Influenza vs. the Common Cold

Family Medicine Physician Sean Wherry, MD, talks with KNSI's Bob Hughes about the difference between influenza and the common cold, what symptoms could mean a trip to the doctor and busting some of those old wives’ tale remedies.

Bob Hughes: We’re seeing an increase in flu now that it's winter, what should we know?

Dr. Wherry: Influenza has an annual pattern to it as it moves geographically across the world. For North America, particularly in the Midwest, it hits during wintertime. As we move further to Alaska and the West Coast, it hits a little bit later. From an epidemiology standpoint and a public health standpoint, those locations will vaccinate a little bit later in the year as that virus moves west.

Flu is probably the most significant viral infection that we’ll see in the community. Flu, to a lot of patients, often meant stomach flu, nausea, vomiting, things along those lines. But it’s important to understand that when we’re talking about influenza, we’re actually talking about a respiratory disease rather than a gastrointestinal disease. Flu is going to be much more severe than the common cold.

Bob Hughes: What are the symptoms that differentiate a cold from influenza?

Dr. Wherry: I will ask my patients “How long did it take you to get sick? Do you feel like you were hit by a bus?” Flu comes on very, very quickly and is often associated with high fever and malaise, which is just the feeling of yuckiness, achy body, significant cough, oftentimes a headache. The cold viruses is what we call an upper respiratory tract infection. It usually kind of starts at the top of your head and kind of moving down — runny nose, some sneezing, increased congestion and then you’ll develop a cough as well. But usually what’s absent is going to be the high fever, the significant amount of body aches and the significant amount of general fatigue. That’s not going to be present in the cold.

Bob Hughes: How long could someone have the flu compared to the common cold?

Dr. Wherry: It depends upon the individual and on their other health problems. The flu, in general, if we don’t treat it — and we do have a window to treat it — typically two weeks.

Now an upper respiratory tract infection also can last a while. But more often you’re going to be closer to that seven-day mark where the symptoms have peaked, and you’re starting to feel better. However, it’s not uncommon if somebody has a good upper respiratory tract infection with a cough, that tickle cough can really linger on for up to a month. But in the absence of fevers, chills, worsening symptoms, generally those people are feeling better.

Bob Hughes: What about remedies at home when you get the flu or cold?

Dr. Wherry: It’s fluids, rest, listening to your body. The old adage of “Feeding a fever and starving a cold” — there’s no evidence for that. If you’re hungry, eat. Listen to your body.

With the common cold, there are a lot of over-the-counter medications. There’s not great evidence that any of those are really going to do anything. Certainly, they’re not going to speed the resolution of the symptoms, but they can sometimes help you feel a little bit better temporarily.

We do recommend that children don’t use the over-the-counter medicines with respect to multi-symptom relief. And that’s because the evidence right now doesn’t suggest that it really does much so we don’t want to put a pediatrics patient at risk if it’s not going to change the course of the cold.
The ones that we do use often and seem to at least help people feel better are things like Tylenol, ibuprofen or Motrin, both which take away aches and pains, swelling and fevers.

A lot of times, people are looking for the nonmedical ways trying to manage their symptoms. Saline sprays, the neti pots and the saline rinses work well from that standpoint. Warm showers can sometimes help loosen up some of that phlegm in those upper airways and get some of it moving out.

You got to understand that our body is designed to fight these things and you’ve got to give it the ammunition to do that and that’s going to be predominantly fluids and rest — not allowing yourself to get to rundown and then making sure that you’re staying well hydrated.

Bob Hughes: How important is prevention and how can we prevent ourselves and loved ones from getting sick?

Dr. Wherry: Trying to prevent them in the first place is our first line of defense. That comes in the form of vaccinations when available, it comes in the form of washing your hands. If you’re sick and you have a fever, don’t go out, don’t go to school. If you’re coughing, cough into your elbow rather than in your hands.

Bob Hughes: How do we know when it’s time to come see you? That it has gotten bad enough?

Dr. Wherry: First, if ever you were concerned, I want you to come in and see me because part of my job is education. Anytime that a patient is concerned that they’ve been sick long enough. Or if they get a funny feeling about the kid, I want to see that kid.

In general, I would typically want to see someone with a high fever. When we’re talking influenza, particularly in a healthy population, we only have about 48 hours after the onset of symptoms to really make a significant change in the duration with the use of some of our medicines. So high fevers accompanied by significant body aches and things along those lines that were rapidly onset, we want to see them relatively quickly. Any evidence of shortness of breath or increased work to breathe, like using muscles in their neck to help breathe, those are all reasons we really want to see them and make sure that they're doing well from a respiratory standpoint.
A lot of times when I actually see people, it’s usually when they’re just sick and tired of what’s going on. It’s usually three to five days into an upper respiratory tract infection where they just want it to end.

Bob Hughes: Besides going into the doctor’s office, what other options are out there to get better quickly?

Dr. Wherry: We do have a lot of options for care. The front door to it would be CentraCare.com or CentraCare Connect which is available 24/7 to communicate via text, phone and chat. CentraCare Connect has access to both schedulers and nurses who are trained to triage. So, you can talk to the nurse about your symptoms and they can help you find the most appropriate level of care for you.