Staying at home but still having a fever?

What Tests Can I Do For My Fever?

A DTAP Stay Home Series Part 3

We touched on the COVID19 situation and the active steps one can take to minimize and prevent infection risks on our past two articles.

Furthermore in our last article we also delved deeper into some of the situations one may face whilst at home, running out of needed medications or even repeated sneezing and scaring away every around. 

But wait, I don’t need further medications, I don’t need to get my sneezing checked but I have this fever which I am worried about. What should I do doc? 

Fever is one of the classic symptoms of one’s body responding to an infection. It is a signal that the immune system is reacting to a foreign invader. These foreign invaders can be anything from the seasonal Influenza Viruses, upper respiratory tract bacterial infections, Dengue fever, the dreaded COVID19 virus or even worse, the most feared HIV virus.

Before we get carried away, let’s explore the facts behind each of these concerns and hopefully we can provide you a handle on how to get these concerns further addressed. From the recapitulation of COVID19, to upper respiratory tract infections and last but not least prolonged fever from possible HIV. 


Let’s start with a short recap of COVID 19, from the WHO-China joint COVID 19 mission, it was studied that those who are at great risk of severe disease and death include those above 60, those with underlying chronic conditions. And of course as previously discussed, the risks of COVID19 include travel to at risk countries including China, especially Wuhan and Hubei provinces, South Korea, Iran and Northern Italy as of March 2020.

Practically the same advice shared previously of personal hygiene and avoidance of crowded places and even ordering in the medications you need delivered to your home would still stand.


Upper Respiratory Tract Infections 

Secondly if it were an upper respiratory tract infection caused by other viruses or bacteria, it would be good to have your doctor assess you especially if there are symptoms of fever, cough, sore throat or runny nose. In the current climate, these symptoms would warrant one to get extended rest at home with a doctor’s note (medical certificate) for at least 5 days. When we get an infection in the upper respiratory tract – nasal passages or throat, it is usually caused by either a bacteria or virus.


A cold is a viral infection of our respiratory tract, and there are more than 200 types of viruses which can cause this. It is also a gradual Onset.


Sudden onset. Contagious after coming into contact with droplets. The FLU virus can cause a lung infection called pneumonia.

So doc, i’ve heard alot about antibiotics as well, can I just get them prescribed to me for my fever?

Antibiotics however only work against bacteria infections.

Instead of taking too many unnecessary medications, you can get tested to see if you have the flu or a bacterial infection.

Point of care testing is convenient, accurate and gives you an answer in 15mins. Furthermore for those at risk or diagnosed with Influenza (above 60 or have chronic diseases) – antivirals can be prescribed. These include XOFLUZA (a one off treatment) or TAMIFLU and lastly if it is likely a cold, vitamin C and zinc are shown to aid in recovery.

And last but not least, especially for those at risk, please do not forget your twice yearly flu vaccinations (Northern and Southern hemisphere strains respectively) and 2 different jabs for a lifetime protection against Pneumonia.

Fever from HIV

But that being said, what happens then if one’s fever is still persistent and there were concerns from a recent sexual exposure? Especially if it was a causal partner and or someone you met overseas?

The CDC page tells us that HIV is spread when anal or vaginal sex, without a condom occurs with someone who has HIV. The other way HIV is spread is through the sharing of needles or syringes, or even equipment used to prepare drugs for injection with someone who has HIV. Some studies have shown that HIV can survive in a used needle for up to 42 days depending on environmental factors. Temperature etc.

In rarer cases, HIV can be spread through oral sex.

The main transmission medium of HIV however is through fluids and these are predominantly blood, vaginal fluid, semen and even saliva. Here are some statistics from medical studies that have been done. And as you can see, needle sharing, needle use has the highest risk followed by anal intercourse.

Ultimately all these statistics mean nothing, if the concern is still there and there is an exposure, the best thing to do for an ease of mind would be to speak to your doctors and decide whether the Rapid HIV test is something necessary for you.

In summary, there are many causes of fever. In the current climate, fever persisting for more than 5 days can be worrisome. And common things being common, in the absence of a travel history, it is most likely due to an upper respiratory tract infection arising from a cold, influenza or even bacteria. The likelihood of COVID19 is low, but one must also keep a suspicion for infections such as dengue and in the rarest of events HIV. Seeing a doctor early would help you get some point of care tests done with results almost immediately to guide your clinical care and most importantly give you a peace of mind.

Take care, stay safe.

