Cold & Flu Primer

If you think you have an upper respiratory infection (URI) — which includes the common cold, most sinus infections, chest colds (bronchitis), the "flu" (caused by the influenza virus), RSV (respiratory syncytial virus), and COVID-19 — there’s a lot you can do at home to feel better faster. Learning what helps the most (and the least) is worth your time, and having these tools can help you get through the sick times! Below you will find information on how to handle if you do get sick followed by information on what to expect this season from viruses including Flu, RSV and COVID-19. The following information is meant for information purposes only. Talk to your physician or non-physician provider for how to address your personal concerns.

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What to Expect with an Upper Respiratory Infection

More than 90 percent of upper respiratory infections are caused by viruses. These infections create different symptoms at each stage. Most colds, flus and COVID-19 resolve in about a week, although some symptoms (like coughing) can take weeks to go away completely even after you are no longer infectious.

Colds, flu, and COVID-19 are contagious from the time you get them (even before you have symptoms) up to ten days after your symptoms start. They’re usually not contagious after ten days, even if you’re still coughing or congested.

The best way to avoid passing on a URI (or catching one in the first place) is to wash your hands frequently, cover your mouth with your arm when you cough or sneeze and wear a mask that fully covers your mouth and nose. It’s also best to take at least a couple of days off work or school while you’re most contagious.

Here is the typical timeline of an upper respiratory infection:

Day 1: Fatigue, headache, sore or scratchy throat.
Day 2: Sore throat worsens, low fever, mild nasal congestion.
Day 3: Congestion worsens, sinus and ear pressure become very uncomfortable. It may be difficult to sleep.
Day 4: Mucus may turn yellow or green (this is normal). Sore throat improves, but coughing begins.
Days 5-7: Energy and congestion improve.
1 week+: Cough usually tapers off after a week, but can take up to 3-6 weeks to fully resolve.

If your symptoms are much worse than these, such as coughing so hard you throw up, coughing up bloody mucus, difficulty breathing, or if you have a fever over 102°F, you might have something more serious going on, like pertussis (whooping cough) or bacterial pneumonia.

If a cold drags on for more than 2 weeks, it can turn into a sinus infection that causes pain around the eyes, nose and/or sinus headaches. Chest colds (bronchitis) cause chest congestion and a hacking cough that drag on for a few weeks.

The flu comes with similar symptoms but features a prominent fever, chills, headache, and body aches that usually last several days.

COVID-19 can feel very similar to other colds and can sometimes have additional symptoms like loss of taste or smell which can help distinguish this virus. It’s important for folks to get tested and stay home with cold symptoms to help prevent the spread of COVID-19, keep everyone safe, and help end the pandemic.

What about antibiotics?

Almost all URIs are caused by viruses, and at present we don’t have medications that work against them. (One notable exception: There are antiviral medications for the flu like Tamiflu. If you start them in the first 24 to 48 hours of symptoms, it might reduce the duration of your illness by about a day.)

As for the small percentage of upper respiratory infections caused by bacteria, most go away on their own — and often just as quickly — even if you don’t take antibiotics. So if there’s a chance antibiotics can help, what’s the harm?

There are many reasons to be conscientious about taking antibiotics, including breeding resistant superbugs or making your health care cost more. However, there’s another reason that’s of immediate concern: diarrhea. Antibiotics can wreak havoc in your intestines and upset the normal balance of bacteria — including the bacteria that help you digest food, which can lead to abdominal pain, bloating, gas, and alternating diarrhea and constipation. Taking multiple courses of antibiotics puts you at risk of potentially long-lasting effects on your gut.

Like everything health-related, the decision about whether to take antibiotics for a bacterial infection comes down to weighing the risks and benefits. Your provider will be happy to discuss the decision with you in detail.

When to be concerned and call your Physician!

Occasionally, viral infections can set the stage for more complicated bacterial infections. If you experience any of the following, call your healthcare provider:

High fever (over 102°F)
Shortness of breath or wheezing
Coughing up bloody mucus
Coughing so hard that you throw up
Feeling worse after 7-10 days of symptoms, especially if you have worsening headache, congestion, or sinus pain
If you don’t start to feel better after 10 days of symptoms

WHAT TO DO IF I HAVE COVID?
COVID-19 SPECIFIC RECOMMENDATIONS

COVID-19 ACTION PLAN

I want RELIEF! At home things you can try for your symptoms!

