Common cold, common flu or COVID-19 - What next? - By Dr Edward Nazareth




 

 

 

 

 

 

 

 

 

 

 


By Dr Edward Nazareth

Jul 4: As the COVID-19 positive cases are markedly increasing, people are anxious to know what may have to be done if they turn positive. In the monsoon season the incidence of common cold and common flu also rises. Many people with symptoms of common cold or common flu are scared to go to doctors or hospitals due to the fear of testing for COVID-19 infection and the aftermath following that if they turn positive. We have to realise that it is very risky to avoid testing if there are symptoms of upper respiratory tract infections such as fever, cough, body ache, headache etc. In this season, many people can develop upper respiratory tract infections from non-COVID-19 viruses and even if it is COVID-19 infection, the course of illness can be mild to moderate. By avoiding testing, if the infection from COVID-19 takes a serious turn, it can be fatal. This unfortunate event can be avoided by early detection and prompt intervention.

On June 27, 2020, the government of India has revised the protocol of clinical management of COVID-19 positive cases. Asymptomatic persons and patients with mild symptoms with a positive report need not be institutional quarantined or admitted to the hospital; they can be quarantined at their homes provided certain norms are followed. The Government of Karnataka has also formulated norms for home quarantine based on the above guidelines and are applicable now.

Common cold, flu or COVID-19?

The common cold is also a viral infection of the upper respiratory system (nose, throat, sinuses, and larynx). More than 200 different types of viruses may cause the common cold. The common cold also spreads from person to person in a manner similar to the COVID-19 infection. The common cold surfaces as an illness about 1 to 7 days after contracting the virus (the incubation period) whereas COVID-19 may manifest as an illness from 5 to 14 days after getting infected. The common cold normally subsides within a week but may last for two weeks. The most important feature of common cold is mild upper respiratory illness with a runny, stuffy nose without fever.

Influenza (commonly termed the flu) is again a viral infection of the upper respiratory and/or lower respiratory system. The flu is caused by influenza viruses. These influenza viruses usually cause more serious symptoms in the respiratory system than the viruses causing common cold. The flu is also contagious like the COVID-19 infection, spreading from person to person almost in the same way as COVID-19 infection. It has an incubation period of about 1 to 4 days. The flu's duration varies from about 5 days to 2 weeks depending upon the severity of the infection. The flu can also become intense and cause pneumonia like in COVID-19 infection and potentially fatal illness in vulnerable individuals. The main features of flu are mild to high fever, cough, fatigue, severe headache and body pain.

A lot of information is already available about COVID-19 infection. Most common symptoms are fever, dry cough and tiredness. There can be a variety of other symptoms like aches and pains, sore throat, diarrhea, conjunctivitis, headache, loss of taste or smell etc. The infection can take a serious turn with difficulty in breathing or shortness of breath.

If we go through the above, it may not be easy to differentiate one from the other. As in COVID-19 infection, 80 to 90 percent people infected by influenza viruses can also be asymptomatic, but they can spread the viruses.

When a pandemic like COVID-19 is hovering over us, it is not safe to neglect the symptoms of upper respiratory tract as common cold or common flu and invite complications. It is necessary to visit fever clinics and get appropriate advice from medical professionals and if needed get a throat swab tested for COVID-19 infection.

ILI and SARI

In COVID-19 reports there are two categories that are commonly mentioned – ILI (Influenza-like illness) and SARI (Severe acute respiratory illness).

Influenza-like illness (ILI) term is used to identify upper respiratory tract infection that manifests with fever of greater than or equal to 100°F, in addition to cough or sore throat. Other symptoms may be fatigue, body aches, headache, loss of appetite, and nausea. Influenza like illness is not always due to influenza virus, it can be due to several other viruses and exact causative virus is not known unless checked. Many of the patients who present with influenza like illness may be tested positive for COVID 19.

The term ‘SARI’ is used for an acute respiratory illness with fever of equal to or more than 38°C and cough. The illness is of more than 10 days duration requiring hospitalization. (In simple terms it is a persistent upper respiratory tract infection of more than 10 days duration.)

Mild, moderate and severe

During the initial period of COVID-19 infection in India, all the persons tested positive were hospitalized at designated hospitals and in certain states this procedure is still followed. Now the throat swab testing for COVID-19 infection is being done for symptomatic persons and in some cases for primary contacts. Most of the primary contacts are only quarantined and not tested if they do not develop symptoms within a specified period. These protocols change frequently and they differ from state to state.

Depending on the symptoms, the COVID-19 positive cases are grouped into mild, moderate and severe. The persons with moderate and severe symptoms need to be hospitalized and those with mild symptoms can stay at home and take care. However, if they are not able to take care at home they may have to be in Covid care centers which need not be hospitals.