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  • References
  • Boily MC et al. Heterosexual risk of HIV-1 infection per sexual act: systematic review and meta-analysis of observational studies. Lancet Infect Dis 9(2): 118-129, 2009
  • Vittinghoff E et al. Per-contact risk of human immunodeficiency virus transmission between male sexual partners. American Journal of Epidemiology 150: 306-311, 1999
  • Del Romero J et al. Evaluating the risk of HIV transmission through unprotected orogenital sex. AIDS 16(9): 1296-1297, 2002
  • Townsend C et al. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000-2006. AIDS 22: 973-981, 2008
  • Baggaley RF et al. Risk of HIV-1 transmission for parenteral exposure and blood transfusion. AIDS 20: 805-812, 2006

Coronavirus, Cold Or The Flu?

How do you tell if you have the Coronavirus, cold or the flu?

It is very difficult to tell the difference between the coronavirus, cold and the flu clinically as the symptoms of all three infections can be quite similar.

Some of the symptoms include:

  • Fever
  • Chills
  • Respiratory symptoms e.g. (cough, sore throat, nasal obstruction/discharge and breathlessness)
  • Body aches
  • Headaches
  • Lethargy 
  • Loss of appetite

As symptoms can range from mild to severe, do not try to diagnose yourself. If you are unwell, please seek medical attention immediately.

As of now, in Singapore, the Ministry of Health has defined what the criterion for a suspect case is, and primary care doctors are using these criteria to send patients to hospital for further management. If you have symptoms described above, and have been to mainland China in the past 14 days, or had frequent or close contact with recent travellers from mainland China, please seek medical attention and your doctor can decide if you should be sent for further testing. 

There have been cases of nCoV with barely any/mild symptoms. Because of this, it is unwise to generalize and say definitively that the nCoV will have this symptoms and the common cold will not. However, the common cold is much less likely to result in death as compared to nCoV. Influenza, on the other hand, can result in death from complications as well.


What are the common symptoms of the Coronavirus and how long before one will start showing symptoms of the Coronavirus?

Common symptoms noted for 2019-nCoV infection include fever, cough and shortness of breath. Other common symptoms noted in coronavirus infections include runny nose, sore throat, headache and malaise. Some less typical symptoms can include diarrhoea, nausea, chest pain, and vomiting. The median duration for the incubation period is about 3 days. The incubation period can range from as little as 2 days to as long as 24 days in rare cases.

Please speak to your doctor if you are feeling unwell.


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Boosting Your Immunity

Our Immune System

Our immune system is our body’s defence against disease-causing microorganisms like bacteria, viruses, fungus, and parasites found in the environment. It is essential for our survival. Without an immune system, our bodies will be open to attack, and falling sick might turn out to be a deadly event. 

The idea of boosting our immunity is familiar to everyone. Your parents might have given you some advice, and the forums on the internet might have provided you with some information – yet the answer to the question of how one is able to boost his immunity still seems elusive. The immune system is extremely complex, and is made out of many parts interacting with each other.

To-date, we still do not fully understand all the parts of the immune system function exactly, but to function well, the immune system requires balance. While there is no scientifically proven link between lifestyle and an enhanced immune function, researchers are at present exploring the effects of diet, exercise, age, psychological stress, and other factors on the immune response. As such, until there is a breakthrough in the research on the immune system, general healthy-living strategies are a good way to start giving your immune system the upper hand.

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Does having a balanced diet help in boosting immunity?

A classification called The NOVA food classification system categorizes food into 4 categories – unprocessed and minimally processed foods, processed culinary ingredients, processed foods and ultra-processed foods. It is known that processed and ultra processed foods, when consumed regularly, are unhealthy for you. They have been linked to conditions such as metabolic syndrome, heart attacks, strokes, early death and even cancer. Processed foods are typically high in calories, salt, sugar, and fat which we all know are not good for you.

Our bodies were evolved to consume unprocessed foods such as vegetables, fruits, whole grains, seeds, nuts and unprocessed meats. We were not designed to regularly eat foods processed in a laboratory that can last 5 years sitting on a shelf. 

It would be ideal if everyone tries to move one’s diet towards less processed foods. While this will definitely require you to invest more time in meal preparations and planning, it is the best way to inject quality nutrition in our lives. Quality nutrition is made up more than just the calories – the macronutrients, vitamins and minerals all contribute to good health and thus a healthy immune system.

Having a varied and balanced diet ensures our body stays healthy and strong.

Does insufficient protein intake directly affect our body’s self-repair and immunity system?

