Balancing benefits and harms of fever

This is a non exhausting list of medical conditions where attempting to lower the temperature is most likely beneficial than detrimental. Discussion with your physicians is encouraged.

• Heart failure, especially if more advanced
• Atherosclerotic cardiovascular disease
• Febrile convulsion
• Epilepsy
• Predisposition to falling blood pressure when standing up (orthostatic hypotension)
• Postural Orthostatic Tachycardia Syndrome
• At risk of falls as a result of low blood pressure
• Poor health
• Regularly emerging problems when temperature has risen in the past.

In brief, Obstructive sleep apnea:
• Is a pro-inflammatory condition
• Facilitates aspiration pneumonias
• Facilitates blood clots
• Often targets older individuals
• Is often related to chronic conditions known to increase the chance of more severe infection leaving the individuals at a greater risk of a severe infection.

Because of lack of published literature, we are unable to state whether obstructive sleep apnea alters the risk of severe infection except among those with diabetes, but it is unlikely to be beneficial.

Treatment of obstructive sleep apnea decreases inflammation, notwithstanding other benefits, while serious complications arising from COVID-19 are linked to out of control pulmonary inflammation.

We are even further away from knowing whether treating obstructive sleep apnea may alter the risk of getting the infection; and whether we may improve the outcome. However, it is unlikely that putting an end to the treatment would benefit in anyway the patient himself.

On March 26, 2020; the sub-departmental committee of the Quebec’s Health and Social services, under the presidence of Dr Diane Poirier published its technical procedure guide with regards to hospitalized patients. It reads (free translation): " Patients with pathologies in need of chronic use of a CPAP or of a non invasive ventilation should have access to these essential therapies in spite of the pandemic. These patients should ideally be taken care of in negative pressure facilities independently of their COVID-19 status. Use of the device and wearing a mask is highly recommended. "

If you are already under treatment with CPAP, APAP, bi-level or home ventilator; be it for obstructive sleep apnea, central sleep apnea, obesity-hypoventilation syndrome, neuromuscular disease etc., you therefore shall ideally continue with your treatment even in a hospital environment in the event of a hospitalization, whether or not you are exhibiting signs of SARS-CoV-2.

Strict measures should be implemented to protect caregivers. Positive pressure therapy has the potential to contaminate the surrounding air (airborne transmission). When healthcare workers strictly always adhere to protective measures, the risk of developing the infection from patients with COVID-19 using CPAP or a ventilator is very low. The risk is much higher when taking care of yet undiagnosed COVID-19 cases without proper protection. Modifications to your device is a possibility, with a new exhaust set up, or a different device. You might be directed to a special unit with better engineering including outward air flow (negative pressure). If your condition is such that positive pressure therapy may be discontinued for a short period, the hospital doctor may judge there is more potential harm to the personnel of you using it than temporary harms to you from not using it. It is all based on clinical judgement.

Keep in mind that the balance of benefits and harms is not the same in the hospital environment where you have not shared the same space and air for several days compared to at home or even in the working environment that are close to a home environment where you might be sharing some eating and sleeping space for several days (firemen, military staff, agricultural workers, etc).

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