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Upper Respiratory Infections – Colds, Flu, Sneezing, Cough, Sore Throat, and Pneumonia. Information to read BEFORE visiting your doctor, and why your doctor may be the last person that wants to see you (written in 2018 – pre-COVID)

First, the reason your doctor, nurse, and other health providers may not want to see you is because they are not immortal or immune to diseases. For example, in the 2003 SARS (severe acute respiratory syndrome) epidemic, some places reported up to 63% of the victims being healthcare workers. Most upper respiratory infections have no medical cure, despite many product ads leading you to believe there is. The most helpful person in your treatment is usually yourself. Below is some information you should find useful.

The first step is having some idea what you actually have. Many people confuse colds, “the flu”, and “strep.” Other people believe they have a non-contagious allergy, when in fact they have a contagious cold.

The “flu” is caused by one of several influenza viruses. It is clinically significant because it can lead to viral pneumonia. In fact, it is the leading cause of viral pneumonia. (I will talk more about pneumonia towards the end of this article when I mention the reasons when you should see your doctor).

Colds are most all other viral respiratory infections that are not specifically caused by influenza. For example: Adenovirus (many types), Metapneumoniavirus, Respiratory Syncytial Virus (A & B), BocaVirus 1 (Human bovine Canine virus), Parainfluenza Virus 1, 3, 2, 4a, 4b, Corona Viruses (several types),  rhinovirus A, B, C, and coxsackisvirus A and B (“CV B6” subtypes, etc.).

What most people do not understand about the influenza and cold viruses is that many times they do not have only one virus, but instead a co-infection of several of them, including the “flu” and several types of cold viruses at the same time.

“Strep” is a bacterial infection caused by a type of streptococcus bacteria. It can occur as a solitary infection, or the result of damage caused by, and secondary to a primary viral infection such a cold.

How to tell the difference, and what can you do if you have an infection

Colds and flu cause many of the same symptoms, so there can be confusion even for medical professionals. Colds share three symptoms that make some people think it is just an allergy. Eyes often burn (with an allergy, they often only itch), sneezing, and runny nose. However, a cold may have a slight fever, sore throat, cough, and sometimes body ache. Common respiratory allergies will not cause a fever, sore throat, or body ache. There is no feasible medical treatment available to cure a cold at this time.

The flu usually lacks causing the symptoms of burning eyes and sneezing seen in a cold, but sometimes causes a runny nose. Sore throat is more common. Body ache and cough is very common, and the fever is often higher. The cough of a cold is often annoying and persistent, while the cough of the flu can get worse and worse (and can lead to pneumonia). There are two types of antiviral medicines available. The first is the group that includes oseltamivir, often known by its brand name Tamiflu. It is only really effective if taken within the first 48 hours of having the flu, and most people only have cold-like symptoms in the first 48 hours. Confirmation of having the flu in the first day or two (versus having a cold) would require a lab test. The second type of medication for the flu (often sold in flu medications in Mexico) includes amantadine. In theory it does affect the flu infection sometimes, but in reality it usually has little to no effect. Note that when trying to determine if you have a cold or the flu, you may, in fact, have both at the same time.

“Strep” often causes a fever, usually causes a sore throat, sometimes body ache; however, the key diagnosis point is having white spots on the sides (lateral) of the lower throat (i.e. in a mirror, the lowest area you can see, behind the tongue, and to the side or sides). Small white spots (blister or ulcer appearance) in the back middle of throat, or roof of the mouth, are usually viral, such as coxsackisvirus (a cold virus), and are not treatable with antibiotics. “Mono” is a viral infection that can present with white on the sides, but is much less common – in all cases of white spots to the sides, you should see a doctor, and you will likely require antibiotics.

Strep infections may be acquired as a single infection directly from someone else (i.e. them coughing and infecting you), or as a result of having a cold. This is common with Rhinovirus (a cold virus) that destroys the barrier of surface cells that helps protect from the throat from bacteria, and makes the patient more vulnerable to bacterial infection of the upper airway such as staph, strep, etc. Thus, during a cold, constantly look at the back of the throat using a mirror, to check for white spots that could be a strep infection.

