Fall is upon us, the leafs are falling, we are all excited to part ways with our summer clothes and put on our fall and winter clothes. Even better holiday season is coming up, lots of delicious foods, couch comas, and family reunions. Indeed an exciting part of the year.
Except for the damn cold. All those gatherings and indoor activities are also a party ground for the viruses that cause the common cold, Flu and Covid. We all dread it and do everything we can to avoid it, and most of us fail. I for one got the flu just a week before Christas in 2014 and Covid just before Christmas 2 years ago. And I am the doctor who should know it all. So, the lesson here is that you can not escape the viruses, no matter who you are.
Well, that was a short and depressing blog. I cant just stop here, I will lose all my audience. So, lets spice it up a little and go over some things you can do to reduce your chance of getting sick and some things that you may be doing that do not really work.
What is a cold any way and how is it different than Flu, Covid?
In short, common cold, Covid and Flu are all the same thing: a viral infection. They are just caused by a different virus. Common cold is caused by many different viruses, but some common ones are rhinovirus, parainfluenza virus and seasonal coronavirus. Viruses are microscopic single organisms that can not survive outside the cell of a living animal. So, they essentially go from one animal to another. They have developed ways of fooling our cells to allow them to get inside. Once inside the animal cell, viruses use our DNA, RNA and protein synthesis machinery to replicate and infect other cells in the body. Each virus has the tendency to attack certain body organs, meaning it has learned to enter the cells of that organ: Each organ has different cells and cell wall proteins, and the virus's ability to enter the cell is if it has the key to that protein on the cell wall, think of the cell wall protein as a gate keeper into the cell, the virus has hacked the code to get in. This is why common cold viruses only cause respitory symptoms and stomach bugs cause GI symptoms.
When we are infected with a virus, we actually do not really know it the first 1-3 days. This is because during this time our immune system has not yet detected or mounted a significant counter offensive against the virus. The main symptoms of a common cold, Flu and Covid actually come from our own immune system, not the virus itself. Once the immune system is activated it initiates a strong attack to kill the virus. This includes molecules called cytokines, machrophages and white blood cells that are designed to kill the virus.
Now, remember, viruses live inside our cells, so in order to kill the virus the immune system actually has a very delicate way of identifying the infected cells and then literally killing and digesting those infected cells. Its like bombing a building that bad guys are hiding in it, in order to kill the bad guys, you just destroy their house. This creates a lot of dust, debris and noise, in our body this creates a lot of inflammation and damage to the organ. This is what makes you feel like crap. Its not the virus itself per se, but the damage caused by our own immune system trying to kill the virus. So, all that sinus congestion, runny nose, cough and nasty fluid that you hack up: most of it is dead cells, viruses, fluid from the inflammation and tissue destruction. And that's why those coughs and snots are contagious, becuase they contain the virus that just got kicked out. If another poor soul is in close contact with you and inhales the respitory virus, or ingest the stomach bug, the virus just got a second chance in life!
Most viruses are eliminated in about 3-5 days. But symptoms such as cough and congestion may last up to 10 days.
What are the main symptoms: you all know it by heart, runny nose, sinus pressure, headache, sore throat, cough and fatigue. Most of the fighting occurs in the first 3-5 days, and that is when you hate life the most. But even after the virus is eliminated, the immune system may take another few days to totally shut down and the infected organ(s) fully recover and rebuild. This is why some of you may have a lingering cough, post nasal drip and sinus pressure and drainage for up to 10 days.
One of the big misconceptions I hear is the period of being contagious. Some people think they are contagious as long as they have symptoms such as that the nagging cough. But you are really the most contagious a day before. you actually feel sick, this is when the virus is having a blast replicating and infecting your body but your immune system has not detected it yet, and the first 3-5 days once you develop symptoms. But for most part, after 5 days the viral load in your system is very low, if any, and you are no longer contagious. Remember, you may still have symptoms up to 10 days from the immune system, but there is no virus in those snots and coughs past 5 days, just your own cells. So you can kiss whoever is willing to kiss you after 5 days.
So, now that you know all about the pathophysiology of colds, lets talk about some myths on how to avoid them.
On a daily basis we are all exposed to many viruses. We inhale them, we ingest them and some may even get into our blood stream. But through the years our immune system has created a massive arsenal of memory immune cells, these are like detectives that float in our blood and line our respitory and digestive system. They detect any virus that they have seen before as an intruder and kill them before they have a chance to infect us. So, we don't even know that we were exposed. We only get infected if the virus is a new version, meaning it has changed its identity (through mutations) and hence our immune system detectives wont recognize it until its too late. Once we are infected, then we depend on other branches of our immune system to mount and offensive. This brings us to how we can help the detectives and other branches of the immune system to work properly:
How to boost your immune system:
Good sleep:. Yes, sleep is very important for a strong immune system. In fact lack of sleep has been shown to weaken our immune system. So, make sure you go to bed in time and get a good 7-8 hours of sleep.
Nutrition: I think you all know this by now, but how you fuel your body plays an important role in how well your body functions. So, eat high quality food and be sure to include 3-4 servings of fruits and vegetables to get all the vitamins you need for a robust immune system.
