Fever is a common reaction of Covid-19 patients, but if prolonged, in addition to the SARS-CoV-2 virus, it can also be caused by other bacterial or viral infections.
The elderly, weak, have many underlying diseases, people who are taking immunosuppressive drugs, long-term corticosteroids (glomerulonephritis, lupus, polyarthritis, organ transplant…), cancer patients may have SARS-virus. CoV-2 multiplies strongly in the body but without fever. However, when a high fever makes the body tired due to dehydration, electrolyte loss, headache, insomnia, poor appetite, causing convulsions in children… it is necessary to reduce fever.
At this time, the patient needs to reduce fever with paracetamol, dose according to age. Basically, paracetamol is safe, but in a small number of people, it will cause liver toxicity and even liver failure. If the patient cannot take paracetamol, 200mg or 400mg ibuprofen can be used.
In addition to taking fever-reducing drugs as directed, patients need to replenish water and electrolytes to reduce fatigue. Electrolytes are mainly potassium, sodium and chlorine present in table salt. Currently, oresol, electrolyte supplements, coconut water, porridge, salted lemon… are common products.
Some cases of fever lasted until 6-7 days, even up to the 10th day of Covid-19 infection. Here, the fever can be caused by a virus or bacteria. There are 3 cases:
1. Fever caused by SARS-CoV-2
Patients need PCR test or rapid test. In case the Ct index is low or the test line (T) is bold, it means that the virus is still abundant and can continue to take antiretroviral drugs. In Vietnam at present, molnupiravir can be used according to the trial program (5 days) or favipiravir.
2. Fever due to bacterial infection
Ordinary people are prone to sore throats, tonsillitis, bronchitis … when infected with Covid are also susceptible to bacterial infections. However, identifying bacterial infections is not easy. If the patient still has a fever that doesn’t go away, a quick test of the T-line is blurred, and there’s no muscle and joint pain, it’s most likely a bacterial fever. At this time, it is necessary to consult a doctor to use antibiotics.
To be sure, a complete blood count is needed to see if the white blood cells are elevated. There are many types of white blood cells, when infected, the number of granulocytes or neutrophils will increase. A CPR test can also evaluate for an infection. In particular, there is a very good test to evaluate bacterial infection is procalcitonin (PCT). Even just based on the PCT index, it is possible to decide whether or not to use antibiotics, dosage and emergency situation.
The type of antibiotic to start using is usually a beta-lactam group (amoxicillin/clavulanic, ampicillin/sulbactam, ceforuxime, cefpodoxime, cefixime…). In adults, it is possible to combine a quinolone group (ciprofloxacine or levofloxacine, moxifloxacine), which should not be used in children because it affects the development of muscles and bones. In children, a combination of macrolides (erythromycin, azithromycin or clarithromycine) can be used, however, the combination of a bactericidal beta lactam and a bacteriostatic macrolide is not the optimal solution.
In addition, there are some other antiviral groups such as cyclin (tetracycline, doxycycline) and metronidazol…
Note, when the patient has taken antibiotics, it is necessary to use a strong enough dose, then the dose can be gradually reduced. Using antibiotics also damages the intestinal flora, so digestive enzymes must be supplemented. Besides, improper use of antibiotics can lead to drug resistance, patients need to be very careful.
3. Fever caused by other viral infections
This case manifests when the rapid test T line is blurred or not up, the test does not show infection. This is caused by infection with another virus, not SARS-CoV-2. At this time, patients often have a runny nose, muscle and joint pain, chills, fever like a common cold and must treat symptoms, wait until the fever is gone.
Patients can take Tamiflu or Arbidol in these cases, however, efficacy is uncertain. In addition to treating fever, patients still need to gargle with physiological saline and povidone iodin 1% or chlorhexidin gluconate 0.12-0.2%, measure SpO2 regularly to notify medical authorities promptly.
BS. Nguyen Huy Hoang
Vietnam – Russia High Pressure Oxygen Center