There were initially a lot of news coming out on the internet and social media that Ibuprofen [Nurofen] and related drugs such as Diclofenac [Voltarol] or Naproxen should be avoided in cases of infection with COVID-19. These are drugs belong to a group of Non-Steroidal Anti-inflammatory Drugs [NSAIDs].

Currently the initial concerns of increased risk of more severe symptoms of COVID-19 when Non-Steroidal Anti-inflammatory Drugs [NSAIDs] {like Ibuprofen} are taken have subsequently NOT BEEN confirmed (3).

There was initially confusion whether these warnings were fake news but highly respected medical journals initially also issued warnings:

Articles in highly rate medical journals such as BMJ {British Medical Journal} had also suggested there could be a link but in March 2020 these were only suspicions, case reports and expert opinions(1). There was no conclusive evidence and many had doubted that there is a link(2).

What is a sensible approach for now?

For viral infections in general:

Should I bring the temperature down? This is a good question and many think fever is dangerous and it comes with a risk of febrile convulsions. More and more doctors now believe that nature developed a fever as a body response for a purpose (7). If we reduce the fever our body may find it even harder to do its ‘job’ effectively. If your child has high fever >39°C and you are giving Paracetamol do not expect the temperature to be in the normal range [36.5-37.5°C] as it may still be between 38-39°C. As long as you child is not in discomfort or pain you may leave it at that.

So, what should we do?

In my experience, it is absolutely justifiable not to give Paracetamol or Ibuprofen if the fever is below 39°C as long as the child is not uncomfortable or in pain. We also know that we cannot prevent febrile convulsions with anti-pyretics (fever reducing medications) at the best of times. It is not well understood why, but the risk of a febrile convulsion stays the same with or without regular Paracetamol or Ibuprofen. 

However if your child is younger than 4-5 months you should see a doctor on the same day. Equally, you should seek urgent medical advice, if your child is unusually irritable, lethargic or uncomfortable, if your child has a fever over 39.5°C [103F], a fever for 4 days or longer or most importantly if you are worried.

You should avoid overwrapping a febrile child. You may use a tepid sponge bath or a wet flannel on the forehead or the calves. It is important not to use cold water but lukewarm water to moisten the flannels. But remember, a fever does not need to be lowered if it is mild.

I advise to use Paracetamol and add in Ibuprofen if needed if your child has no other reason not to use it:
(1) if your child is uncomfortable and
(2) if the fever is over 39°C [102.2F].

Your doctor may be able to advise if it is safe to give a little bit more Paracetamol than indicated on the bottle for a short while.

If you have given Paracetamol in the correct dose and you child has still a temperature over 39C or is in pain I would advise to give Ibuprofen. 

see: Information –> Information for Parents –> Infections –> Acute viral infection: What can I do?

Literature: