POV: Everyone in your household survived the first week back to school. You’ve sent in 100 snacks, completed 3 back to school meet and greets, and registered for all the after-school activities. Heck, you’ve even dressed up your kid in the assigned colors of the rainbow a solid two out of five days last week! In fact, you’re doing so well that “bedtime” before 11pm is almost a thing again. Hallelujah!

Then you hear it from down the hall, a cough and a sniffle, it’s faint at first, and then it gets louder and louder until “MOMMYYYYY I DON’T FEEL GOOD”

You walk down the hall and up the stairs to confirm- it’s too early, it’s only the second week of school, you place the back of your hand on their forehead, hot potato. Fever confirmed.

Is it flu? Is it covid? Is it RSV? Is it Rhinovirus? Oh god, I hope it’s not bacterial. Are we all going to get it? I don’t want it!  

Whether you’ve got school aged kids or not, we’ve all been there. It starts with a sniffle, a scratchy throat or a general feeling of “blah” and then snowballs into a fever, chills, and if you’re super unlucky, in a few days it’s coming out of both ends.

Today we’ll go through the modified 5 “W’s” of upper respiratory illnesses (URIs) so you know what you’re up against, what you can try and tackle at home, and when to call your doctor.

We’ll also talk about some natural ways to help you feel better and what you can do to maximize your chances of staying healthy this cold/flu season- we will call these the “bonus W’s”

Note: I will not be discussing lower respiratory infections including bronchitis, pneumonia and bronchiolitis. Maybe we’ll cover those another day. In case you were wondering- the upper respiratory system includes the nose, mouth, sinuses, pharynx and larynx while the lower respiratory system includes the airways (all below the larynx)

Difference Between Upper and Lower Respiratory Tract | Definition, Structure, Function, Similarities and Differences (pediaa.com)

Who (are these viruses?): Fall is typically when respiratory viral illnesses like to wreak havoc on our lives. The most common offenders include flu, COVID (which has been particularly active this summer, and I suspect this will continue through the fall), rhinovirus (the common cold), adenovirus, RSV, parvovirus and parainfluenza. To be honest, there are many more that cause similar symptoms, we just aren’t always able to test and identify them. The good news is that it doesn’t really matter because for the most part, the treatment for these viruses is the same!

What (are they doing to my body?): Most viral illnesses start similarly, you think you might have a scratchy throat, or maybe your nose is running a little extra, nothing groundbreaking. Over the next few days your throat feels like someone is scratching it with a knife, you can’t breathe out of your left nostril while your right one won’t stop leaking and you’re coughing so hard you swear you’re going to break a rib. Your body feels like someone ran over it with a semi- truck, multiple times, sometimes even your hair hurts, also you want 4 extra blankets and can’t possibly get out of bed today.  

Here is a list of typical symptoms a viral URI may cause:

Fever
chills
cough
congestion
body aches
malaise
fatigue
sinus congestion/pressure
runny nose
decreased appetite
vomiting
headache
diarrhea
Upset stomach  

When (will I feel better?):  Most viruses follow a typical pattern

1. Incubation period: this is simply the time between when you were exposed to an infection and when you start to show symptoms. It depends on the type of virus you have been exposed to, but for upper respiratory infections it can be anywhere from 1-5 days. For COVID the incubation period may be up to two weeks.  You won’t have any symptoms during this time, but the virus is actively multiplying in your body.
2. Prodromal: At some point your immune system notes the intruder and gets to work clearing the infection- this results in inflammation and may have symptoms of fatigue or a low-grade fever. This is typically the day you feel like something might be brewing, but you can’t be sure. For illnesses with shorter incubation periods, this may overlap with the third stage.
3. Illness: At this point you KNOW you’re sick and may experience any of the typical symptoms we discussed above- fever, chills, cough, congestion, body aches, nausea etc. This can last anywhere from a few days to a week depending on the virus.
4. Decline: This stage refers to the time when your immune system has mounted an adequate response, and the number of viral particles starts to decline. You should gradually start to feel better. It is important to note that you are still contagious during this time, and you should watch for a phenomenon referred to as “double sickening”.
5. Convalescence: This is the final stage, where you feel better and start to get back to your activities.