The repair of cells in our body requires protein synthesis which in turn requires us to ingest dietary protein, be it from animal or plant sources. Insufficient protein intake over an extended period of time can cause changes in body composition such as reduced muscle mass, strength and function. Protein and amino acid deficiency has also been linked to repression of the immune system. 

How much protein should we have daily? What are the foods rich in proteins that we should consume?

The recommended amount of protein daily is about 0.8 grams of protein per kilogram of body weight. This amounts to: 56 grams per day for the average sedentary man. 46 grams per day for the average sedentary woman. That is about 200g of meat or about 300g of soybeans.

Some protein rich food include lean meat, poultry and fish, eggs, dairy products like milk, yoghurt and cheese, seeds and nuts, beans and legumes (such as lentils and chickpeas) and soy products like tofu. It is always advisable to get your protein intake from a variety of sources, and the preparation of these proteins should preferably involve less frying. 

Does consuming 5 to 7 servings of fruits and vegetables of various different colours per day: especially red, orange or yellow vegetables, which contain a large amount of beta-carotene, which will be converted into vitamin A that play a critical role in enhancing immune function?

It is always advisable to increase your intake of fruits and vegetables, and the less processing they have undergone, the better. Beta carotene is a red-orange pigment found in plants and fruits, especially carrots and colourful vegetables. Many epidemiological studies have shown an association between diets rich in carotenoids and a reduced incidence of many forms of cancer, and it has been suggested that the antioxidant properties of these compounds are a causative factor.

Since the immune system plays a major role in cancer prevention, it has been suggested that beta-carotene may enhance immune cell function. The theory is that beta-carotene is converted to vitamin A, an essential nutrient, which has antioxidant activity, and helps to protect cells from damage. It is recommended that people get beta-carotene and other antioxidants from food instead of supplements, at least until research finds out whether supplements offer the same benefits. Eating 5 servings of fruits and vegetables daily provides 6-8 mg of beta-carotene.

Is drinking 8 glasses of water a day the standard recommendation to maintain a healthy immune system? Should the amount of water drunk be determined by age or daily activity?

Studies have produced varying recommendations over the years. But your individual water needs depend on many factors, including your health, how active you are and where you live. You’ve probably heard the advice to drink eight 8-ounce glasses of water a day. That’s easy to remember, and it’s a reasonable goal but it is rather arbitrary. Other health professionals recommend drinking till your urine is colourless or a light yellow.

Most healthy people can stay hydrated by drinking water and other fluids whenever they feel thirsty. For some people, fewer than eight glasses a day might be enough. But other people might need more. For the majority of people, there probably isn’t any need to worry about water intake. The thirst instinct is very reliable and it is safe to recommend drinking just beyond the point of thirst. 

There is no best way to stay hydrated. Hydration can even come from foods such fruits, vegetables or soups. However, plain water seems to be the cheapest and most direct way to stay well hydrated. Beware of sports drinks, isotonic drinks and energy drinks though – they may contain more sugar than you might otherwise need to stay hydrated. Whether or not you want to add a slice or lemon or some herbs to your water is purely a personal preference. 

It is important to have a well balanced, varied diet that encompasses many different types of food. The idea that a particular food is linked to a particular benefit is more in line with Traditional Chinese Medicine. However, Western Medicine is indeed catching up to this idea, as more chemical compounds are being found in various foods that may indeed help boost immunity and can be beneficial for the body. 


Mushrooms contain polysaccharides that can regulate and improve the immune function.

Mushrooms do indeed have high levels of polysaccharides (specifically Beta-glucans) contained within their cell walls. This class of therapeutically active compounds are widespread within the mushroom kingdom, and within our bodies they interact with specific polysaccharide receptors on our immune cells, possibly modulating and regulating our immune response. Mushrooms also are low in fat, highly nutritious, high in antioxidants and are very tasty!

Garlic and ginger: studies have found that garlic can be used as a powerful antioxidant and antibiotic which can help in combating viruses and it can also shorten the time when having a cold. Ginger can warm the stomach and relieve the cold as well.

Ginger and garlic have both been used for millennia in cooking preparations all around the world, and both are high in bioactive compounds which have anti-inflammatory and antioxidant effects. Scientists are still studying the many biochemical compounds and metabolites of ginger and garlic and their properties. While no studies have proven directly that they can shorten a cold, many people do report feeling symptomatically better after drinking ginger teas or garlic preparations. 

