Here We Go Again: The Return of the Common Cold
As the season for catching colds approaches, it's time to take even more care to prevent the spread of germs and minimize contact with people already sick. However, since the emergence of COVID-19, this year's season may appear a bit different.
For almost two years, we've been routinely wearing masks, preventing the majority of typical common cold transference. However, this could change in the coming season. With the vaccine readily available, the implications of scaled-back mask mandates will undoubtedly continue into the winter months, and since you may have forgotten what it's like to have a cold, let's take a look.
An unprecedented low
Colds have been around for thousands of years, likely even before human recordings of it. Millions of Americans experience them every year, averaging two or three bouts for adults and four or more for children.
"The common cold is caused by an estimated 200 different viruses, most of which are rhinoviruses," said Kristine N. Dye, Ph.D., an assistant professor from Stetson University. "Others include coronaviruses, respiratory syncytial viruses (RSVs) and adenoviruses."
She noted the wide variety helps explain why we're capable of being infected with several common cold viruses each year.
'Since we've started wearing masks, the number of visits I've had in my practice [for the common cold] is down.'
Since COVID-19 hit our shores in early 2020, there has been a marked decrease in the number of cases of people having colds.
"It's been less, there's no question about it," reported Jonathan S. Appelbaum, an M.D. from Florida State University. "Since we've started wearing masks, the number of visits I've had in my practice [for the common cold] is down. Last year, we had an unusually low influenza season—we've never had a flu season like that."
According to the Centers for Disease Control and Prevention (CDC), there were 2,038 flu cases reported between the end of September 2020 and mid-April 2021, with about 700 deaths. Compare that to the 2019–2020 flu season, when there were an estimated 35 million cases resulting in more than 22,000 deaths.
Fall and winter
It's extremely easy to catch a cold as viruses enter the body through the lining of moist mucous membranes, such as the mouth, eyes and nostrils.
"They can be spread through a variety of transmission methods, such as droplets and contaminated surfaces," Dye said.
"The cough or sneeze spreads droplets throughout the air and even if you're not right next to a person, you can inhale them and get infected that way," Appelbaum added.
From the University of Cincinnati College of Medicine, Carl J. Fichtenbaum, M.D., receives special surveillance from a local hospital reporting the incidence of cold and flu symptoms.
"We often do extended tests where we look for all the common cold viruses," he said. "I've seen rhinoviruses and respiratory syncytial viruses circulating in the community, though I haven't yet seen much in the way of influenzas."
The common cold can manifest at any time but is most prominent during late fall and winter, which Appelbaum attributes partially to our tendency to stay close together inside due to the weather.
"Viruses are less easily transmittable in well-circulated areas because the particles get dispersed, so odds are you're not going to inhale it," he explained. "It's where you're confined and the air isn't moving that much. Droplets hang up in the air and you can easily breathe them in."
Additionally, Fichtenbaum noted the significant risk of children returning to school and bringing viruses home. "Parents then go to work, give it to their colleagues, and it circulates around the community—that's the natural circle of life of viruses."
There are several primary symptoms of the common cold, including:
- Sore throat
- Coughing and sneezing
- Head and body aches
- Nasal congestion
On average, common colds last 7 to 10 days. They begin with an incubation period, which is when you become infected, followed by three stages of progression. Symptoms present within the first three days, followed by a peak stage on days 4 to 7—this is also the most contagious period. Stage three is from day 7 onward until the cold is gone, although in certain cases people can be sick for weeks.
Diagnosis, treatment and prevention
A cold is easily recognizable and can usually be handled independently—there is no cure or prevention.
"A lot of people go to the doctor for an antibiotic and antibiotics don't do anything to cure a cold because it's not a bacteria," Appelbaum said.
Dye explained that using antibiotics to treat a virus can actually lead to worse outcomes.
The endurance and intensity of the common cold are dependent on which virus is causing the illness, the level of self-care and immune system functioning. Treatment is crucial for anyone asthmatic, immunocompromised or with respiratory conditions, as the cold can progress to secondary infections, pneumonia, bronchitis or the emergence of asthma symptoms.
"Older people and those with other conditions are more at risk," Appelbaum said.
"If you're an immune-suppressed person—say, you've had a transplant or are a cancer patient—and get the common cold, it can cause shortness of breath and pneumonia, and it might look almost like COVID-19," Fichtenbaum added.
If you decide your symptoms are serious enough, see a doctor who will evaluate congestion levels and examine the throat and lungs to rule out other diagnoses. Appelbaum advised seeking medical attention if a cold's severity does not diminish at all after six days, or in the instance of shortness of breath as that could be indicative of the infection reaching the lungs.
"Although we have drugs and medications that can treat the symptoms of common cold viruses such as nasal decongestants, cough suppressants, etc., we don't have many drugs to treat the viruses that cause the common cold themselves," Dye explained.
The best course of action is to get plenty of rest and fluids and cut out any caffeine, alcohol or smoking. To reduce the risk for yourself and others, wash your hands regularly, sanitize frequently touched surfaces, keep a healthy distance from sick people and avoid touching mucous membranes with dirty hands. If you get sick, the best strategy is to stay home to keep everyone else safe from infection.
The common cold and COVID-19
It is worth mentioning the various overlaps between the common cold and COVID-19, as COVID-19 displays parallel ailments, especially for people fully vaccinated.
There's also the potential to infect other tissues, subsequently causing a "body-wide inflammatory response" necessitating hospitalization, Dye said.
Two other differences are incubation and recovery time—colds are short, but COVID-19 can range from weeks to months.
"Depending on the stage of disease, different therapies are recommended," Dye continued, detailing a strict regimen of antivirals, antibody therapies, steroids/immune modulators, and mechanical ventilation in nearly fatal cases—that's quite different from optional over-the-counter drugs for the common cold.
Experts surmise the drastic contrast originates in immunity.
"Each year we come in contact with lots of different germs in the environment that help train our immune system to respond," Fichtenbaum said. "Since we haven't had the same experiences recently, our immune systems have to re-learn it all over again. And, because of this, the upcoming cold season has the potential to be far worse than in the past."
"Common cold viruses we experience today are mild due to thousands of years of adaptation, whereas COVID-19 has just spilled over into humans recently and is still highly pathogenic. Through viral evolution, and most importantly an increase in human immunity through vaccination, we expect COVID-19 to be the next common-cold coronavirus," Dye said.