by Dr. Wanda Filer M.D. updated by Dr. C.H. Weaver M.D. 10/2020

2021 Will create new challenges as the "common cold" the "flu" and COVID-19 infections all have some common symptoms and will be occurring at the same time. Read on for cold season coping strategies and guidelines for diagnosis and treatment.

We’ve all heard the bad news: there is no cure for the common cold. But how do you know if you have a run-of-the-mill viral cold or something more serious like COVID-19 or Influenza? When should you seek medical attention? And what are the best treatments for the symptoms.

Defining A Cold

When we talk about a “common cold,” we’re talking about a virus (most often a rhinovirus), which triggers symptoms that may start with a sore throat and runny nose and can include coughing, sneez­ing, watery eyes, headaches, and body aches.1 These symptoms last about seven to 10 days, and most adults average two or three colds per year (children can have more).1 While the symptoms can be annoying and may result in a few missed days of work, most adults who come down with a cold will recover within that 10-day window.

Managing Symptoms

If you have a viral cold, there is no miracle remedy, but there are steps you can take to feel more comfortable. Wanda Filer, MD, MBA, FAAFP, president of the American Academy of Family Physicians, says the best approach is to treat symptoms and get ade­quate rest. Though the most effec­tive strategies will vary depend­ing on the severity of your various symptoms (see chart on page 46), maintaining adequate hydration should be a primary objective.

“Dehydration can come with a cold or flu because you’re con­gested, it hurts to swallow, or you’re stuck in bed,” Dr. Filer says. Though you may think that because you’re not active you’re not in need of as much water, the opposite is true. Symptoms of a cold can result in “insensible losses” of fluid, Dr. Filer says: “When you’re sick with a low-grade fever, you perspire more; when you’re congested you breathe faster and lose fluid by more rapid in­spiration and expiration; when you’re sick you lose fluid more rapidly than is typical.”

Maintaining hydration in these cases is important be­cause it helps move mucus through your sinuses and chest, allowing you to clear the con­gestion and avoid more-serious infection. To help ensure that you are getting enough liquid, Dr. Filer advises, “Keep an eye on your urine; if it’s dark yel­low, you’re dehydrated.” Clear liquids (water and tea) are ideal, she adds, though sports drinks can also be helpful.

Hydration and rest are im­portant steps regardless of your symptoms, as is patience, Dr. Filer says. A cold can last as long as 10 days, and a cough from a cold can linger longer—up to several weeks. Ultimately, she says, “there is no magic answer—time is the treat­ment for most common viral cold symptoms.”

To See The MD Or Not To See The MD, That Is The Question

There is no doubt that a nasty cold can lay you low, and we’ve all had that moment of wondering if what started as a cold has progressed to something that requires a visit to the doctor. Dr. Filer says that, as a general rule, if you’ve been sick for less than two weeks, your fever has remained below 102 degrees, and you haven’t developed shortness of breath or severe body aches, manag­ing your symptoms and getting rest is likely a good call.

If, however, you develop a high fe­ver, significant aches, shortness of breath, or very local­ized sinus or headache symptoms, a call or visit to your provider is a good idea. And if you have a com­promised immune system or any existing chronic condition, such as asthma or chronic obstructive pul­monary disease, it is always better to play it safe and seek medical care at the onset of symptoms.

Cold Versus Flu or COVID-19

In some cases, symptoms that you might initially think are related to a cold may actually be the begin­ning stages of an influenza virus, or the flu. It could also be COVID-19. The difference in symp­toms, Dr. Filer says, is the severity: “If you’re running a fever higher than 102 degrees, accompanied by intense body aches (especially in the back, arms, and legs) and sig­nificant discomfort in your chest (influenza is a lung infection), you may have flu or COVID-19.”

This Flu season it will be especially important for individuals to know if they have COVID-19. If individuals develop any symptoms that should assume they have COVID-19 and act accordingly until they can get a test. This includes distancing, hand washing, and staying away from "at risk" individuals. There are several rapidly available tests and individuals with symptoms should get tested promptly.

The key to treating the Flu and COVID is getting to the doctor early on in the progression of the illness—ideally within the first 48 hours. Both anti-flu medi­cations, and anti-COVID mediations work best when administered within the first 48 to 72 hours.

The most effective strategy to avoid being hit by the flu is to get a flu shot—a dose of flu vaccine. While it’s ideal to get a flu shot early on in the fall when the vac­cine first becomes available, Dr. Filer notes that it’s never too late in flu season to get the vaccine.

Cold Medicine Is Not Recommended For Young Children

It is hard to see your child come down with cold symptoms. Stuffy nose, cough, sore throat—all symp­toms we know are uncomfortable and get in the way of kids’ school schedules and activities. But while it may make a parent feel better to offer up fruity cough syrup or similar over-the-counter med­ications, Dr. Filer says that consensus among physi­cians is that the potentially harmful side effects of these medications, which are often overdosed by parents wanting to alleviate their children’s discom­fort, outweigh their benefit.

