You don’t need a doctor to tell you that viruses that attack our noses and throats and lungs are really letting us have it now, they are in full force, and we are all pretty sick.What is going on?
The answer involves taking a fresh look at problems that predate COVID by about 10,000 years or more- the viruses that cause colds, including influenza and RSV.
Let’s start with what is a cold. I don’t know about you, but I hate having a cold. And when I am in the grip of one, I keep thinking this little word, cold, is really the wrong word for it. We used to call it the grippe, because we really are in the grip of something horrible when we get a cold. Or the ague, because the achiness is a torture too.
So really, what is going on when we have a cold?
The best answer is that a cold is nothing less than a virus burning off the lining of your nose, throat and lungs. So many viral infections involve the burning off of the lining of some part of the body. Viruses that cause stomach flu burn off the lining of the stomach and intestines. And for colds, the virus burns off the lining of the inner tissues that touch air- nose, throat, lungs, as well as eyes.
How do we know that? Three ways:
First, a way we can tell a virus is infecting you is by taking a sample of the infected area and swab it in the lab on a sheet of cells called a tissue culture. If a virus is there, it will kill that sheet of cells.
Second, in studies of colds, samples of the lining of the nose, throat, and lungs reveal that the lining is destroyed in large areas
Third, all the mucus that comes with a cold contains elements of the destroyed lining sloughing off
Now, not all viruses can infect the lining of airways, it is a specialty limited to a group of viruses called respiratory viruses. These viruses are now all too familiar to us all. They include the influenza, RSV, rhinovirus, and coronaviruses, as well as some lesser known ones such as the adenoviruses and parainfluenza viruses.
This list of viruses is a list of Species NOT Diseases. By this I mean that all the species listed here can give you a cold. No one could possibly tell if your cold (or flu) is caused by which of these species of virus by talking with you or even examining you. Everyone of these viruses can cause exactly the same sort of cold as each of the others. With the exception of COVID-19, none of the other respiratory viruses cause any troubles unique to their species.
So what do all these species of cold viruses do when they attack? In every instance, the symptoms result from harm done to the lining of whatever part of the airway they hit, let’s take a tour of our airway and we will find a tour of cold symptoms:
IF the virus, WHATEVER the species, attacks THIS part of your AIRWAY, here is the symptom that happens:
- Nose- runny nose
- Throat- sore throat
- Vocal cords- stridor and croupy cough if young, hoarse if older
- Trachea, bronchi, and lungs- cough, and at times wheeze
- Eyes- pink eye
In fact, when you have a cold, you can know exactly where the virus is burning a layer of cells. If you have only a runny nose, the burning is localized to your nose.
Typically all the respiratory viruses land on top, starting with the nose and then burning down to the lungs. Hence the start of a cold commonly starting with a runny nose, then sore throat, then cough. But it can happen in any order and any combination, all depends on where the virus burns.
Now, let’s talk about some now very famous specific species of virus, the influenza and RSV.
Unique to all respiratory viruses, the influenza virus changes, or mutates, in a regular, very constant, always annual manner. Every winter it infects humanity and every summer it infects barnyard animals. To go from infecting people in January to infecting pigs, horses, cows (hence swine flu and bovine flu) in July, it must mutate and so every winter we have a slightly altered set of influenza viruses.
This is why we can do a new flu shot every year. Because every spring and early summer, stations around the world sample influenza viruses in barnyards around the world, find the new mutations, and create a new vaccine for the coming winter. It is an astounding effort and success!
Here in NE Ohio, the influenza virus completes its journey from animal to people in mid-December, almost every year. And this pattern has repeated regularly over many decades, perhaps centuries.
The exceptions include influenza pandemics, and then the last few years.
The pandemics happen when the mutation in animals creates a very different strain, and the influenza virus goes rampant, at odd times of year. This was seen in 1918 causing the worst loss of life in the shortest time from a virus that we know of in history. But there are far milder pandemics of influenza virus, the most recent being in 2009 when it hit in the spring.
The last few years saw the impact of the COVID-19 pandemic on the influenza virus epidemics. A couple of years ago, for the first time in recorded human history, there was no influenza epidemic, none. This was staggering, welcome, but staggering. No one knows for sure why this was, but it did occur during lockdowns, masking and distancing, so that may have been why. Last year the influenza winter epidemic arrived right on time, but was strikingly mild.
Now, and we mean right now, the winter influenza epidemic has hit very, very early. It has appeared intensely in the Southern US in October or earlier, instead of mid-December, and it is more intense than ever in the early weeks. Typically a flu epidemic will start off slowly and gradually infect every part of the US at greater and greater frequencies. Not this year, the influenza virus is at high levels of intensity right off the bat, all across the South and spreading to here, all in October.