Double sickening: when you have a viral illness, the infection can weaken your immune system and make you more prone to a secondary infection, it is important to follow up with your doctor if you experience:
– Sudden worsening (after initial improvement)
– New onset of fevers
– Recurrence of fevers are previous resolution
 Oftentimes the secondary infection is bacterial and will require antibiotics for treatment.

dc03d885f0dbf4a02d2edf40a61255def7c1bd64 (1100×763) (openstax.org)

All said and done you should expect to start feeling better within 7-10 days and back to baseline within a few weeks.

Symptoms that should prompt a visit to your doctor:
Progressively worsening symptoms after 5-7 days of illness
Double sickening (discussed above)
High fevers that are difficult to control with over-the-counter fever reducing medications
Inability to tolerate fluids
A cough or hoarse voice that lasts longer than 4 weeks

People that are at risk of complications from upper respiratory infections:
1. Elderly
2. Infants
3. Patients with underlying lung conditions (asthma, COPD)
4. Patients with illnesses that cause immunocompromise
5. Patients that take immunocompromising medications

Symptoms that should prompt a visit to the ER:
Difficulty breathing & chest pain

Where (am I getting this from?):  
1. Viruses can be transmitted through the air from respiratory droplets (if someone coughs or sneezes without covering their mouth).

2. From contaminated surfaces- say for example someone sick coughs into their hand and then opens a door, if you open the same door, the virus is now on your hands. If you then go and touch your nose, mouth or eyes, the infection can enter your body.

https://apps.hhs.texas.gov/providers/NF/credentialing/cna/infection-control/module2/paste_image1.png

Why (am I getting sick? ALL THE TIME): I get this question a lot, and some winters it genuinely feels like you are sick the entire season, with only a few days of reprieve. Truth is, there are countless numbers of viruses that cause illness and now that you know how viruses are transmitted, you can understand how easy it is touch an infected surface or be near someone that coughs and catch the infection yourself.

Additionally, your immune system is more susceptible to infection when you are stressed, eating poorly, or have not been getting enough sleep.

If you really are having trouble clearing infections, if your cold is always turning into pneumonia or if you’re getting sicker than everyone else around you, it may have something to do with your immune system or another underlying condition. If this sounds like you, be sure to follow up with your PCP so you can get to the bottom of what’s going on.

The bonus W’s

What can I do to treat it?  As John Mayer once said, “your body is a wonderland” and it REALLY is! As you may have figured out by now, your immune system takes care of the viral infection all on its own. But there are things you can do to stay comfortable, and even speed up the healing process!

Things to keep you comfortable & (maybe) speed up healing:

1. Acetaminophen and/or ibuprofen- these medications can help reduce your fever, body aches, headache, sinus pressure

2. Over the counter cough/cold medications- be sure to consult your doctor if you have high blood pressure

3. Saline rinses- to help with congestion

4. Lots of fluids- to keep you hydrated and help replace any fluid loss from fevers or extra trips to the bathroom

5. Neti-pot- another good one for congestion

6. Steam/ humidifier- helps to break up the congestion in your nose

7. R-E-S-T! Your body is working hard to fight off infection, the more rest you get, the faster you heal.

What can I do to prevent it?

1. Wash your hands! Wash your hands! Wash your hands!
   Everyone, every time– not just employees who are returning to work per the posted bathroom signs. EVERYONE must wash their hands after using the bathroom, every time. It’s also a good idea to wash your hands before you eat, and anytime they are visibly soiled.
2. Stay hydrated, eat well and get enough rest to keep your immune system functioning optimally
3. Stay up to date with seasonal vaccinations
4. Take extra precautions when viral spread is especially high
5. Try to gather outdoors (limits accumulation & spread of viral particles)
6. Improve your air quality with a HEPA (high efficiency particulate air) filter
7. If you have central HVAC (heating, ventilation and air conditioning) make sure the fan is set to on, rather than auto when you have visitors.

If you’re still reading, you’re now well equipped for this upcoming respiratory season. I hope this information has been helpful. Stay tuned for part 2 when I’ll be talking more about the immune system and the role of food, rest and movement, in optimizing your immune function!

Sincerely,
Corsano MD- Your friendly neighborhood PCP

Resources: medical news today, CDC, Cleveland clinic, Healthline
Images: see links above