This is the first  in a series of home treatment of COVID-19 symptoms. Please click here for all of my COVID-19 articles. 

What can we do to treat COVID-19 at home? For me as a family doctor, this is really important because at this moment we still don’t have prescription antiviral treatment. So, I will do my best to tell you how to help at home, using evidence-based research and my 20 years of family doctor experience. Please share this on social media if you find it helpful, there are icons above and below this post to make it easier. My goal as usual is to empower people, give them some hope in dark times, make sure we all realize we have a lot more control over virus infections than we realize.

Let’s all relax for 10 breaths

First things first…close your eyes, take ten deep breaths. Envision the happiest place in your life. I mean it. Deep breathing, like in yoga, can reset your anxiety and recenter you immediately. I’m doing this a lot lately, this helps me to be calmer for my next patient, to be more present at the dinner table with my family, to steady me when I read the news.

OK, do we feel centered? Great. Let’s continue.

Your best treatment is super healthy food and rest.

I really must stress  right now that while some over the counter (OTC) meds are helpful for symptoms, healthy sleep and super healthy foods, plus not stressing out, are much more important than any OTC meds, because that’s what boosts your immune system and fights the virus. Zero OTC meds help you get better quicker, they only provide symptom relief. You will get better quicker if you eat amazingly healthy inflammatory foods, stay hydrated (SPORTS DRINKS  DO NOT COUNT!), and keep your stress hormones down by trying to stay positive. This is bedrock stuff in every infection. Please read my post last week for more specifics.

Treating the fever…or not?

The main symptoms of COVID-19 are fever, cough, fatigue, and shortness of breath. The last of course is the most concerning, but let’s focus on the others, starting with fevers.

First, I must mention that you do not have to treat a fever! One of my golden rules: treat the patient, not the fever. You absolutely do not need to take medicine just because your thermometer reads 102. Fever is not a disease, it is healthy and natural, it actually helps your immune system to fight the virus. Treating a fever is only for your personal comfort, it does nothing to make the infection go away quicker. I actually think people focus way too much on the temperature reading, especially parents. Plenty of kids are running around just fine with a fever, there’s no need to stress them out every two hours checking their temp if they’re not acting uncomfortable. Same goes with yourself. When do I get worried? Certainly if  a temp is over 104 (40 Celsius) I am more concerned and I would want people to call their doctor for advice. But again it’s not just the number, it’s the overall clinical picture: if there’s no fever but a child is very lethargic, that concerns me. If there’s no fever but you are really short of breath, call your doctor or 911.

So now that we’ve said that, of course you should take medicines if you want to feel more comfortable or if your child is miserable. To treat fevers and pains, there remain the same three major OTC medicines for decades, across the world. Let’s list them in order of my preference to fight the COVID-19 fever:

Acetaminophen (brand name Tylenol). This is the American name; much of the world calls it paracetamol or Panadol. This is a terrific pain reliever for many, and is the safest choice for sure over the NSAIDs due to less risk of heart disease, less bleeding risk, and less kidney risk. Its main risk is to cause liver damage, so people with liver disease are always told to take less or none of this. At very high doses (over 4,000 mg a day) for a long time it can cause liver troubles. but otherwise when sick for a few days, this medicine is my top choice for everyone, at any age. For adults, the regular dose is 650 mg and  max dose is 1,000 mg, up to 4 times a day. The kid dose is always 10 mg/kg per dose (same as ibuprofen). BE VERY CAREFUL if you have acetaminophen AND combo syrups, as many syrups already include this ingredient, and it’s super easy to accidentally take too much. Check the labels carefully!

Ibuprofen (brand name Advil). This also is a great pain med, in many ways superior to acetaminophen because it’s also anti-inflammatory, on top of usual pain relief. It’s especially helpful for flu-like body aches and headaches. The usual dose is 400 mg (usually two 200 mg pills) up to four times a day, and for kids is the same as acetaminophen at 10 mg/kg per dose (follow the label dosing).

Ibuprofen is part of a class of medicines called Non-Steroidal Anti-Inflammatory Drugs (NSAIDs). There are a ton of prescription NSAIDs but the only other major OTC version is called naproxen (brand name Aleve). Naproxen is basically extended-release ibuprofen, only twice a day compared to ibuprofen’s 4 times a day max. For chronic pain, that makes naproxen a better choice, but I think generally stick with ibuprofen, it has less stomach side effects like the heartburn, especially if taken on an empty stomach or just before bed. If you’re taking these meds for a few days and feel nauseous and heartburn, it’s probably the side effect. Stopping or taking less of the NSAID helps, but if you must continue, you can add a heartburn pill like famotidine (Pepcid) twice a day or omeprazole (Prilosec) once a day.

Please note the potential confusion between these two NSAIDs: Aleve and Advil sound similar but are different meds, and many people confuse the two and mess up the doses — or worse, they accidentally take both at the same time, which is never a good idea! You’ll get no extra pain relief and will just burn a hole in your stomach — or worst, cause kidney failure.

You may have heard reports that ibuprofen isn’t so safe in COVID-19, but as of this writing that has zero evidence of proof. But that also just reinforces why most doctors and health groups recommend acetaminophen over ibuprofen as choice #1, especially with people over 65.

Aspirin. This is nature’s natural NSAID, found in willow bark leaves and patented as aspirin for over 100 years. It can be a very effective pain medicine, but there are some major side effects which limit this to a third-line choice. We never use this for children due to the rare but serious risk of Reye’s syndrome, a brain and liver disease most commonly when children and teens are taking aspirin for a flu or chicken pox. We also have to be careful in some elderly people, especially those who are on blood thinners such as coumadin/warfarin, as the combo could cause internal bleeding. (Ibuprofen also carries this bleeding risk with blood thinners, which again is why I prefer acetaminophen as our default choice).

Supplements. Let me just mention that supplements such as turmeric, SAM-e and  boswellia are impressive for chronic pain issues such as arthritis (as I blogged about here), but for short term relief it wouldn’t work. Stay tuned on this, as people are researching turmeric especially as a natural anti-inflammatory.

Combo Medicine

If you are really miserable, you can take an NSAID and acetaminophen together, as the synergy is very effective. If you do this, it’s best to do the lower doses of each, such as 400 mg ibuprofen with 650 mg acetaminophen. And only do this sparingly. Some people recommend alternating, I understand the concept and it’s fine if you find it useful. Generally, people already know which of the two works better for them.

My Bottom Line

COVID-19 infection is serious for many, of course, but 80% of infected people do just fine at home taking care of it, and after a few days they will be done and will be fine, with protective antibodies after that (for how long, we don’t know yet). So don’t freak out if your test comes back positive for COVID-19, treat it like you would the flu or a cold — just with more serious social isolation in the house. Keep your focus on immune system boosting, through amazingly healthy foods, rest, and stress relief.

I hoped I’ve helped empower and educate you, please share this, also follow me on Facebook at Bainbridge Baba Doc for more COVID-19 updates.

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