Cough and Chest Congestion

Antihistamine/decongestant combo (e.g., brompheniramine/pseudoephedrine)
Cough suppressant: Dextromethorphan (Delsym)
Expectorant (mucus thinner): Guaifenesin (Mucinex, Robitussin)
Gentle hot tea (chamomile, licorice root, peppermint, thyme) with or without honey or lemon juice; Traditional Medicinals “Throat Coat” or “Breathe Easy” teas.
Honey (1 tablespoon of raw honey 1 to 3 times daily). Note: honey is not safe for infants under 12 months.
Steam inhalation: An effective way is to steam a bathroom with hot water and sit in the steam for 20-30 mins at a time. Another way is to boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.

Sore Throat

Pain relievers: Acetaminophen (Tylenol). It’s OK to use the maximum dose for 1 or 2 days while your symptoms are at their worst. Follow directions on the packaging.
Cooling or numbing medicines: Chloraseptic spray, lozenges, gargle echinacea tincture in water.
Saltwater gargles throughout the day: 1 tablespoon of salt in a glass of warm water.
Warm tea with honey, Traditional Medicinals “throat coat” or “breathe easy” teas, “sore throat tea“:
- Peppermint (teabags or fresh)
  8 slices fresh ginger
  4 cloves garlic
  Juice of 1/4 of a lemon
  Honey
  - Peel the garlic cloves, then whack them with the side of a knife to release the essential oils.
  - Boil the peppermint, sliced ginger, and crushed garlic in 4 cups of water for 10 minutes.
  - Add lemon and honey to taste.
Chicken soup or other clear broth.

Nasal Congestion and Sinus Pressure

Oral decongestants: Pseudoephedrine (Sudafed) is the most effective choice., Anticipate requesting and showing ID for the medication at the pharmacist counter. Avoid decongestants if you have poorly controlled high blood pressure.
Nasal spray decongestant: Oxymetazoline (Afrin). Don’t use this for more than 3 days, or your congestion will come back even worse.
Pain relievers: Acetaminophen (Tylenol). It’s okay to use the maximum dose for 1 or 2 days while your symptoms are at their worst. Follow directions on the packaging.
Nasal steroid spray: Flonase, Nasonex, Nasacort
Nasal irrigation twice daily with warm salt water (neti pot, NeilMed Sinus Rinse, Nasaline)
Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.
Moist heat compresses over your sinuses for several minutes a few times a day.
Herbs: Goldenseal, Bi Yan Pian, Sinupret

Runny Nose

Oral decongestants: Pseudoephedrine (Sudafed) can be the most effective choice for many. Anticipate requesting and showing ID for the medication at the pharmacist counter. If you have high blood pressure, avoid pseudoephedrine or take care to monitor your blood pressure while you take it.
Nasal spray decongestant: Oxymetazoline (Afrin) can be used for a short time. Don’t use this for more than 3 days, or your congestion will come back even worse.
Antihistamines: Allegra, Zyrtec, Claritin, Benadryl (all available in generic formulas) are all effective. Benadryl (diphenhydramine) will make you sleepy; the others won’t. Antihistamines tend to work better for runny noses from allergies, but they can help a bit, and they come in some of the combination cold/flu products.
Saline nasal spray
Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.

Fever

Fever reducers: Acetaminophen (Tylenol), ibuprofen (Motrin, Advil)
Drink lots of water.
Take a warm or cool shower.
Warm tea (chamomile, peppermint)

Headache and Body Aches

Pain relievers: Acetaminophen (Tylenol), ibuprofen (Motrin, Advil). It’s okay to use the maximum dose for 1 or 2 days while your symptoms are at their worst, as long as there are no contraindications. Follow directions on the packaging.
Moist heat compresses or cold packs.
Rub on Tiger Balm.
Take a nap.
Take a warm bath with Epsom salts.

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