The people with mild symptoms are those with uncomplicated upper respiratory tract infection. Their symptoms are mild such as fever, cough, sore throat, nasal congestion, fatigue and headache. These are people who do not find difficulty in breathing. The saturation of oxygen in their blood remains normal. These people recover without any intervention.

The people with moderate symptoms of COVID-19 are the ones with clinical and radiological (X-rays or CT scan) examination showing features of pneumonia with no signs of severe disease. People of any age group with presence of fever, cough and breathlessness (dyspnea) and blood showing less amount of oxygen (hypoxia) are grouped as people with moderate disease. These people need hospitalization in designated hospitals.

The severe form of COVID-19 infection is very critical. It is further grouped as severe pneumonia, acute respiratory distress syndrome (ARDS) and sepsis. Most of the people in this category need artificial respiratory support through ventilators.

Home quarantine

The government of India guidelines (issued on June 27, 2020) gives people who are tested positive with mild symptoms, two options, either to opt for home quarantine or to quarantine at Covid care centers. The guidelines for home quarantine which were earlier issued on May 10, 2020 are applicable. The Government of Karnataka has added few more points to these and they are published on July 1, 2020.

The treating medical officer has to decide if the person who is tested positive for COVID-19 is asymptomatic, pre-symptomatic or has very mild illness. The person should be of less than 50 years of age without any co-morbidity like renal impairment, stroke, tuberculosis and any other immune deficiency diseases. The diabetes, hypertension, thyroid problems should be under control.

Such a person should have the requisite facility at their residence for self-isolation and also for quarantining the family contacts. The person should have the facility for separate well ventilated room for isolation, preferably with attached toilet. The positive person should stay in the identified room and away from other persons in the home, especially the elderly and those with comorbid conditions like hypertension, cardiovascular disease, renal disease, etc. The person should fill an undertaking on self-isolation that he or she would follow home quarantine guidelines. The person shall have pulse oximeter, digital thermometer and personal protective equipment (facemasks, gloves) to be used during home isolation. The person or care giver is required to record the essential parameters in a document specified by the local authorities.

The most important requirement is a care giver who should be available to provide care on a 24 x7 basis. A communication link between the caregiver and hospital is a prerequisite for the entire duration of home isolation. The person should regularly inform his health status to the district surveillance team.

Immediate admission to the designated hospital may be needed if serious signs or symptoms develop. These could be difficulty in breathing, persistent discomfort in the chest, mental confusion or inability to arouse, or on the other hand when advised by the treating medical officer.

The home isolation is discontinued after 17 days of onset of symptoms or after 10 days of positive report in asymptomatic people. The guidelines do not insist on further testing after the home isolation.

Covid Care Centers

In the second week of April 2020, the central government had formulated guidelines to set up Covid Care Centers. The Karnataka Government has adopted these guidelines from July 2, 2020 to set up Covid Care Centers.

The Covid Care Centers are to take care of mild or very mild cases or Covid suspect cases. These centers were not needed in several states and districts as the number of positive cases were less and all the people with positive report were admitted to designated hospitals. This is still the practice in several states, but the Government of Karnataka has started Covid Care Centers at Bangalore. Covid Care Centers may be needed now as the numbers of positive cases are steadily rising.

The Covid Care Centers are makeshift facilities. These are basically for persons with positive report who need not be admitted to the hospital and those who are not suitable for home isolation. These centers are mainly to cater to the positive patients with critical state like pregnancy and all children below 10 years of age. These may be set up in hostels, hotels, schools, stadiums, lodges etc., both public and private. Some hospitals which are handling regular, non-COVID cases can also be designated as Covid Care Centers as a last resort. Every Covid Care Centre is attached to a dedicated/designated COVID-19 hospital for referral purpose. Any person developing signs of deterioration in the Covid Care Center is shifted to the designated hospital. The Covid Care Centre is also for those who are COVID-19 positive but have no home quarantine facility.

What is our responsibility?

- As the COVID-19 positive cases are exponentially rising, we all need to be careful to avoid infection. As there are many asymptomatic persons with shedding viruses all around extra precautions are needed.

- Unfortunately if there are symptoms, one has to seek appropriate medical advice. Better to go to a fever clinic and follow the advice of the medical professionals.

- Many a times our problem may be a simple common cold or common flu.

- If the report is positive and the disease is mild, there is option for home quarantine provided facilities are available. If the facilities are not available, the Covid Care Centers are likely to be established soon.

- But, avoiding testing and hiding the disease can be a fatal mistake not only for the person but also to his family and society.

 

 

  

Comment on this article

  • Rudolf Rodrigues, Mumbai

    Wed, Jul 8 2020

    Dear Respected Doc,
    Please read the below latest comment by WHO & group attentively!::

    "Jimenez said historically, there has been a fierce opposition in the medical profession to the notion of aerosol transmission, and the bar for proof has been set very high. A key concern has been a fear of panic.

