me say it loudly: ACETAMINOPHEN IS GENERALLY TERRIBLE TO TAKE WITH AN INFECTION!!!!!

Yes, I know hospitals give it like candy. Yes, I know many healthcare providers advise acetaminophen at the drop of a hat. All acetaminophen does is suppress a fever and reduce pain-- it won't help a cough, it won't help kill the infection, and acetaminophen has been found to prolong illnesses such as influenza by decreasing your body's immune system functioning.

Where COVID is concerned, unless your healthcare provider has specifically told you that you or your child should treat a fever, letting a fever run its course in COVID could be important for survival.

In the article cited for fever, the abstract lays it out clearly:

Fever works by causing more damage to pathogens and infected cells than it does to healthy cells in the body. During pandemic COVID-19, the benefits of allowing fever to occur probably outweigh its harms, for individuals and for the public at large.

I try to advise all my patients to let the fever work. When I had influenza for the first time a few years ago, I took my own advice. I'm the person who is laid out on the couch for a 99-degree fever. So I spent about 18 hours with an influenza fever over 102, moaning in agony, sleeping, and whining to my husband about how bad I felt. My knees hurt and my head hurt. Eventually, my fever broke. And you know what? I felt pretty good! My symptoms were nearly gone after that. When I had COVID last fall, I never took acetaminophen. In fact, I don't think we even own a bottle in our house. For my family, we take ibuprofen when we need it. I generally recommend ibuprofen over acetaminophen.

So remember, fever is good. It's a sign that your body is taking care of biz. And, as usual, never take medical advice from the internet. Have a conversation with your primary care on why he/she recommends Tylenol. This blog is not to replace medical advice from your primary care.