Over-the-counter and easy-access medications

Expectorants (such as Guaifenesin) and mucolytics (such as ambroxol, erdosteine, or acetylcysteine). Expectorants reduce the viscosity of bronchial secretions to increase mucus flow. Mucolytics degrade the mucus molecules. Both are very useful to modify mucus and make a more productive cough, expelling mucus that will carry bacteria and viruses bound with it. Mucus (commonly called phlegm when referring to in in the trachea and bronchial tubes of the respiratory tract) is a very important component responsible for the capture and removal of viruses, bacteria and other debris; you do not want to suppress this substance in a respiratory infection, but rather embrace and enhance it. Staying hydrated is very important because phlegm mucus is water-based, and with and without expectorants, proper hydration will help the mucus production and cilia function to help remove infectious germs. Becoming dehydrated, especially when the phlegm mucus is already heavily saturated with waste it is trying to remove, can cause the mucus to become too think and sticky to move. Drink more liquid than you think you need. Remember that if you have a productive cough, especially with thick secretions, change you position periodically. Lie on your side, then your other side, and face down. Do not just lie on your back or sit in the same position. You need to loosen and expel as much as possible, as often as possible, even if it means interrupted sleep for a few days. This is essential to not let your flu or cold progress to pneumonia! The use of expectorants and mucolyics can be very helpful, and sometimes vital, and they will function best when you stay well hydrated.

Cough suppressants (such as dextromethorphan) should be used only as needed. Coughing is desired, but not in excess.

Sleeping pills and alcohol should be avoided. Anything that could suppress the body’s normal breathing is a risk.

NSAIDs (non-steroid anti-inflammatory drugs such as ibuprofen, aspirin, etc. – includes acetaminophen/paracetamol). They are often used to reduce pain (headache and body ache) and to reduce fever. A fever of over 50°C (lethal body temperature for humans) would be required to actually kill existing viruses. However, a fever in the 38°C to 40°C range still seems to work against viral infections in several ways, especially interfering with replication, thus not letting the viruses overload the immune system as much, and contributing to the elimination of the viral infection. A fever over 40°C is even more helpful, but can be dangerous. While some people are okay up to even 42°C, I would not advise over 39.5°C. Below 39°C, I do not advise that an otherwise normal person take NSAIDs just for reducing symptoms. NSAIDs also decrease the immune system functioning, especially B-cells, that are necessary to fight infection. On the other hand, anyone taking aspirin for a known heart (cardiovascular) problem should not stop taking aspirin; both the respiratory infection and the termination of aspirin could increase the odds of a heart attack.

Steps to prevent infection

Hand Sanitizers. Not as effective as many believe. Most viruses and some bacteria require the alcohol content (active ingredient in most sanitizers) to be over 90%, with the ideal being 95%, to effectively kill most all the germs. Most hand sanitizers are 60% to 62% alcohol, and many viruses are unaffected at that concentration. Thus, hand sanitizers may help lower the risk, but they can also give a false sense of security, so never expect your hands to be clean enough to touch your face until after you have washed them very well with soap/detergent and water or a real antiseptic hand cleaner that you are sure will work.

Sanitize your environment. Keep counter tops, door knobs, handles, keyboards, telephones, touch screens, etc. clean with disinfectants. Keep clothes, especially shirt sleeves, clean. Do not share a common hand towel, and keep them clean. Use a humidifier because the virus has a lower survival in warm and humid places, and has a higher survival in cold and dry places. Also, dry air adversely affects your natural defenses in your airway.

Influenza vaccine. The only real scientifically-based reason not to get one is the risk of Guillain Barre syndrome. However, getting the flu infection also carries the same risk. The probability of getting Guillain Barre syndrome from campylobacter from undercooked chicken or poor restaurant food handling while eating out is much, much higher than getting the flu shot. Not getting the vaccine increases your probability of getting the flu, which increases by 100 times your probability of getting viral pneumonia. Getting the flu, and other respiratory infections, has also been shown to correlate with a greater risk of a heart attack. The vaccine risk is much lower than the risk of getting the flu.

