Flu and RSV and COVID, oh my!
It may feel like everyone you know is sick right now- and it is true! There are a LOT of different viruses going around right now. If you have not been sick already you likely will be soon. Realistically, we cannot (and really shouldn't need to) see a doctor every time we have viral respiratory symptoms. I do my best to maintain availability for sick visits the same or next day for my patients, but if everyone is sick simultaneously there is a limit to what I can do- I am just one person and there are only so many hours in the day! I want to make sure that everyone who needs my attention is able to be seen which means I physically can't see everyone. The good news is, there are plenty of things you can do at home to manage your symptoms safely!
Below I will provide some guidelines on when you can safely manage your symptoms at home, some medication and home remedy recommendations, as well as guidelines for when you do need to contact your doctor or seek emergency medical care. If you are not my patient, always be sure to discuss your specific circumstances with your own physician. If you are one of my patients, when you contact me- please do so as early in the day as possible and give as much detail as you can about when your symptoms started, what symptoms you are having, and any at-home testing and treatments you have done so I can best triage each patient.
Common Symptoms and How to Manage Them
Runny nose, nasal congestion, mild cough without difficulty breathing: These are typical symptoms of a respiratory virus and will get better on their own. Most viruses will have the worst symptoms on days 3-5 of illness then will improve on their own. Cough can persist for up to 6-8 weeks but should be gradually improving throughout that time. Warm humidified air and nasal saline rinses can help with congestion. For young kids who can't blow their nose, a nasal suctioning device like a NoseFrida can be used after applying saline drops to remove mucus. Honey can soothe a sore throat and help reduce cough but cannot be given to children under 1 year old. Mucinex DM can help make it easier to clear mucus and suppress cough. Sudafed (containing pseudoephedrine- the kind you get from the pharmacist behind the counter) is the best medication for nasal congestion. Sudafed is not appropriate for people with high blood pressure, so if you have high blood pressure I recommend Coricidin HBP. These medications are not appropriate for some children so be sure to check the medication instructions and contact me if you are not sure. Antibiotics are not appropriate treatments for respiratory viruses- they will not help you get better any faster and they can cause other side effects. Green mucus does not necessarily mean you have a bacterial infection. If cough is not improving as expected or is getting worse after 7-10 days, or there is any wheezing or difficulty breathing, you should seek medical evaluation.
Sore throat: If accompanied by nasal congestion, runny nose, and cough, this is likely viral. Honey, Chloraseptic spray, and salt water gargles can help soothe sore throat. Ibuprofen and/or Tylenol can also be used as needed for pain. If there are no other respiratory symptoms, if the sore throat is accompanied by a fever, significant redness, swelling, or white patches on the tonsils, or if you have known contact with someone who had Strep throat then you should seek medical evaluation for possible Strep testing.
Ear pain: If accompanied by nasal congestion, runny nose, and cough, this is most likely viral and will improve on its own as other respiratory symptoms improve. Ibuprofen and Tylenol can be used as needed for pain (no ibuprofen for kids less than 6 months old), but treating the congestion is the most important thing (using Sudafed or another decongestant). If ear pain is accompanied by fever, lasts more than 2 days, if you have significant hearing changes, or in a child with known history of ear infections, please seek medical evaluation to examine the ear.
Sinus pressure: This is usually related to other viral symptoms (nasal congestion, runny nose, cough, etc) and antibiotics are not needed in most cases. If sinus pressure is persisting for more than 10 days, gets better but then gets worse again, or is accompanied by a new fever later in the course of illness, eye pain, or tooth pain, this is more concerning for a bacterial sinus infection. In this case I recommend that my patients contact me to discuss- often this can be diagnosed and treated virtually.
Fever, chills, body aches: These are most commonly seen with more severe respiratory viruses such as COVID and Flu. Tylenol and ibuprofen can be given alternating every 4 hours as needed (no ibuprofen for kids under 6 months old). If you have these symptoms I recommend that my patients take an at-home COVID test and contact me with the results so that we can arrange treatment if you are high risk or further testing for Flu. COVID tests can be falsely negative until day 2-3 of illness, so a negative test on day 1 does not mean you do not have COVID. I now have a combination Flu A+B plus COVID-19 rapid test! If I see you in person for these symptoms I will recommend this test instead of the COVID-19 test alone. Fever in an infant 6wks or younger is an emergency and you should take them immediately to a pediatric emergency department. Fever in a child lasting 5 days or more requires evaluation- my patients should contact me right away through Spruce so I can arrange this.
Vomiting and diarrhea: There are some GI viruses going around right now as well, and these symptoms can often be seen with flu. Usually they are short-lived and improve on their own within 1-2 days. The most important thing in this case is hydration- make sure you are replacing each episode of vomiting and diarrhea with 8oz of fluid in addition to your usual intake. It is okay if you are not eating as much as usual but try to stick to your usual eating pattern as much as you can tolerate. Many people find it easier to tolerate bland, easily digestible foods like toast, plain rice, broth, bananas, and applesauce but you do not have to limit your diet if you are tolerating food well. Spicy and greasy foods are likely to make you feel worse. If you vomit more than twice I recommend that my patients contact me through Spruce so that I can provide a prescription for an anti-emetic. I do not recommend anti-diarrheal medications in these cases because they slow your body's ability to clear the infection out. If these symptoms are accompanied by severe abdominal pain, there is blood in your vomit or bowel movement, or if you are unable to keep down liquids, you will need to be evaluated in an emergency department.
Chest pain, difficulty breathing (not just through your nose), unable to keep down fluids, decreased urine production: These are more serious symptoms and will require evaluation in an emergency department.
If you have any questions or concerns not answered here- please do not hesitate to contact me (or your own physician if you are not my patient)!
I strongly believe in using preventive measures whenever possible. Regular hand-washing, avoiding direct contact with others who are sick can help prevent illness transmission. I strongly recommend getting your flu shot and updated COVID booster if you have not already done so. RSV vaccines are now available for pregnant patients in the third trimester and for adults over age 60. I do not stock these in the office, they are available at most retail pharmacies and grocery stores and are free with insurance. Monoclonal antibody to protect against RSV is available for infants up to 8 months whose mothers did not receive the RSV vaccine in pregnancy and for children up to 19 months with increased risk of severe disease (prematurity, lung disease, etc). These are available through certain local pediatrician offices. Programs are also available to provide low-cost or free vaccines to uninsured patients through the health department. For my patients who are uninsured- please contact me so I can direct you to local resources.
Stay healthy this season!
Dr. Berens