Once upon a time, say 2019, scratchy throats and runny noses were expected realities of the common cold — nothing some tissues, Vicks VapoRub and time couldn’t fix. But the pandemic, for better or worse, has fundamentally shifted how we think about respiratory illnesses and the hundreds of viruses that cause them.
Headlines warning of new Covid variants; unseasonal surges of flu, RSV and human metapneumovirus; and unusual symptoms stemming from viruses that usually cause cold-like symptoms, including adenovirus and enterovirus, have made many of us hyper aware of the germs that make us sick.
But is the extra attention and worry over what exactly is causing your stuffy nose or cough necessary?
Put simply, no, experts say, but there are some exceptions for people with weakened immune systems.
People want to know what’s wrong with them and saying it’s just a virus is not good enough anymore.
Dr. Chris Chao, urgent care physician
“During the pandemic, we generally ran every test available because we wanted to know if it was Covid or if there was an alternative diagnosis, but this over-testing has carried into this post-Covid era,” said Dr. Chris Chao, an urgent care physician at WakeMed Health & Hospitals in Raleigh, North Carolina, and president of the College of Urgent Care Medicine. “People want to know what’s wrong with them and saying it’s just a virus is not good enough anymore. Everyone who comes in with a sore throat now wants a strep, flu and Covid test, but in most cases none of that’s really indicated.”
Respiratory viral panels can detect more than a dozen viruses at once, including influenza and SARS-CoV-2, the virus that causes Covid, as well as a number of viruses that cause colds: RSV, adenovirus, rhinovirus, enterovirus and HMPV.
However, for healthy people with mild cold symptoms, doctors say these tests are not worth the cost because treatment — hydration, rest, cough suppressants if needed — is the same for most viruses. (Viral infections are not treatable with antibiotics.)
Plus, test results, positive or negative, can be wrong and are often unreliable indicators of active infection.
“Every test has the right place and time,” Chao said. “But if a test is used inappropriately, you’re going to get bad data, like false negatives and false positives, and the unintended consequences of that can be just as severe as missing a diagnosis.”
Is my cold different?
Covid has also made many of us forget that it takes time to recover from a cold, said Dr. Jason Bae, an urgent care doctor at Palo Alto Center Urgent Care in California. Up to 50% of his daily cases are cold-related, with most patients wondering why they’re still sick after a couple of days. But most colds can take a week or more to leave your system, according to the Centers for Disease Control and Prevention.
On average, adults will get two to four colds per year, while young children will get anywhere from six to eight, the American Lung Association says.
Immunity to respiratory viruses, however, has waned after years of isolation and mask-wearing, especially among kids, Bae said, so some people may be sick for longer periods of time as their immune system catches up.
Knowing which virus is causing a cold is helpful and sometimes necessary for immunocompromised people, including those with HIV, cancer, or chronic kidney disease, because a virus could morph into something more serious, such as a secondary bacterial infection.
Rhinovirus C, one of the most common cold-causing viruses, can lead to bacterial pneumonia in children who have or are susceptible to asthma, said Ann Palmenberg, a researcher and professor with the Institute for Molecular Virology at the University of Wisconsin-Madison.
“In other cases, a child gets a rhinovirus B infection, nobody cares and they’ll get over it,” said Palmenberg, adding that a typical child gets about 13 rhinovirus infections per year, many of which never cause symptoms — and that doesn’t include all the other germs they catch.
Much of the paranoia surrounding common colds at this stage of the pandemic “comes from ignorance about how our microbiome and immune systems interact with the environment,” Palmenberg said. “We’re supposed to be exposing ourselves to germs because that’s how you develop immunity, a lot of which is cross-protective with a great number of viruses.”
The good news, she noted, is that cold-causing viruses aren’t behaving any differently and haven’t changed on a molecular level since Covid took over.
When are colds a cause for concern?
Still, what is harmless to one person could be deadly to another.
Katherine Zitterbart learned she had stage 3 breast cancer in 2020. The 53-year-old from Pittsburgh said she spent the first two years of the pandemic alone in her apartment, fearing Covid would kill her as she underwent a mastectomy and aggressive rounds of chemotherapy and radiation.
Since testing positive for Covid in January, Zitterbart has developed chronic nasal congestion and a potentially deadly allergy to peanuts, among other disabling conditions. Now, something as trivial as a cold could seriously threaten her already vulnerable health.
“When it comes to a cough, cold or sneeze, I’ll get a spike of, ‘Oh my gosh, is this another infection?’” Zitterbart said.
Other people who develop such symptoms are not as concerned.
Dr. Sterling Ransone, a family medicine physician at the Riverside Fishing Bay Family Practice in rural Deltaville, Virginia and board chair of the American Academy of Family Physicians, said most of his patients are so fatigued from the pandemic that they don’t realize or care that their persistent cough could be caused by a respiratory virus they’re likely spreading to others.
“People come in for their blood pressure or diabetes check and say, ‘By the way, I had a fever last night and I’ve been coughing for the last five days,’” Ransone said. “When I tell folks they might have a virus, I don’t see a lot of fear,” especially since the national public health emergency for Covid ended in May.
That said, it’s important to know when a cold does warrant a trip to your primary care doctor, urgent care clinic or emergency room.
Here are some signs that medical attention may be needed, according to Ransone and the CDC:
- A fever that doesn’t improve over two to three days with fever-reducing medications.
- Symptoms that improve but then quickly worsen.
- Infants younger than 3 months old with a fever of 100.4 degrees or greater.
- Feeling “air hungry” — when you feel like you can’t get enough air or complete a sentence without shortness of breath.
- Pulse oximeter readings that drop below 90%.
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