As we will see with every respiratory virus but the one causing COVID-19, there are no good drugs to kill off the virus. In the case of the influenza virus, Tamiflu has been touted as a solution, but it is completely ineffective after 2 days of symptoms, and even at its peak success rate early on, in mild infections, the level of help is pretty tiny. It is a useful drug to make a difference when influenza infection is severe enough to cause hospitalizations. But for the vast majority of children with influenza infection, admission to the hospital is rare, and the help from Tamiflu is not worth the risk of seizures it can cause in childhood.
Now our tour of respiratory viruses comes to our next species, the Respiratory Syncytial Virus, or RSV. For some reason, this virus, the RSV, has attained a very loud sense of alarm. RSV has long been known to cause wheezing colds in infants, but really it is one of many viruses that cause colds.
RSV got its name because in the lab, when you drop some RSV’s on a sheet of cells, before it kills the sheet of cells, it merges the cells into many very large cells with many nuclei. The very large cell with many nuclei that results from this merger is called a syncytium and since the damage is done mostly to the cells of our airways, it is called the Respiratory Syncytial Virus.
In talking about RSV, it is good to really make the distinction between the species of the virus infecting your child, and how sick they are. Easily the most severe respiratory infection, outside of COVID, I have ever seen was caused by a virus that almost no one cares about, the rhinovirus. The rhinovirus causes most of the colds in children and adults. But like any cold virus, it can cause very severe illness. And like any cold virus, it can cause very mild illness.
Just as for rhinovirus, so too for RSV, and influenza, and all respiratory viruses. Each infection in a child with any of these viruses can be very mild, just a sniffle for a day, or very severe, requiring hospitalization, or any level of severity in between. The species of the respiratory virus cannot tell you how sick the infection your child has now will be. So it does not good to know the species to know how bad the infection will be.
We make this point now with RSV, because the news that RSV was detected in a child in your child’s classroom or day care center currently causes great alarm. The sense out there is that RSV typically causes very severe illness. But it needs to be stated clearly that RSV does NOT typically cause severe illness. It can, but so can every cold virus. RSV may even be more likely to cause severe illness, but it still doesn’t do so in most instances.
The key point, and it really is a very important point, is that the severity of your child’s current cold is determined solely and entirely by the severity of their symptoms, with this illness, not any pattern seen in others.
Soon we will present what gives and indication of worrisome severity, but the name of the species is not one of the indications, or all that helpful in determining if this cold will get worse, or not.
TREATMENT OF COLDS
This will be a very disappointing section. As of the fall of 2022, medical science has not yet developed any medications that have much impact at all on cold symptoms. With one exception- ibuprofen. Acetaminophen also can help with fever control, but readers of Real Answers will recall that we recommend ibuprofen given concerns about use of acetaminophen and increased risk of developing asthma.
Ibuprofen helps reduce fever and achiness and pain, so if your child with a cold has fever, or achiness, or pain, ibuprofen can help. But it is not very helpful to reduce cough, runny nose.
But what about all those aisles of cold remedies at every drug store and grocery store? And if there are no cures, don’t some of these meds at least help relieve the suffering caused by runny nose, sore throat, and especially cough, even a little bit? Just a bit?
I really wish the answer was yes. Having suffered some nasty colds recently myself, the agony of the symptoms cries out for relief.
But in every honest study of these meds, the cough syrups, the expectorants, the decongestants, the antihistamines, we find that kids who take any of these meds continue to have just as much runniness in their nose, just as sore a throat, as many coughs an hour, and as many days of cough as those who take water. The sad truth is that they simply do not work.
So what to do?
A great help with coughs comes from the fact that when you swallow anything, you cannot breath, at all. That’s a good thing, since you don’t want to swallow fluid or food into your lung. The airway seals with a swallow, which not only halts breathing, but coughing too. So if you increase the time you swallow, you decrease the time you cough. That’s why sipping fluids, or sucking on any thing like cough drops or candy, will decrease cough, at least while you are swallowing.
Since all the symptoms of cold come from a virus burning the lining of your airway, breathing in warm, very moist air is comforting too. That can be done with a humidifier, or sitting in a bathroom misted with a hot shower, or if older, simply breathing while a cup of hot water in near your nose.
WHEN TO WORRY
As noted above, with the exception of the virus that causes COVID, the name of the virus does not help anyone know if the illness will be of concern or not. With COVID we know to be concerned about spread and diagnosing it leads to quarantine. We do not quarantine for other colds, whether caused by influenza, RSV, rhinoviruses, or other viruses. And that’s good because one is typically contagious with cold viruses, except COVID, for about 3 weeks!
So how to tell if your child’s cold is worrisome and needs medical attention, if not by testing the name of the virus?
The symptoms that raise concern are few in number, can be observed, and should be your key guide to knowing when to worry when your child has a cold:
- Struggling to get air in and out of their chest. This is different than having a clogged nose, this is about if your child is moving air in and out of their chest comfortably. If there is any question about this, we need to see your child, or their doctor does. If the struggle seems at all severe, go straight to the ER. But if the air is flowing nice and easy, they don’t feel good, their throat hurts, their nose is full of mucus, their cough is really bad, but when not coughing, breathing is comfy, then this issue is not present.
