Is that sneezing or coughing fit a sign of allergies, a cold, the flu or COVID-19? If you also have a fever — a temperature above 100.4 degrees Fahrenheit or higher — those symptoms probably signal infection and not just allergies acting up. (Wait 30 minutes after eating or drinking to get an accurate measurement.) sestovic/Getty Images
You might have hoped the coronavirus pandemic would cancel what we doctors usually think of as "sick season," but as cool weather signals the annual arrival of autumn allergies, colds and flu in the U.S., sick season is still right on schedule.
In my clinic, that means a flurry of visits and calls from patients worried about their runny noses, coughs and sore throats.
Before the emergence of COVID-19, it was already tough for patients to know how seriously to take those common symptoms. Allergies and colds are mostly just a nuisance, but a severe case of the flu can kill.
Now our unprecedented times are about to merge with the highly precedented. The flu routinely kills between 12,000 and 61,000 people in the U.S. each year, and COVID-19 has already killed more than 200,000, just since February.
Those big combined numbers of deaths can be scary, especially if you've skipped or postponed your usual health routines and check-ins with a doctor this year. Now's the time to get back in gear: Here are a few steps to improve your chances of staying healthy, even during sick season.
Establish a relationship with a primary care provider before you get sick
Do this now. Being an established patient can help you more quickly get in to see a doctor or other health care provider when you get sick. Having a clinician who already knows your medical history when you call helps, too — the clinician may feel more comfortable making certain treatment recommendations online or over the phone and will know when it's better to have you come in for a physical exam because you have certain risk factors.
Keep your vaccinations up to date
Primary care providers, as well as pharmacists, can help track whatever vaccinations you need — and those immunizations are especially important during a pandemic. This fall, as every year, the Centers for Disease Control and Prevention recommends vaccines against influenza for pretty much everyone older than 6 months, including pregnant women and the elderly. The agency also recommends immunization against pneumococcal pneumonia as part of routine vaccines for children and for healthy people age 65 or older, or sooner for some adults with underlying health problems. These are two respiratory illnesses seen more often in the fall and winter months that can turn nasty.
But other serious, vaccine-preventable illnesses can be circulating in your community too — whooping cough and measles, just for starters. Talk to your clinician about which vaccines are appropriate for you and for the kids in your life. There's no benefit to waiting to get this year's flu shot, by the way — the CDC says September and October are "good times to get vaccinated."
Justin Ortiz, a critical care doctor and professor of medicine at the University of Maryland, notes that vaccines are lifesaving in another way this year — by helping to reduce cases of flu and pneumonia that would otherwise deplete resources needed to fight the pandemic. "Severe flu can fill up our hospitals," he says. "If another wave of COVID-19 coincides with influenza and pneumonia season, there will be fewer health care resources to treat both."
Got seasonal allergies that flare in the fall? Nip symptoms in the bud with early treatment
While vaccines can help keep some respiratory infections away, they don't prevent ragweed, pollen, dust or mold in the air from triggering symptoms like runny nose, sneezing, itchy or watering eyes, headache and even fatigue. If you know you struggle with airborne allergens this time of year, start your usual medicines before symptoms develop, or at the first sign, to prevent or help stop the inflammation that makes symptoms escalate. Allergies can develop at any age; if your symptoms are new, talk to a health care provider about your best treatment options.
Timing is key, says Dr. Stuart Cohen, chief of primary care for the University of Alabama at Birmingham: "The one thing we're telling our patients is go ahead and start taking their nonsedating antihistamines or use their steroidal nasal sprays if they usually suffer with allergies. They shouldn't wait until their symptoms progress to start using those every day."
It's important to remember that although allergies can cause upper respiratory symptoms and possibly a change in your sense of smell, they don't cause fever, which is common with COVID-19 and the flu.
And, speaking of fever, be ready to check for one
Keep a thermometer in your home, since checking your temperature is a good place to start in distinguishing allergies from an infection if you're feeling unwell. Just remember the definition of a true fever — a temperature at or above 100.4 degrees Fahrenheit, or 38 degrees Celsius.
Fever is a key symptom that helps clinicians make a diagnosis and decide what level of care you need, so having that information when you first reach out can be important.
Even if you have a slight fever, recognize that your doctor may tell you to simply rest, drink plenty of fluids and "watch and wait" to see how the symptoms develop. Many of the old rules still apply, even in a pandemic: COVID-19, colds and flu are all caused by viruses, not bacteria, so antibiotics won't treat them.
Make online tools work for you
Many medical offices now have links online to help you sign up for a telehealth appointment, even for routine health maintenance. If you have chronic health issues, call or check online with your health care provider soon — before the cold and flu season is in full swing. A clinician can review your routine medications and doses, help make sure you have an ample supply at home and may also suggest more ways you can reduce your risk of getting sick, based on your individual history.
Also, familiarize yourself now, before you get sick, with the CDC's Coronavirus Self-Checker or other online support tools from your local health care system, like this one put together by Johns Hopkins Medicine. These resources can help you differentiate among symptoms and provide a way to search for and contact health care providers if you don't already have one who routinely manages your care.
Keep maintaining social distance, wearing a mask and washing your hands
We're likely to see a jump in coronavirus cases as cooler weather pushes us together indoors for longer periods, so don't let down your guard. These now familiar basics of public hygiene will be even more important over the next several months.
And while the cool air alone is enough to cause a runny nose, it can also be a symptom of the common cold, flu or COVID-19 — all very contagious respiratory diseases. So although wearing a mask when you have a runny nose may be uncomfortable, doing so will help keep you from spreading whatever you have to people you love and will help protect you from catching another bug. Wearing a mask may be even more important if you have allergies that make you sneeze — propulsive sneezes are definitely a way the coronavirus spreads.
When patients ask Ortiz if they can be co-infected with the coronavirus and another virus like the influenza virus, he says "absolutely" and reminds them that though it may feel harder to breathe when you have an upper respiratory illness and wear a mask, covering your nose and mouth this way "won't cause problems with air exchange," even for many people with asthma or COPD. Mask wearers, even those with bad head colds or the flu, can still get plenty of oxygen.
Pay attention to your symptoms and know the red flags
It's helpful to keep track of any respiratory symptoms you develop as they begin or change, to help distinguish the signs of allergies from an infection. But don't go it alone — check with your doctor's office if you're uncertain, to let the office also help you triage symptoms and decide on a plan. And if you have chronic medical problems, especially lung disease, it's important to reach out for care at the first sign of illness.
How do you know if what you're experiencing is an emergency? Some common red flag symptoms that signal you should call 911 include sudden chest pain or pressure; new confusion, a change in consciousness or inability to stay awake; or any signs of a lack of oxygen (such as blue or purple lips or gasping for air).
Bottom line this fall: Don't panic. Do ask for help
Never hesitate to seek help from your primary care provider when it comes to your health worries, no matter how small, because no one is immune to the fear of getting really sick. The medical community has adapted to COVID-19 by building more ways for patients to be informed and get guidance — and this should be welcome news, since good communication may save lives and ease us all through the challenging months ahead.
Kristen Kendrick is a board-certified family physician in Washington, D.C., and a health and media fellow at NPR and Georgetown University School of Medicine.
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October 04, 2020 at 06:00PM
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