But after admitting he wasn't 100% on Friday on the back of suffering with illness this week, Tonali gave Howe the green light when Newcastle's head coach asked him whether he felt able to come on in the second half on Saturday.
At that stage, Newcastle hadn't yet conceded the equaliser but Fulham were on top and the visitors deservedly drew level when Sasa Lukic cancelled out Jacob Murphy's first half opener.
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Tonali was immediately introduced alongside Harvey Barnes and Fabian Schar, with Anthony Elanga and Will Osula later brought on, and Howe's changes and Newcastle's squad depth changed the game, with Bruno Guimaraes scoring a last gasp winner.
Asked about Tonali after the Italian was forced to drop to the bench for the midweek Benfica game due to the illness, Howe said: "All options were open.
"I had a little chat with Sandro at the start of the second half and said 'how do you feel, do you feel you can come on and be yourself?'. And he said he felt OK. Whereas yesterday he still felt he wasn't 100% fit.
"It's great to have him so honest and thinking of the team not himself. It's a great quality."
Howe also eased concerns surrounding Botman after the defender was forced off in the aftermath of Fulham's equaliser.
The immediate worry was that Botman - who has been in fine form lately - had suffered concussion, but Howe says that's not the case.
"I think he's OK," said Howe.
"There's no concussion, it was a cut, but very good from the on-field physio to recommend I take him off."
Schar replaced Botman to make what was his first appearance since the September win over Wolves.
Howe said: "I thought it was important for Fabby to come on and do well. Difficult moment for him.
"He's been an ever-present near enough since I've been here. Obviously the challenge is greater this season with the arrival of Malick and Sven's form and Dan's form.
"For all the defenders to step up and play is not easy with the group we have. I'm delighted with how he played and that will do him the world of good."
Newcastle climbed into the top half with the win, and Howe said: “I didn't think the performance was bad. Definitely the result we were looking for. Difficult game today. You can't under-estimate the challenge of Tuesday to Saturday, emotions, playing a very difficult opponent.
“I'm delighted with how we found a way to win. A late gal at home, there's no better way to win, arguably.
“I thought the strongest part of our performance was the last 20, 25 minutes, half an hour, and that pleases me because that means the squad is in a good place. The attitude of the guys coming on the pitch was excellent."