Is it a cold, flu, COVID or RSV?
It’s the most “unwonderful” time of the year: cold and flu season. You or someone you know has probably already fallen victim to sniffles, stomach problems, congestion and headaches as it seems a little bit of every ailment is going around this year.
Johns Hopkins Blooms School of Public Health has been tracking fall and winter illnesses and reports that combined percentages of emergency department visits for flu, COVID-19 and RSV are rising rapidly due to significant increases in flu. COVID and RSV are rising as well, and the U.S. Centers for Disease Control estimates that flu and COVID will increase even more in the coming weeks.
But why do we normally see these ailments on the rise during winter?
“Winter is the time of year when most people experience cold and flu-like symptoms,” says Dr. Evan Stalnaker of UPMC Washington Family Medicine Residency. “For health-care providers, we consider cold and flu season to be a little more encompassing, including the months from October to March – that is half the year. Quite simply this occurs because on average these months are the coldest; this prompts more people to stay inside and remain in closer proximity to one another, which fosters easier transmission of germs.”
When it comes to what’s going around the most during this cold and flu season, viruses are mostly to blame for the misery.
“Most colds or upper respiratory infections are caused by viruses, with rhinovirus being the most common,” says Dr. James Solava, an internal medicine physician with Allegheny Health Network’s (AHN) Primary Care Institute. “The flu is also caused by a virus, but it is a different type. These viruses tend to be transmitted more easily during the winter months because people stay indoors more frequently due to the cold weather.”
That close proximity to others increases the risk of spreading and transmitting viruses. In contrast, during the summer, people spend more time outdoors and are not in as close proximity to others, reducing the likelihood of catching a cold. “Other risk factors for catching a cold include being very young or very old, having chronic health conditions, or a weakened immune system. Additionally, smoking and poor nutrition can increase the risk of catching a cold more easily.”
Is it cold or flu?
All of these ailments are annoying, make you feel miserable and can potentially put some people at risk for serious complications depending on underlying health. How do we know what we are really sick with or whether it’s serious? When it comes to different symptoms, they can often tell us whether we have a virus or bacterial infection.
“The symptoms of a cold can often be very similar to those of other illnesses,” Solava explains. “For example, a sore throat can be a symptom of a cold, but it can also indicate strep throat. Similarly, a cough can be associated with a cold, but it can also be a symptom of pneumonia. Other common cold symptoms include congestion, runny nose, sneezing, headache, fatigue, muscle aches, and fever.”
How can doctors figure out what is ailing you? To determine the specific diagnosis, they can perform a nasal swab to identify viruses such as RSV or flu, or a throat swab to diagnose strep throat.
“Bacterial pneumonia typically presents with more severe symptoms, such as significant shortness of breath, high fever, and coughing up thick mucus,” Solava says. “Strep throat, a bacterial infection, usually includes white spots on the tonsils, swollen glands under the jaw, and fever.”
When it comes to our noses, sinus infections can be particularly challenging to diagnose. Many people believe they need antibiotics for a sinus infection, but these infections can be caused by allergies, chemicals, viruses, or bacteria.
“Only bacterial sinus infections require antibiotics,” Solava said. “Viral sinus infections usually resolve within seven to 10 days, with symptoms peaking between three to six days. Bacterial sinus infections can last longer than 10 days and may exhibit a pattern where symptoms improve slightly before worsening again.” The presence of mucus or facial pain does not necessarily indicate whether the infection is bacterial or viral.
The ‘common cold’
What we call the “common cold” is an upper respiratory infection. It is usually a mild illness that resolves on its own, but there are more than 200 types of viral families known to cause the illness and likely many more that haven’t even been identified yet.
“There are just a few, however, that make up the vast majority of cases and these include rhinoviruses, coronaviruses, influenza, respiratory syncytial virus (RSV), and adenoviruses, with rhinoviruses comprising 50% of all causes of the illness,” Stalnaker said. “There is no way to identify which of these viruses gave you a cold based on symptoms alone. Most common symptoms include nasal discharge, nasal obstruction, and a dry or scratchy throat. A cough usually develops later; this is a result of nasal discharge that is dripping into the back of your throat. Clinicians call this ‘postnasal drip.’ Other symptoms may be a low-grade fever, general malaise, headache, and muscle aches and pains.”
For most viruses, the incubation time is 24 to 72 hours. That means from the moment you are exposed to one of these viruses, your first symptom will manifest within those three days. Most illnesses last anywhere from three to 10 days, but unfortunately a cough can persist for weeks after all other symptoms have resolved.
“We do not need to identify the specific virus because the treatment is the same for each: we treat the symptoms,” said Stalnaker.
What is the best at home remedy for these illnesses and when is it time to go see a doctor? A physician will offer advice on those questions in the Feb. 6 Total Health.