Exercise: aerobic exercise has been shown to boost the immune system, help clear the airways and reduce risk of viral infection.
Hand washing: I think this one is self explanatory. Now, to be effective, you need to wash at least 10 seconds. Water/soap works as well as instant soaps.
Reduce Stress: I think you have all experienced an illness during times of high stress, This is because stress causes release of various hormones that suppress the immune system and put you at risk of infection. In addition, our sleep quality suffers during stress, increasing our risk of illness even more. It is natural that we all will have times of stress in our life, but if stress is a constant daily part of your life, you need to take steps to reduce it.
Vaccines: vaccines are essentially dead viruses, viral parts or in case of the new Covid vaccines mRNA of viruses (part of their DNA) that remind our immune system of that particular virus. When you get a vaccine you actually "infect" your body with that virus, so the immune system gets a refresher and increases the amount of those circulating detectives. So, when the actual virus gets in, there are lots of detectives waiting to kill it before it has a chance to infect you. This is why you actually may feel a little sick the next day after a vaccine, because your immune system has mounted an offensive. Its a good thing! Now, the vaccine itself is made of inactivated and incomplete parts, so it is physiologically impossible for you to actually get infected. The protection usually takes about 2 weeks, this is the time it takes for your immune system to create enough detectives and deploy them to appropriate body parts. So, don't feel too confident the day after your vaccine or blame the vaccine if you so happen to get sick within that 2 week period.
Fever: fever is body's natural defense system to kill viruses. Our immune system works better and faster at slightly elevated temperatures whereas viruses slow down at those higher temperatures. So I actually tell my patients to avoid taking anti-fever medications like Tylenol/Ibuprofen unless the fever gets too high, generally above 102. The important thing is to maintain hydration as fever leads to loss of body fluid through skin perspiration and water vapor in breathing faster. So, get yourself some blankets, and binge watch and nap during those fever and chill cycles.
Antivirals: In case of Flu, the antiviral Tamiflu does work quite effectively to shorten the duration of symptoms if taken within the first 24-48 hours of symptoms. For those exposed, there is also a prophylactic dosing. Tamifu is quite safe and has no significant interaction with other medications. So call your doctor right away if you have flu or been exposed. For Covid, Paxlovid does work to shorten the duration of symptoms but not that significantly. In addition, it may interact with other medications and put you are risk of rebound Covid in 2-3 weeks. So talk to your doctor if you have Covid, depending on your risk factors and illness severity Paxlovid may or may not be an option.
The Myths:
Vitamins supplements; I think by now most of you know my stance on vitamins and supplements. So, it will not be a shock to you if I say there is NO scientific data to support the claim of taking vitamin C. In fact studies have shown that taking vitamin C does not prevent getting sick or improve the outcome ( one study showed that it may reduce the duration of symptoms by 1/3 of a day, but other studies did not even show this minuscule benefit). So, unless you hate fruits and vegetables and are not eating your three servings, there is no reason to load up on Vitamin C or any other vitamins during the cold season. Use that money to buy stocks, bitcoins or whatever else you want, but please do not buy Vitamin C.
Zinc: well, I have to be honest, I had not heard this one before, but it came across on my research for this blog. There were anecdotal studies in 1980s that showed Zinc blocks the the virus from entering cells in the test tube. But human studies have failed to show any significant benefit. In addition, zinc can have significant side effects if taken intranasally (loss of smell) or. orally (nausea, vomiting).
Echinacea: this was quite popular few years back, but research has not shown any significant benefit in preventing or treating colds. In addition, the various brands have different preparations as these are not regulated, so the benefit and risks are not well established.
Antibiotics: This one is near and dear to all of us primary care doctors. In the old days doctors use to give antibiotics to anyone with any sign of a cold. I know I got my share fare of them when I was a snotty little kid. But we now know that antibiotics do not in any shape or form help with viral infections. So, you may ask, why did. I feel much better after taking one day of my Zpack. There are 2 reasons: first is that by the time you call your doctor, get a response and your antibiotic, you are most likely already on day 2-3 of your illness, and remember I told you the main symptoms of viral infections last 3-5 days. Well, it just so happen that most people get their antibiotic just around the same time that the virus's natural life cycle is about to end, so you would have felt better regardless. This is called a coincidence! Another reason in case of a Zpack in particular is that Azithromycin, or Zpack, also has a small amount of anti-inflammatory effect, so it does make you feel better just as if you had taken Iburpfen or Aspirin. You do not need antibiotics for few days of cold symptoms. If your symptoms last longer than 10 days, or if you start getting worse after an initial recovery phase, these are sigs of bacterial infection and antibiotics may be indicated.
Ok, lets end this blog by talking about what does work to treat viral infections. Incase of Flu and Covid, we now do have antivirals that work effectively if taken within the first 24-48 hours of symptoms. Although Paxlovid (the antiviral against Covid) does have some risk factors and medication interferences. As for common cold, unfortunately there is no treatment. So, rest, hydration, fruits and vegetables, and good sleep is really all we got. I am working on a treatment, at which case I will strike gold, get very rich and buy myself and Megan a private island in the Caribbean and you will never hear from us again.
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