Feeling under the weather just got a whole lot scarier in today’s environment of fear surrounding the new respiratory symptoms. But we need to remember to breathe and examine the facts. We are still in the cold and flu season. Other conditions are still prevalent such as rhinovirus, influenza A, influenza B, allergic rhinitis, bacterial infection, sinus infection, strep throat, etc. There are many overlapping symptoms, but there are also some that stand out and help us differentiate from one another.
The individual response to fever and infection varies, which is why you won’t see definitive terms like “always” and “never.” This symptomatic guide is simply created by numbers in what we have seen with patient presentations and is not a definitive diagnosis; only your health care practitioner can do that.
The current pandemic is caused by a virus with an affinity to the respiratory tissues and membranes, so it makes sense that it primarily affects the lungs and causes related symptoms such as dry cough and shortness of breath. Fever is the body’s response to an infection and an effort to activate the immune response necessary to handle a high-profile invader, so it also makes sense that fever (with accompanying fever symptoms like chills and muscle aches) would accompany this virus. The mucus production symptoms such as runny nose and sneezing are uncommon in the novel virus. Gastrointestinal symptoms can present less commonly, such as diarrhea and nausea in early stages of infection, and some studies say this can indicate a fecal oral route of transmission (vs respiratory droplet).
The common cold can still be caused by other viruses like rhinoviruses, parainfluenza viruses, and other cold-causing virus families. Colds, as you probably know, are mild and self-limiting. They do not cause shortness of breath and rarely cause fever on their own. Yet they can still cause those weird and random aches and pains. They often cause us to have upper respiratory symptoms like runny nose, sneezing, postnasal drip, mild coughing, and sore throat due to the increased mucus production with coughing. Patients often describe their sore throat when ill with a cold-causing virus as a “scratchy throat.” The cough associated with a cold often feels like a “tickle” and makes you clear your throat often. We expect colds to last at least 7-10 days.
The flu, short for influenza A or B, is the usual suspect around this time of year for making so many ill, and still is! This is why there is such a push for flu shots earlier in the season because, outside of general good hygiene, it’s the only way modern medicine and public health know how to prevent the illness that is common from late Fall to Spring. The flu commonly makes us have a fever and all the things that come with it, including chills, body aches (myalgias), night sweats, headaches, and extreme fatigue. The fatigue associated with a flu makes some people feel like they have been “run over” without the injury. The flu causes many people to look ill; in medicine we call this “toxic appearance.” People with the flu will often have a dry cough, congestion and runny nose, and the mucus is likely clear in color. There can even be a faster heartbeat than normal (tachycardia). There is no cure for the flu, but certain medications can shorten the duration. Most often, we expect the flu to last at least 3-7 days. Flu A is at higher risk for development of pneumonia, secondary bacterial infections, and ear infections.
When discussing viruses, it’s important to remember that, for some, it is just the start to more potentially serious conditions. Viruses, like any of those discussed above, can progress in some to bronchitis and pneumonia. These conditions are complex, but, in short, bronchitis is a cough that lasts 1-3 weeks with no fever and no chest pain. Pneumonia, on the other hand, commonly has fever, productive cough, increased heart rate, low oxygen saturation, chest pain and shortness of breath.
We are also heading straight into allergy season in many parts of the country, including the Seattle area! This can be a stand-alone issue or an additional layer on someone’s illness. If you are typically sensitive to environmental or seasonal outdoor allergies, this can increase upper respiratory symptoms by causing congestion, postnasal drip, runny nose, headaches, dry cough, watery eyes, and itchy eyes, ears, nose and throat.
Then we get into sinus issues, which can also be muddy and hard to differentiate from other illnesses. Sinusitis can occur when you have had a recent upper respiratory infection. It presents with congestion, sinus pressure, and mild to moderate headache. Sinusitis does not present with fever and usually lasts for less than 10 days. A sinus infection, on the other hand, is more often intense and painful. Sinus infections present with congestion, occasional fever, sinus pain, and localized sinus pressure, and the mucus will be green or yellow in color. These infections usually last longer than 10 days.
Talk to your doctor or medical provider to help you clarify your symptoms and decide what is best for you. Right now, calling your medical provider on the phone or scheduling a telemedicine visit is the best first step to take when trying to decide what to do next when you have symptoms.