It used to be that a runny nose and scratchy throat meant you had a cold—armed with tissues and hot tea, you’d get over it in a week. The COVID-19 pandemic has changed how we think about respiratory infections. A third of Americans are worried they’ll get seriously sick from coronavirus, RSV or the flu. News headlines keep us wary: 10% of Americans are infected with the latest Omicron strain, HV.1, and scientists warn of a tripledemic. At the first sign of a sniffle, it’s easy to fear the worst.
Colds are dubbed common for a reason: Americans suffer 1 billion of them annually (two to three per adult, five to six per child). Like other viral infections, we catch a cold when a sick person coughs or sneezes near us and the contagious droplets enter our mouth, eyes or nose. Direct contact with a sufferer, or sharing items like utensils or phones, also spreads germs.
The peak seasons of respiratory illnesses occur between November and March, when we gather indoors to keep warm. Low winter humidity dries out our nasal passages and, without free-flowing mucus, infection can quickly take hold.
It can be tricky to distinguish a cold from serious respiratory viruses, but there are some key differences. Common cold symptoms are mild and their onset is gradual. Classic complaints include sore throat, sneezing and a stuffy nose. (If you have a cough, it’s tickly, not deep.) You’re better in a week or less.
In contrast, the symptoms of COVID-19, RSV or the flu start abruptly and are often severe—sometimes they can even be fatal. COVID has four typical signs: a loss of sense of smell, diarrhea, shortness of breath and severe fatigue. RSV’s cardinal symptom is wheezing; the flu delivers severe body aches, fever and fatigue. Because new coronavirus strains like HV.1 can begin with unusually mild symptoms, home COVID tests are useful. RSV and flu are diagnosed by a simple oral swab at your healthcare provider’s office.
Colds can occasionally turn into sinusitis, bronchitis and pneumonia, especially for smokers or individuals with weakened immune systems. Consult your physician if you develop a persistent fever, shortness of breath, intense sore throat or headache, or if you are sick for more than 10 days.
With your doctor’s approval, consider echinacea capsules at the first sign of a cold: 100 milligrams three times daily for 10 days may lessen the severity of your symptoms. To loosen congestion, stay hydrated with water or tea with honey and lemon. Soothe your sore throat with a salt water gargle (1/2 teaspoon salt in 8 ounces of warm water), acetaminophen (Tylenol) or ibuprofen (Advil). Try nasal saline or steam; a vaporizer at your bedside to increase the humidity helps loosen nasal congestion. Taking 80 milligrams of daily zinc for two weeks may shorten the course of a cold, but watch out for gastrointestinal side effects (vomiting or diarrhea). Antibiotics kill bacteria–not viruses–and are of no use.
Americans spend over $20 per person on medications for every cold. Most over-the-counter oral remedies like Sudafed PE treat nasal stuffiness with phenylephrine, recently found by the FDA to be ineffective. (Digestion renders it inactive.) But if you bought a combination cold preparation with this ingredient (such as Dayquil or Tylenol Cold and Flu), don’t throw it away—the other components will help with throat pain and cough. Phenylephrine does work nasally (Neo-Synephrine), but use it sparingly: It can cause rebound nasal congestion and raise blood pressure.
The tips to prevent the spread of COVID apply to the common cold: Use hand sanitizer or wash your hands regularly with soap and water for 20 seconds when needed. Disinfect shared surfaces like kitchen countertops and light switches. Sneeze or cough into your elbow and encourage others to do so, avoid touching your face and consider wearing an N-95 in a crowd (concerts, airplanes). Stay home if you’re sick. Get adequate sleep and exercise, and eat nutritiously to keep your immune system strong.
Long-term Vitamin C supplementation has been shown to prevent upper respiratory infections. (Eat an extra orange daily instead of taking a pill.) Updating your vaccinations against COVID, flu and (if you qualify) RSV are practical ways to stay healthy. Because the common cold is caused by over 200 viruses, there are no available vaccines.
Mary Jenkins recently retired after nearly 40 years as a family practice physician in New York state.