Fever: A misunderstood friend

Recently, a friend with a speech impairment gestured to convey that his son had a fever. He tapped his hands over the forehead and frowned. That was enough for me to understand what he was saying. I tried finding the correct gesture in sign language for fever and realised that he had just used it. The gesture is similar to numerous emojis meant to convey fever. This always makes me wonder. Foreheads are the coolest part of the body even when someone has a fever.

Despite being the coolest part of the body, the forehead temperature check was the most popular screening method to check for fever during the COVID-19 pandemic. This is probably because it is the most accessible part of the body. A showroom or shop with an appropriately dressed man (and very rarely a woman) with a temperature gun was meant to convey that it is a safe place that is following COVID-19 protocols. Once I was rushing to check in at an airport and I asked the person with a temperature gun if my temperature was OK. He responded, “You are very cold, sir!”

The forehead is the most exposed part of the body and when someone sweats, it can become cooler than the rest of the body. When temperature guns became popular for checking fever, many people questioned its safety. It was then said that these gadgets do not emit any rays but collect rays emitted by the body and convert it to an electric signal, which is then displayed as temperature. Some people objected to having a gun-like object pointed at their forehead. In response, the norm changed to checking temperature on the wrist, which is also said to be more accurate.

Coming back to the question of fever, it is defined as having a temperature above the normal range due to an increase in the body's temperature set point. The increase usually follows an infection. Like cough, fever is part of the body’s defence mechanism. Canadian Physician, and one of the founding professors of John Hopkins Hospital in the USA, Sir William Osler once declared, “Humanity has but three enemies; fever, famine, and war, of these by far the greatest, by far the most terrible, is fever.”

Fever was considered to be a disease in itself. It was much later that we learnt that fever is a manifestation of some disease usually an infection. It is not surprising that the symptom was mistaken for the disease as fever caused by infections has been a major cause of mortality in humans for over 200,000 years. Until the late 19th Century, approximately half of all humans were said to die from infections before the age of 15. Fever, as the most ancient hallmark of disease, dates back to a time before civilisation. By the 18th Century, fever was thought to be ‘a harmful by-product’ of infection. In the 16th Century, Italian Astronomer and Physicist Galileo Galilei invented the thermoscope, which was an equipment to measure changes in body temperature, including fever.

Fever has evolved as a defence mechanism. It is said to contribute to the host’s defence as the reproduction of pathogens can be hindered at higher temperatures. Fever has been described in various medical texts as assisting the healing process. Studies on various warm-blooded vertebrates suggest that they recover more rapidly from infections or critical illness when they develop a fever. Other studies suggest reduced mortality due to bacterial infections when fever is present.

Fever is a matter of great concern for parents and healthcare professionals, especially ones dealing with children’s health. This is because fever has been associated with dreaded outcomes in children. Doctors and parents often fear febrile convulsion (commonly called fever fit). However, we must remember that such convulsions have no correlation with the degree of fever and that not every child who has fever will develop a febrile convulsion.

Many people also develop fever after a vaccination. It is regarded as a good sign as it suggests that the body is reacting to the vaccine and developing the required antibodies to help the body’s immune system fight specific infections. Though many would argue that this fever does not need to be treated, very high fever must be controlled with antipyretics. A fever that is recurring after vaccination needs medical attention as it may be due to other causes.

Sponging is a popular method to reduce fever. While using such a method, it is important that we use lukewarm water or water at 35 degree Celsius to be precise. This is because cold water can cause closure of the vessels and hamper the transfer of heat from the core of the body where it is produced, to the skin, where it is lost. In other words, cold water will trap the heat inside the body. When the fever exceeds 38 degree Celsius, it is important to control it and avoid any further increase as it may lead to seizures. The sponge method is an effort to bring down the body’s temperature and provide comfort to the patient. Sponging is particularly important for infants and the elderly when they suffer from high fever, as they are more prone to such seizures. However, we must remember that sponging is not a treatment for fever. It only helps control body temperature.

Medications that lower fever are called antipyretics. As of 2019, studies correlating the use of antipyretics and the risk of death in those with infection have reported mixed results. In animal studies, worsened outcomes have been reported with the use of antipyretics in influenza as of 2010. However, such studies have not been carried out among humans. Already, there are different opinions among doctors on when to treat fever. Most fever guidelines advice treating fever above a certain degree only and they discourage the use of antipyretics in mild or even moderate fever. It is likely that the use of antipyretics to treat mild to moderate fever will be discouraged even more commonly in the future.

Fever can also be produced ‘artificially’ by a patient. This is done by artificially heating the thermometer or by self-administered pyrogenic substances. An artificial fever might be suspected if the pulse rate is significantly less than what would be expected for the degree of fever noted. One should consider this diagnosis for all patients when there is no other plausible explanation for a fever. Some patients who pretend to have fever may actually have a serious mental illness that may require medical attention.

On a lighter note, fever definitely needs more positive publicity. It does not help that it is often used to describe intense, nervous excitement as associated with sporting events, rock shows and political gatherings with terms such as cricket fever, music fever, and election fever. Perhaps a more appropriate word for these ‘symptoms’ is mania or collective madness. Unfortunately, no doctor can cure these ‘symptoms’!

By Dr Spalchen Gonbo

Dr Spalchen Gonbo is a Paediatrician based in Leh.

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