“There is no evidence to show that over-the-counter cough and cold medicines are good for kids; in fact, there’s advice against giving kids these medicines,” she says. “We generally don’t recom­mend them for children.”

Antibiotics Will Not Cure A Cold

Antibiotics are not an effective treatment for a cold virus. “The majority of head colds are viruses, and we know that antibiotics do not work on viruses,” Dr. Filer says. Antibiotics treat bacterial infections, which can develop as secondary infections in the wake of a cold but are not the same.

Dr. Filer says that often a red flag in determining whether a cold has become a bacterial infec­tion is “double sickening”—when you feel your health was actually improving but are then hit hard again by worsening symptoms. “That sequence tells me you may have moved from a viral infection to a secondary bacterial infection,” she says. In that case, antibiotics may be prescribed after a thor­ough examination and, sometimes, lab tests to confirm the bacterial diagnosis.

Influenza

Flu season is considered to be underway, as of November 30, flu activity had been elevated in the United States for about four weeks, and is expected to increase as we move into winter, according to the Centers for Disease Control. According to the CDC during an average year ~125-200 people a day die of the flu. Influenza is preventable and most of these deaths would not occur in vaccinated individuals. This year the persistence of the COVID pandemic makes flu symptoms even more problematic. How do you know if you have the flu or COVID-19? Individuals should of course discuss these symptoms with their heath care provider however a new test may help sort things out from home.

FDA Authorizes First Combination COVID-19, Flu for Home Use

The FDA announced it authorized the first combination test that allows patients to collect saliva samples at home and have them analyzed at a laboratory for the presence of COVID-19, influenza A and influenza B.Quest Diagnostics makes the RC COVID-19 +Flu which is intended for those with a respiratory viral infection “consistent with COVID-19” and for whom home collection is “determined to be appropriate” by a health care provider. Quest Diagnostics indicated that it takes approximately 2 to 3 days for all patients and 2 days for “priority patients” (eg, hospitalized patients) to receive antibody and molecular diagnostic test📷 results.Remember it is not too late to get vaccinated......​Flu season is here again, and besides a fever and runny nose, it can bring about the longtime controversy surrounding vaccines. In order to protect more human lives this year and to clarify some of the most common misconceptions surrounding the flu vaccine, the team at Consumer Safety.org met with Dr. William Schaffner, an infectious disease specialist at Vanderbilt Medical University. Below are answers to some of the most common queries surrounding the flu vaccine.

What You Need to Know for the 2020-21 Flu Season

  • Flu vaccines have been updated to better match circulating viruses
  • The nasal spray flu vaccine (live attenuated influenza vaccine or “LAIV”) is again a recommended option for influenza vaccination of persons for whom it is otherwise appropriate. The nasal spray is approved for use in non-pregnant individuals, 2 years through 49 years of age. There is a precaution against the use of LAIV for people with certain underlying medical conditions. All LAIV will be quadrivalent (four-component).

How is the Flu Vaccine Created?

Contrary to popular belief, the flu vaccine you receive this year is not the same vaccine that you received last year. The flu, also known as influenza, is a respiratory virus that is able to mutate and evolve over time. According to Dr. Schaffner, the virus can “change sometimes from year to year, perhaps every 2-3 years.” Therefore, the vaccine needs to change and evolve as well to keep people protected every year.Because parts of the world experience flu season at the opposite time that we do, there are actually two vaccines developed every year – one for the northern hemisphere and one for the southern hemisphere. Each vaccine is developed nine months prior to flu season in a collaborative effort between the World Health Organization (WHO), the FDA, and the CDC. whose expert committees can “make recommendations about the creation of the vaccine” for each half of the world.

Who Needs the Flu Vaccine?

Everyone is at risk for the flu, and therefore with a few exceptions, everyone is recommended to get vaccinated. According to the CDC, everyone six months or older should receive an annual flu shot. Contrary to popular belief, this recommendation includes pregnant women, seniors, and children. It’s also important to note that not only is it safe for pregnant women, but the mother’s vaccine will actually protect the infant for six months after its birth.In milder cases of the flu, a person experiences cold-like symptoms. However, in its most severe form, the flu can lead to complications like pneumonia and even death. According to Dr. Schaffner, those most at risk for more serious complications include “people who are age 65 and older, and people who have underlying illnesses – heart disease, lung disease, diabetes, and the like who are immunosuppressed.” By receiving the vaccine, not only are you protecting yourself from this harmful virus, but you are also protecting those around you who might have a harder time fighting the flu.Besides infants under the age of 6 months old, people who have Guillain-Barre syndrome, a very rare illness should NOT get the vaccination. Dr. Schaffner says that “if you’ve had Guillain-Barré syndrome within 6 weeks of getting flu vaccine previously, you probably should not get flu vaccine this time.”

