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Cold and flu season

By Gino C. Bottino, M.D.

Winter is here, and with it comes cold and flu season. In the United States, more days of work (and probably play) are lost to colds and flu than any other illness. According to CDC estimates, the flu has caused between 140,000 and 710,000 hospitalizations and between 12,000 and 56,000 deaths each year since 2010. The common cold is even more pervasive with millions of cases being reported in the U.S. each year. Adults average two to three colds per year, and children have even more.

Cold or flu?

The flu, caused by the influenza viruses, spreads and causes illness around the same time as the common cold. Since the common cold and flu have similar symptoms, it can be difficult (if not impossible) to tell the difference based on symptoms alone. In general, flu symptoms are worse and can include fever, chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue.

In both colds and flu, a virus attacks the cells lining the upper respiratory system. As these cells become infected, the body’s immune response kicks in as the body fights off the offending foreign organisms.

Flu season comes about as the “old” virus mutates into a “new” virus and starts spreading around the world. This spread follows the prevailing winds, so we call it the Asian flu. Our scientists are able to get the foreign organism while it is in Asia and develop a vaccine for it in time for flu season in the U.S.

Why we feel sick

When we have the cold or flu, our fighting cells send out a signal for the body to raise its temperature to help kill these organisms. Sometimes the byproducts of our body’s immune response get into our blood and cause unwanted systemic reactions like muscle aches and pain, which cause us to feel sick all over.

Our immune system doesn’t tolerate foreign invaders and fights them off vehemently. Our bodies deal with any invasion as a threat to our health, thus ensuring that a minor attack doesn’t become life-threatening.

Remember, colds can develop into pneumonia, which is where the phrase “you’ll catch your death” came about in the pre-antibiotic age.

The common cold

Common cold symptoms include stuffy nasal passages, phlegm and mucous production, sore throat, coughing, low-grade fever, chills, and general malaise. Sinus involvement can cause pressure buildup and pain around the eyes and nose, leading to a severe headache, while throat involvement causes pain and swelling of these tissues, making swallowing difficult and painful. If the vocal cords are affected, you could have difficulty breathing and talking.

Antibiotics are not recommended because their routine use leads to their eventual ineffectiveness in treating diseases that are more serious. When a viral illness persists for longer than two weeks, a secondary problem, or superinfection, is usually the cause. At this point, medical attention is required, and antibiotics can be used to treat the infections that develop on top of the viral illness.

Common cold treatment should be symptomatic and supportive. Resting, keeping up with fluids and nutritional requirements, and staying warm and dry are the cornerstones of treatment. You can use aspirin, Tylenol (acetaminophen) or Advil (ibuprofen) for fevers and general malaise. Antihistamines and adrenergic agents (decongestants like Sudafed) will reduce swelling and mucous production of the respiratory and nasal passages. Cough medicine’s relief is based on mild narcotic suppression of the brain’s coughing center, and expectorants like Robitussin-DM help loosen respiratory tract mucous so you can bring it up and out. Read labels carefully to compare ingredients and make yourself aware of possible side effects and contraindications. Remember that antihistamines can cause significant drowsiness, inability to concentrate and visual disturbances.

The flu

Unlike colds, influenza viruses infect the entire respiratory tract, not just the lining. They’re also blood-borne, affecting the entire body. Common symptoms include muscle aches, abdominal pain, diarrhea and headaches.

Because of the flu’s severity, it can easily progress to pneumonia due to bacterial superinfections.

Like the common cold, treatment for the flu is largely supportive, with antibiotics only given with persistent symptoms or signs of progressive disease.

When treating the flu, I don’t recommend combination medicines. It’s better to know exactly what you are taking and why and to have the ability to adjust your dose when needed. This approach reduces side effects and is more cost-effective.

Aspirin and similar drugs like ibuprofen treat fever and aches while reducing swelling and inflammation, making you feel much better while fighting the symptoms of these illnesses. My personal choice is to take Advil and Sudafed separately as needed.

Unlike with the common cold, antiviral agents can be given for the flu. However, in my experience, they often don’t work well and have side effects that can be worse than the flu. Newer antivirals like Tamaflu are much improved, and I suspect we will have relatively side effect-free active antiflu agents in the near future. Elderly and immunosuppressed patients should receive these antiviral agents right away, as they are only effective when administered within a day or two of acquiring the illness.

Prevention

You can only catch a cold by direct exposure to the viral organism. This usually occurs when someone with a cold coughs on you or shakes your hand after coughing. The best prevention is avoiding close contact with sick individuals and large crowds.

Staying warm, not getting wet and all the things our moms told us really don’t prevent exposure. Likewise, being exposed doesn’t mean you’ll get ill. If the viral load (exposure dose) isn’t too great, a healthy person with good immunity may fight the illness off before getting sick. If you are cold, wet and run down, your immunity is lower, and it takes less to make you sick. So mom’s advice wasn’t all that bad!

There’s no scientific evidence that taking vitamin C and other reputed immune enhancers can prevent or reduce the effects of the common cold; however, zinc lozenges, not pills, have been clinically proven to help reduce the duration of cold symptoms.

Preventing the flu by getting the flu vaccine is safe and effective. Getting vaccinated before flu activity begins helps protect you once flu season starts in your community. It takes about two weeks after vaccination for you to be protected, so make plans to get vaccinated now if you haven’t already. 


Gino Bottino, M.D., has had wide experience in medical practice and emergency medical matters. A member of United States Power Squadrons First Aid Support Team (FAST) and the Safety Committee, Gino also has a background in competitive sail racing and is familiar with health-related problems afloat.

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