Fermented food: Due to their high probiotic content, fermented foods can give your immune system a boost and reduce your risk of infections like the common cold.

The bacteria that live in your gut have a significant impact on your immune system. Due to their high probiotic content, fermented foods can give your immune system a boost by activating various receptors of cells with certain proteins that spur the immune system into action. Fermented foods are eaten all over the world and include foods like Yoghurts, Cheeses, Kefir, Sauerkraut, Tempeh, Natto, Kombucha, Miso and Kimchi. 

Lotus root is rich in vitamin C polyphenols and dietary fiber, it goes a long way towards improving and strengthening the immune system.

Lotus root has been a part of the cuisines of numerous Asian countries for thousands of years. Lotus roots are indeed rich in vitamin C. Vitamin C is a potent antioxidant and a cofactor for a family of biosynthetic and gene regulatory enzymes. Vitamin C contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. Lotus root is also rich in dietary fibre, which contributes to healthy bowel habits and in turn, a healthy gut microbiome which aids in innate immunity. 

In conclusion..

It is important to have a well balanced, varied diet that encompasses many different types of food. Eat different types of vegetables and fruits and experiment with different recipes from various cultures. That way, you can experience and enjoy these foods in many different ways and flavours. 

Lifestyle tips

Exercise helps in boosting immunity! What examples of exercises are recommended for this period with danger of getting coronavirus?

Exercise improves your overall fitness, and acute exercise has been shown to be an immune system adjuvant that improves defense activity and metabolic health. Various studies support a clear inverse relationship between moderate exercise training and illness risk. Exercise training has an anti-inflammatory influence mediated through multiple pathways. However, too much exercise is also a stressor on the body, and overly intensive training has been linked with a higher illness risk. 

The novel coronavirus has been shown to be capable of community spread and some people are choosing to limit their exposure by avoiding crowded public places. Some activities that you can do at home include weights training, body weight exercises and aerobic activities like skipping or jumping. 

Emotional stress also has a detrimental effect on our immunity.

Maintaining a positive mood can enhance the immune system and having good stress relieving methods helps in improving our immunity as well. Researchers have found a wealth of evidence that positive emotions can enhance the immune system, while negative emotions can suppress it.

Scientists don’t yet fully understand the biological mechanisms at work, but they know that negative feelings like stress, sadness, and worry cause a spike stress hormones including adrenaline and cortisol, which in turn suppresses the immune system. Stress also can over activate the immune system, resulting in an increased risk of autoimmune diseases such as arthritis and multiple sclerosis. Skin conditions such as psoriasis, eczema, hives and acne also may worsen, and stress can trigger asthma attacks. 

Some simple ways you can relieve stress include exercising, relaxing by yourself, spending time with friends and family, doing the things you like to do and getting adequate rest and sleep. 

Sleep & Immunity

The lack of sleep can affect your immune system negatively. Sleep is the body’s way to repair itself and the immune system is essential in the restoration of cells. Studies show that people who don’t get quality sleep or enough sleep are more likely to get sick after being exposed to a virus, such as a common cold virus. Lack of sleep can also affect how fast you recover if you do get sick. During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you’re under stress.

Sleep deprivation may decrease production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don’t get enough sleep. The lack of sleep is not just associated with physical health problems, it is associated with mental health problems as well. 

Both quality and quantity of sleep are equally important, and sleep is important for all groups of people – from the young, to the old, and everyone in between. The problem with society today is that many of us are sleep deprived. This is something that our parents have been right all along, that sleep is essential for a healthy life. 

Vaccines for immunity strengthening?

A vaccine is a biological preparation that provides active acquired immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism and is often made from weakened or killed forms of the microbe, its toxins, or one of its surface proteins. When introduced to the body, the body sees the antigen as a foreign substance and develops the mechanisms needed to eliminate this threat. With these mechanisms, the body is able to fight off this infection in future easily should it be exposed to it again. 

Different vaccines have different dosing schedules and many have been given to us as part of the National Immunization Schedule. Some vaccines like the influenza vaccine have to be given every year, some vaccines like measles vaccine may only have to be given once in your lifetime. Speak to your doctor about what vaccines you require and what their dosing regimes are like.

In conclusion..

The most important thing to remember about immunity is maintaining a healthy and balanced life. This can be achieved with various lifestyle choices in diet and your day to day activities. During this time of concern with the Novel Coronavirus on everyone’s minds, it is important that we be socially responsible and try our best to be as healthy as we can be. Hopefully the above discussion can help in that. 

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