When Should a Person Get the Flu Vaccine?

Dr. Schaffner recommends anytime between September and November and went on to explain that “vaccine interest on the part of providers and patients stops around Thanksgiving.” However, though our interest may wane, the peak season for flu outbreaks is often in February. So if it hits December or January and you still have not gotten your flu shot, Dr. Schaffner urges you to head to your nearest flu clinic. “RUN! Do not walk. Run and get your flu shot, because you can still get protection before the flu hits most seriously.”

Can the Flu Vaccine Give Someone the Flu?

No. After a flu shot, you may experience a headache, sore arm, redness, or a bump near the inoculation site, but the vaccine cannot give you the virus. As Dr. Schaffner explains, “The flu vaccine is not the complete virus. It’s broken up pieces of the virus. It can’t reconstitute itself and give you the flu.” The flu shot is administered during a season with high rates of colds and other airborne infections. Oftentimes when people get sick after a flu shot, they mistake a common cold for the flu by simple coincidence.

Is the Flu Vaccine Always Effective?

No, the flu shot is not 100% effective. In an age of money-back guarantees, many critics wonder why they should bother with a flu shot when they might still contract the virus. Dr. Schaffner argues that, “the protection effectiveness is measured as protection against the disease completely. What that doesn’t tell you is that you often get partial protection.” So you get a flu shot, and you still get the flu. The flu shot is still doing its part by lessening the severity of the virus. When it comes to a virus that takes tens of thousands of lives per year due to complications of high fever and pneumonia, Dr. Schaffner welcomes your complaints saying, “It’s wonderful that you’re here to complain. You didn’t die!” A mild case of the flu is better than a deadly case of the flu.

Can The Flu be Treated?

The Food and Drug Administration (FDA) has approved Xofluza (baloxavir marboxil) for the treatment of acute uncomplicated influenza in patients aged ≥12 years old who have been symptomatic for no more than 48 hour. Xofluza is a single-dose oral medicine approved to treat the flu based on clinical trials results demonstrating that it significantly reduced the duration of flu symptoms.(3,4)

About Xofluza

Xofluza is a first-in-class, single-dose oral medicine designed to target influenza A and B viruses. The FDA approval was based on 2 randomized controlled clinical trials performed in 1832 patients who were assigned to receive Xofluza, placebo, or oseltamivir within 48 hours of experiencing "flu like" symptoms. The results of the study showed that patients who received Xofluza had a shorter time to symptom relief compared to patients who received placebo.The most common adverse reactions associated with therapy included diarrhea and bronchitis. XOFLUZA was approved based on results from the Phase III CAPSTONE-1 study of a single dose of XOFLUZA compared with placebo or oseltamivir 75 mg, twice daily for five days, in otherwise healthy people with the flu, as well as results from a placebo-controlled Phase II study in otherwise healthy people with the flu. XOFLUZA significantly reduced the duration of flu symptoms compared to placebo, and demonstrated similar efficacy compared to oseltamivir. In clinical trials, XOFLUZA was safe and well-tolerated with a side effect profile similar to placebo. The CAPSTONE-1 and Phase II study results were recently published in the September 6, 2018 issue of the New England Journal of Medicine.

With the flu killing 30,000 to 40,000 individuals in the United States, it is imperative that more people recognize the dangers of the virus and the benefits of the vaccine. While the vaccine is not 100% effective, doctors and scientists work diligently every year to save as many people as possible from this deadly disease. You can make a difference too! Make the step towards health for you and your family this flu season and schedule your flu vaccination today.

​Natural remedies can provide relief from uncomfortable symptoms

Cold season is in full swing. Unfortunately, there is no cure for the common cold—it just has to run its course. When you’re sidelined by the sniffles, it’s tempting to race off to the drugstore for an over-the-counter drug that promises relief—but there are several natural remedies that can provide relief without side effects. These remedies won’t “cure” what ails you, but they can make you more comfortable and they might even shorten the duration of your cold.

If you’re tired of sniffling, sneezing, and coughing, try one of these natural remedies and see if you can find some relief from your nagging symptoms.

Use a humidifier. Winter air is cold and dry, which is especially irritating to sore throats and nasal passages. If you’re feeling congested, a humidifier can help clear that congestion. Place a humidifier in your bedroom so that you can breathe easier while you sleep. Even after the cold has run its course, you may want to consider making the humidifier a habit during the winter months. For an extra dose of relief, add a few drops of eucalyptus oil to the humidifier.