- Severe pain. Colds nearly always cause misery, but not severe pain. The nasal infection causes quite a bit of nasal irritation, and sore throats hurt quite a bit. Coughs are a tremendous source of misery, but don’t typically cause severe pain when not coughing, or even with a cough. So if severe pain shows up, we have to consider the situation as going beyond the usual cold. If the pain is severe enough, proceeding directly to the ER is advised. If you are unsure, definitely give us, or your doctor, a call.
- Stiff neck. Colds often cause the neck to be sore, but not stiff. Stiff means you can’t move it, not that it hurts to move it around, but that it won’t move. If you can touch your chin to your chest, your neck is not too stiff. If there are any questions about this being present, do call us or your doctor.
- Dehydration. Dehydration requiring IV fluids is very unusual with colds. It is seen more often in the vomiting and diarrhea of stomach flus. Everyone with a cold can get dry. The nose gets dry, the mouth gets dry. But with a cold, your child is typically able to drink all they want and that is the best way to avoid dehydration. We would be concerned if dehydration is present if your child stops peeing, if their mouth becomes dry and lips cracked, if their eyes look sunken, and if they start looking a bit wilted. If there are questions about if actual dehydration is present, do give us, or your doctor, a call.
- Colds a great scourge of humanity and childhood, they cause and bring an astounding amount of misery to us all.
- Thankfully, most colds in childhood, even infancy, are mild, may cause lots of awful symptoms, but no harm, and pass leaving the child as fine as before the cold.
- Rarely, colds can cause more serious illness. The key signs of such are trouble getting air in and out of the chest, severe pain, stiff neck, and/or true dehydration. If these signs show up, seek medical attention.
- All colds are caused by a group of viruses called respiratory viruses, the group of all viral species that have figured out how to infect human tissues that touch air, but still inside the body.
- The species that are included in human respiratory viruses include some familiar, some unfamiliar names:
- Rhinovirus is the most common cause of colds in humans
- RSV- for some reason a species generating a lot of attention and dread
- Influenza virus- the well known and unique respiratory virus that mutates with much regularity in the spring and summer, coming back to our region typically in mid-December through –April every year. COVID has disrupted this pattern.
- Old coronaviruses. Four coronaviruses that do not cause COVID have been causing about 25% of all common colds in humanity for the last 8,000 years.
- Parainfluenza viruses
- Each species of these viruses, and others, that cause colds can cause very, very mild illnesses all the way to very dangerously severe respiratory illnesses, including pneumonias. Knowing the name of the species causing your child’s cold WILL NOT tell you how severe the illness will be.
- This year for some reason, RSV which has been around likely for thousands of years, has achieved great notoriety. We now often hear of this school or that day care having an outbreak, reminiscent of the dread that accompanied hearing of an outbreak of COVID. But RSV is not COVID. It can cause serious respiratory illness, but so can all the cold viruses listed above. And it can very easily cause very mild colds, just like all the cold viruses listed above. Being diagnosed with RSV does NOT determine that your child will have a serious cold.
- BY FAR the most important way to know if your child’s cold will be mild or severe, is to watch them. If the cold remains mild, a bit of sniffles, a mild cough, better in a day or two, then you can be confident your child’s cold was mild, even if the virus was in the species of RSV or influenza. Of course, if the symptoms are more severe, a very upsetting runny nose, a very sore throat, and horrible cough, then you know it is a more severe cold, even if it is not RSV or influenza.
- Sadly, even in the era of mRNA vaccines for COVID, there are no known substances that relieve a runny nose, or cough very much at all. Swallowing can soothe a sore throat and interrupt coughing, so increasing swallowing by sipping fluids does help. But decongestants, cough syrups, and expectorants have repeatedly failed to demonstrate any relief in test after test and in real life. Every day we see children with very uncomfortable colds, with terrible coughs and noses despite days of use of these largely fraudulent cold remedies.
- We do not quarantine for colds. They are already everywhere, and since one is often contagious for 3 WEEKS, unless you remain fully isolated for 3 weeks, you will be spreading it anyway. It is a very different situation than for COVID where a quarantine of as little as 5 days can slow spread.
- It bears repeating that the key to staying safe with colds is to seek medical attention if your child with a cold has any of the signs of more serious disease: struggling to breathe, severe pain, stiff neck, and or serious dehydration.
We are experiencing very, very intense levels of colds. The respiratory viruses seem to be feasting on us all. As noted the influenza epidemic of 2022-23, due to hit in mid-December, has arrived at least 2 months early and has started off more intensely than usual. RSV is up, all cold viruses are up. So millions of us, likely nearly all of our children, will be getting colds this fall. And COVID continues to vary and therefore will continue to spread.
So get a flu shot and the full COVID vaccination series for everyone in your family 6 months old and up. These are the ONLY steps you can take to actually shield your and those you love from colds, that miserable disease.
To your health,
Dr. Arthur Lavin