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Cold or Flu: What to Know, What to Do
Comparative “Anatomy” of the Cold or Flu
The age-old question is it a cold or is it the flu? There are some clues to help you decide. Colds begin gradually with sore throats and rarely have fevers, headaches and muscle aches. The main symptoms of a cold are sniffles, runny nose and a wet sounding junky productive cough. Flu on the other hand hits you like a freight train suddenly with a high fever usually greater than 100-102 degrees F with a bad headache and muscle aches, rarely do you have sniffles and if there is a cough it is usually a dry non-productive cough. The flu causes severe fatigue you will be wiped out. Colds usually get better by 1 week at the most but the flu can linger longer.

See the chart below for some differences in symptoms and presentation

Symptoms                  Cold                                              Flu
Onset                            gradual                                        sudden
Fatigue                          rare                                              severe
Fever                             hardly ever                                  101-102F
Body aches                   rarely                                           very common
Chills                              rarely                                           common
Sore throat                    common                                     sometimes
Headache                      sometimes                                  common
Nasal congestion          very common                              rare
Cough                             common productive                  rare dry unproductive
Complications               sinusitis, ear infection                 sinusitis,
Prevention                     hand washing, avoidance           hand washing,
Treatment                      symptomatic antihistamines      symptomatic

A good rule of thumb is to ask yourself, where most of my symptoms occur? If they occur from  the neck and above, such as,  sore throat, runny nose it’s a cold. If they are primarily below the neck,  body aches and a bad cough it's probably the flu.

The common cold is somewhat of a misnomer. It is not just one virus, but about hundreds of different viruses that make up the “cold.”  Over half of them are a type of virus called rhinovirus and there are 99 different types of rhinoviruses!  That is why we can send a man to the moon but we can’t cure the common cold! All these heterogeneous distinct types of viruses make it difficult to develop a vaccine to prevent the cold or even an antiviral drug to combat it.

An RNA virus in the family called Orthomyxovirus causes the flu.  There are 3 main types called Influenza A, B, and C. Influenza A is further divided into subtypes. Humans can be infected with all 3 types of Influenza A, B, and C. Most of the virus subtypes of Influenza A also have natural animal hosts such as birds and pigs. And even though from year to year the viruses mutate and change called antigenic shift and drift, we are still able to develop new vaccines every year to prevent infection.

The best way to prevent the flu and any complications that can develop from it, such as pneumonia, is to get a yearly vaccination. The CDC recommends that everyone 6 months and older should get a flu shot. But last year, there an antigenic drift after the vaccines were made, which caused the predominance of a subtype of the flu virus not well covered by that vaccine. That’s why last year was a terrible season. The outlook this year is better since we are finding the predominant circulating strains are covered well with this years vaccine!

Antiviral medications
Also because the flu is a somewhat more homogenous and uniform when compared to the cold, we have been able to develop antiviral medications. These medications can help prevent the flu if you take them after exposure but before you get sick or they can help shorten the course of the illness but only by a day or so.Antiviral medications are a good idea especially for high-risk individuals who may get serious complications from having the flu. Those are people with compromised immune systems, chronic illnesses such as diabetes, or respiratory conditions such as asthma or COPD and emphysema.

And while colds and flu for most of us are just a nuisance, they can be deadly for those who have severe asthma, other respiratory problems or those who are immune compromised. While our bodies are fighting off these viral infections they become more susceptible to secondary more serious bacterial, "super" infections. In fact the death rate attributed to the flu is due to the secondary bacterial pneumonias that develop. It is also believed colds in young kids might play a role in the development of asthma by programming their immunes systems.

Good hand washing is key to preventing both colds and the flu. As well as making sure you don’t touch your face, eyes, nose and mouth during this cold and flu season without washing your hands since this is how the viruses can be transmitted. Cover your sneezes and cough not with your hands but use the inside crook of your elbow, if you don’t have a tissue you can use. And be sure to throw out used tissues immediately.

Lifestyle Strategies
As with many diseases and medical conditions your lifestyle can critically affect your health.  So eating healthy is at the top of the list. A diet rich in bright and colorful fruits and vegetables have chemicals, called phytochemicals, which have antioxidant properties that can boost your immune system. Yogurt has probiotics that appear to strengthen your immune system in your GI tract and mucus membranes. It increases the amount antibodies in your mouth and nasal passage where viruses often enter. Some studies showed it appears to decrease susceptibility to colds and flu by 25%.  Green tea has a family of antioxidants called catchins which help stimulate the T cells of the immune system to help prevent colds and flu. There is actually very little evidence that vitamin C prevents colds but studies show that people with low levels of vitamin D are almost 40% more likely to get a respiratory infection. So other than exposure to sunshine, sometimes in short supply during the winter months of cold and flu season, eating foods that are vitamin D fortified such as dairy foods, tuna and salmon or taking a supplement of about 1000u/day can help. Cutting your alcohol consumption is also a good idea as heavy alcohol use suppresses your immune system and makes you more susceptible to viruses and secondary complications from it such as super infections.

Other lifestyle strategies that can help prevent cold and flu are to reduce your stress levels. Natural virus killing chemicals increase during relaxation techniques such as biofeedback. Massage and saunas also have been found to bolster your immune system through stress reduction and lower cortisol levels, which is a stress hormone that decreases immune function.  A German study found people who took a regular sauna twice a week had half as many colds.  They theorized that as you inhale the very hot air it might help kill flu and cold viruses. Don’t smoke, statistics show smokers have more frequent and severe colds that more often get secondary complications such as pneumonia.

Regular moderate exercise reduces stress levels with endorphin release and suppression of stress hormones such cortisol, which again help bolster the immune system. Studies found that people who exercise had 23% reduction in upper respiratory infections. Lastly, keep in touch with friends and families research shows people with close ties to friends and family where less susceptible to colds than those socially isolated individuals.

Looking to the future
Looking to the future, exciting new research is showing promise for treating and preventing colds and the flu.  New studies may lead to a single universal flu vaccine. In past vaccines targeted the head of the flu virus, an area that was able to mutate thus requiring yearly new vaccines. This newly discovered antibody targets the stem area of the virus, which is similar in many different types of flu strains and doesn’t mutate much. Another recent study just cracked the genetic code for the common cold by getting the DNA sequence of all 99 different strains of human rhinoviruses. This has allowed researchers to identify areas of similarities thus grouping these 99 diverse strains into 15 smaller similar groups. The hope is to eventually develop classes of antiviral medications and vaccines aimed at these 15 different groups. Researchers believe we may see development of these new types of therapies within the next several years!

But for now, we will have to use common sense and listen to our grandmothers, an ounce of prevention is worth a pound of cure!

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© Dr. Leigh Vinocur, 2022.