Just add garlic. Garlic has many antiviral, antibacterial, and antifungal properties. It has been used in medicinal practices in Asia for centuries. While garlic won’t “cure” you, it can boost the immune system. Some evidence indicates that mega-doses of garlic at the first signs of a cold can reduce the severity and duration of symptoms. One to two garlic cloves a day may help alleviate the symptoms of a cold. Chopping the garlic will help activate the allicin, which is the ingredient that combats colds. Steep the chopped garlic with hot water, lemon, and honey for an immune-blasting tea. If you’re not a fan of garlic, garlic supplements are available

Drink tea. Tea won’t make your cold go away, but it might make you feel better. There are several herbal teas on the market that promote relaxation. Furthermore, tea is a great way to warm up when you’re suffering from the chills associated with colds and flu. To make a homemade cold-fighting tea: boil water, fresh ginger, lemon, cinnamon, and a dash of cayenne. Sweeten with honey or maple syrup.

Steam shower. A steam shower or steam room is an excellent way to ease the congestion associated with a cold. A steam room is sort of like a supersonic humidifier—the heat and steam can loosen up the mucus and provide some relief. Some steam rooms even add eucalyptus or peppermint oil for further relief.

Homeopathics. There are several homeopathic remedies on the market that target specific cold-related symptoms. Consult a holistic practitioner to find the homeopathic remedy that matches your specific symptoms.

Neti Pot. A neti pot is a small pot that can be filled with warm saline water and used for nasal irrigation. Neti pot enthusiasts swear by this method as a way to both prevent colds and reduce congestion when a cold has set in. You can find neti pots in many health food stores.

Rest. Let’s not forget the most important remedy of all—sleep. Once you’ve been afflicted by a cold, the only thing to do is stop and rest and let your immune system do its job.

Can Certain Foods Help Reduce Your Risk of Getting the Flu?

Dr. Malik who leads the Master of Science in Nutrition for Wellness program at Bastyr University shares the immune-boosting potential of certain foods that may help reduce your chances of getting sick?

  • Mushrooms – a good source of vitamin D and an underutilized immune-boosting food. In fact, clinical researchers discovered improved immune responses in cancer patients who are receiving chemotherapy and radiation after consuming mushrooms.
  • Turmeric – typically found as a bright yellow powder, this immune system booster is often used in Asian curry dishes. You may also find turmeric supplements, but be careful with these - many have failed quality testing but are still available on store shelves.
  • Sweet potato – a fall and winter favorite that’s high in vitamins A and C, a one-two punch when it comes to knocking out bacteria and viruses.
  • Ginger – may help our immune cells win the battle against colds and the flu. Add fresh ginger to your stir-fry recipes or as part of a salad dressing!
  • Fresh garlic - researchers are discovering that this common ingredient may help kill bacteria and viruses. When possible, consume fresh garlic as opposed to relying on garlic capsules/supplements--the jury is still out as to whether these have the same effect.
  • Hot tea – a perfect beverage on a cold day, we are finding that it may help our bodies ward off infections. Not only that, but as an added bonus, drinking tea will help keep you hydrated.
  • Cinnamon – a fall and winter favorite, it contains essential oils that may help reduce the amount of time we spend getting over a cold or the flu. But, be careful about using cinnamon sugar, which is not the same as pure cinnamon!
  • Berries – naturally high in vitamin C and other powerful antioxidants, these can be enjoyed fresh or frozen. I would recommend consuming whole berries, rather than relying on juices/smoothies. There has been some talk that Elderberries may help you recover from illnesses faster, but further research is needed to know for sure.
  • Honey – this sweetener has been used as an antibiotic for centuries. It was believed that ancient Romans would apply it to their eyes when they had a bout of conjunctivitis (“pink eye”). Turns out, they were on to something: honey has been found to prevent the growth of bacteria. Add it to your tea or as a topping on your whole grain pancakes or waffles.
  • Yogurt - a good source of vitamin A, protein and zinc, yogurt is a great snack. Not only that, but yogurt contains healthy bacteria that may protect your digestive tract from disease-causing germs.
  • Combine yogurt, berries, and a teaspoon of honey, and you’ve got a near perfect superhero snack!

About Dr. Neal Malik📷Neal Malik, DrPH, MPH, RDN, CHES, EP-C leads the Master of Science in Nutrition for Well program and teaches core courses at Bastyr University’s California campus. Dr. Malik is also a Certified Exercise Physiologist, as well as a Certified Health Education Specialist. Dr. Malik is highly devoted to helping the community achieve optimal health. He focuses on nurturing the mind, body and spirit to maintain a state of positive wellness.

References:

  1. Frequently Asked Flu Questions 2018-2019 Influenza Season
  2. Health and Safety Investigator with ConsumerSafety.org
  3. Genentech Announces FDA Approval of XOFLUZA (Baloxavir Marboxil) for Influenza
  4. Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents