According to the website “Grammar Monster“, the phrase “under the weather” is a nautical term first used on sailing ships. If a sailor was ill, he was sent below deck to protect him from the harsh weather. Therefore, he would be sent down to get “under the weather.” Nowadays, we use it synonymously with “caught a cold” and “feeling ill” to let people know we have common cold symptoms.

Since everyone in Denver, including myself, has common cold symptoms this week, I thought I would go ahead and write about it. A cold is frustrating. It is ubiquitous during the winter. It can mimic other illnesses. There is no cure for it.

The common cold is very different from the flu and from COVID. While they are all caused by viruses, the flu is caused by the influenza virus and is much more severe. The CDC has a good chart showing the differences between the two: CDC Cold Versus Flu

Common Cold Stats

The most recent data on the cost of the common cold was done in 2003 and is published in the February edition of the Journal of the American Medical Association (JAMA). At that time, it was estimated that the common cold costs the US economy $40 billion every year. This cost comes from a combination of medication costs, copays, and loss of productivity. Interestingly, the loss of productivity was the largest cost at $25 billion. The common cold causes 500 million infections per year. These infections lead to an estimated 110 million doctor’s visits, 23 million telephone calls with doctors, and 6 million ER visits.

As a doctor, treating the common cold can be very unsatisfying, mostly because we have no fix for it. We can treat symptoms, but, oftentimes, I find myself telling patients it will just have to run its course. The common cold is caused by rhinovirus, and like all viruses, it does not respond to antibiotics. It is important to distinguish a common cold from bacterial sinusitis, which does respond to antibiotics. The guidelines that I follow to determine this are from the Infectious Disease Society of America (IDSA):

When To Use Antibiotics

The following clinical presentations (any of 3) are recommended for identifying patients with acute bacterial vs viral rhinosinusitis:

• i. Onset with persistent symptoms or signs compatible with acute rhinosinusitis, lasting for ≥10 days without any evidence of clinical improvement (strong, low-moderate);
• ii. Onset with severe symptoms or signs of high fever (≥39°C [102°F]) and purulent nasal discharge or facial pain lasting for at least 3–4 consecutive days at the beginning of illness (strong, low-moderate); or
• iii. Onset with worsening symptoms or signs characterized by the new onset of fever, headache, or increase in nasal discharge following a typical viral upper respiratory infection (URI) that lasted 5–6 days and were initially improving (“double-sickening”) (strong, low-moderate)

Why Can’t We Use Antibiotics For Everything?

We try to limit antibiotic use to bacterial infections only for a couple reasons. One reason is that all antibiotics have side effects and if the antibiotic is not going to help you at all then any side effect is an unnecessary risk. Another huge problem caused by the over use of antibiotics is the risk of bacterial antibiotic resistance.

A good example: I imagine most of you have been prescribed a “Z-pak” in the past. This is a course of azithromycin in which you take 2 tabs on the first day and then one tablet daily for a total of 5 days. Z-paks were very popular in the past to treat sinus infections and other bacterial infections. However, due to that popularity, rates of antibiotic resistance are climbing. Strep pneumonia is a bacteria that commonly causes sinus and ear infections. It now has a 30% resistance rate to azithromycin. A resistance rate this high has made azithromycin essentially obsolete. The IDSA no longer recommends azithromycin for the treatment of bacterial sinusitis.

Over-The-Counter Treatments

So to treat the common cold, over-the-counter regimens and saline nasal rinses are usually recommended. For specifics please ask your doctor and be sure to review my article on The 5 Most Dangerous Over-The-Counter Medications. Vitamin C and Zinc are both very popular natural treatments for the common cold. Data on these treatments are mixed. In fact, I don’t have a strong recommendation on these either way. I generally tell my patients that there is little data to support the use of these supplements, however, if taken in the proper dose there is little harm. You can review some of the data online here: Zinc for the common cold and Vitamin C for the common cold.

Cold Prevention

You can’t catch a cold from being cold outside or from not drying your hair in the winter. You have to come in contact with the virus. The best way to avoid infection is to wash your hands well, wear a mask in high risk places, or avoid indoor gatherings all together if you can. Be sure to stay home from work if you are ill. Your coworkers will thank you for it. Don’t shake hands during cold season, an easy fist bump will do. Sneeze into your elbow or shoulder, germs can travel 19 to 26 feet at 100mph if not blocked. Read more about prevention at the CDC.

I hope this is helpful and maybe some of this information will help to curb the cost of the common cold and to curb the rise in antibiotic resistance. As a Wise Patient, I want you to understand the costs, risks and limitations that we face in treating such a common illness. But for now I am going to go drink some tea and take a nap, because right now, I’m still under the weather.

This article was written just before COVID hit the US. The CDC is still the best resource for COVID information. Need to know what risk factors you have for COVID? Check out: Top 7 Conditions That Put You At Risk For COVID-19