Avoid being near anyone with a respiratory infection. Sneezing and coughing are obvious ways you can catch their disease. However, shaking hands, touching objects they have touched, and even just breathing the same air can infect you. Viruses and bacteria stay in the air much longer that most believe, due to a “gas cloud” of the cough or sneeze Keep your distance. If you must meet with someone that has a cold or flu, consider meeting them outside rather than indoors. Face masks worn by the infected person help to some extent. However, typical “surgical” face masks worn by the non-infected offer much less protection. You would need a mask that is rated at N-95 or N-100 to be more effective. Remember that the eyes are also vulnerable to being the area that acquires an infection and need protected if the infected person is likely to cough or sneeze close to your face.

Living with infected people. Wash your hands after every contact. Never touch your face unless just after washing your hands. Consider using a loose long-sleeved shirt or jacket when taking care of them Use a fan to pull air out of their room and through a window.

Control your own infection. Take measures to control your respiratory infections when you have them. Coughing and sneezing into a natural fiber fabric works best. This can be disposable (but best if larger than a common facial tissue such as Kleenex), a cotton handkerchief, or your own shirt if nothing else. Do not use your hand. It does little to block the path of germs, and saturates your hand with germs that will then go to everything and everyone you touch. Leave the area if possible to sneeze or cough, or at least do not face other people. Open a window if one is available, especially inside a vehicle, when you cough or sneeze. Do not shake hands! While all this is primarily to help protect others, the viruses you spread can mutate (colds) or recombine (flu) and later re-infect you. Stay home from work or places where you would have unnecessary contact with other people. Also note that a spontaneous unexpected or explained respiratory “allergy” (sneezing with or without itchy eyes) may actually be a very mild cold, or the beginning of a cold, and infection control measures should not be ignored just because you want to believe it an allergy instead of a cold.

When to see a medical professional

There are three reasons to see a medical professional when you have a respiratory infection. The first would be if you have a confirmed, recent case of influenza, and need a prescription for an antiviral medication. The second is if you have identified something that resembles “strep throat”. The third is respiratory distress or pneumonia. Do not see a healthcare worker for a cough just because it annoys you. You may be disappointed that there is not much you can take in the area of medication to cure your cough, and you can needlessly infect the healthcare workers. The cough should subside when the viral infection is over. If you must visit a healthcare professional, please take exaggerated precautions no protect the workers and other patients at the medical facility.

In the case of pneumonia and respiratory distress, many viruses can cause pneumonia both as a direct viral pneumonia or a secondary bacterial pneumonia, as well as bronchitis – both direct viral bronchitis or a secondary bacterial bronchitis. This is no longer just the annoying infection in the throat, but within the lungs and/or the air tubes branching into the lungs. This can in extreme cases progress to the inability to breath, and should not be ignored. A typical respiratory infection starts mild, then gets a little worse, but not severe, then gradually gets better. Most cases resolve without the need of a doctor. However, if the infection goes from bad to worse, do not “wait and see.” This is when you need medical assistance. Warning signs: excessively weak, difficulty breathing or shortness of breath (walking short distances such as to another room requires breathing effort).  Pain or pressure in the chest or abdomen, especially when breathing in or out. Sudden dizziness or confusion. Severe or persistent vomiting. High fever or sweats with body ache. Odd sounds or sensations in lung areas when breathing such as rubbing, creaking, crackling. Faster than normal breathing (such as over 20 breaths per minutes at rest) with shallower than normal breaths. Bluish lips, or finger nails that go from a healthy pink color to a dull pink or graying white color are other serious warning signs.

Bacterial pneumonia is usually treatable with antibiotics, but the outcome is better the sooner you start taking an antibiotic.

Viral pneumonia is much more challenging, many places have limited resources for treating it, and it can get more severe before it resolves (if it resolves), often leading to permanent damage to lung tissue. Avoiding pneumonia is very important. Stay rested (do not push yourself), stay hydrated, and make use of a productive cough and fever instead of trying to suppress both because they annoy you.

 If breathing becomes difficult, get checked for pneumonia as soon as possible!