    “If people hear airborne, healthcare workers will refuse to go to the hospital,” he said. Or people will buy up all the highly protective N95 respirator masks, “and there will be none left for developing countries.”

    Craving for your reply!!!!

    Thanks,
    Rudolf Rodrigues

    DisAgree Agree Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Wed, Jul 8 2020

    Dear Doc,
    As I had spec updated confidently about nobody escaping covid19 due to it being "airborne transmitted" like any other viral flu, please read the latest findings:

    New Delhi: The World Health Organization (WHO) on Tuesday acknowledged the emerging evidence of airborne spread of COVID-19 after an open letter by over 200 scientists gave evidence that the virus floated and remained suspended in the air.

    “The possibility of airborne transmission in public settings – especially in very specific conditions, crowded, closed, poorly ventilated settings that have been described, cannot be ruled out,” Benedetta Allegranzi, WHO’s technical lead for infection prevention and control, said at a virtual press conference.
    "However, the evidence needs to be gathered and interpreted, and we continue to support this,” she added.

    “There is significant potential for inhalation exposure to viruses in microscopic respiratory droplets (microdroplets) at short to medium distances (up to several meters, or room scale), and we are advocating for the use of preventive measures to mitigate this route of airborne transmission,” the open letter said.

    Until now, it was accepted that the disease transmitted through droplets through nose, eyes and mouth.

    DisAgree Agree Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Tue, Jul 7 2020

    Doc,
    Everyday new reports are pouring in on Covid19 making it all the more BAFFLING, latest is that it existed much before it started in China -Oxford experts:- Read below:

    "The explanation for this could only be that these agents don't come or go anywhere. They are always here and something ignites them, maybe human density or environmental conditions, and this is what we should be looking for," he stressed.

    Last week, Spanish virologists announced the discovery of traces of the novel coronavirus in a sample of Barcelona waste water collected in March 2019, nine months before COVID-19 was identified in China.

    The Italian National Institute of Health said last month that sewage water from Milan and Turin showed coronavirus traces on December 18, 2019.

    By Tuesday morning, the total number of global COVID-19 cases stood at 11,590,195, while the fatalities rose to 537,429, according to the Johns Hopkins University......... "

    If the above is true then an entire new story will unfold!

    DisAgree Agree Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Mon, Jul 6 2020

    "But, avoiding testing and hiding the disease can be a fatal mistake not only for the person but also to his family and society.
    The reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators. And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%. We have no clear data on how many have recovered after ventilatory support, but our data may not be different from other countries. Official figures show that the mortality in India is about 2.87% of the total positive cases reported. These include all those died with or without ventilatory support"

    DOC,
    IF 90% OF PATIENTS ON VENTILATORS PERISH, WHY NOT KEEP THEM OUT IN FRESH VENTILATED AIR, LIKE IN A GARDEN AND DIE A HONORABLE DEATH AND SAVE LACS OF RUPEES??


    Doc, do you know the population, poverty, ignorance, myths, et all in our country? And how much practical your advice be considering all this??

    CRAVING FOR YOUR VALUED RESPONSE!

    DisAgree [4] Agree Reply Report Abuse

  • Dr. Edward Nazareth, Mangalore

    Tue, Jul 7 2020

    These are study reports..10% still survive. Just because 90% die even on ventilators, it is our duty to try our best to save life till the end. At least 10% survive. At present most of the cost of the treatment is borne by the government in COVID designated hospitals.
    I have personal experience where the relatives of the terminally ill patients request doctors not to discontinue life support even though they know that their loved one will not survive. When it comes to life and death, it is a natural human tendency to chose life at any cost.
    By seeking medical assistance at the early stage of illness due to COVID 19 infection, catastrophic complications can be avoided. People should realize this and save themselves.

    DisAgree [2] Agree [5] Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Mon, Jul 6 2020

    Dear Doc,
    IMHO, Since this CORONA virus is a highly virulent influenza variant which is airborne it's not going to spare anybody unless you sit isolated in a sealed capsule till it goes away!

    Since it spares 70-80% of the population, a n infection rate of 40% will give us herd immunity which is the only solace!
    I remember when I was a teenager every year around monsoon season a deadly viral conjunctivitis used to erupt, which used to last for a week! I remember it used to not spare a single person! The remedy that time was instilling coriander seed water only with sunglasses for photophobia, & some used to use Pyrimon drops! This virus persisted for 5-6 years & later vanished on it's own! You can check this out with anybody from Mumbai!

    If it has not spared top royal families & personalities do you think it'll spare any ordinary person!
    FYI, latest victim is jr. Donald Trumps girlfriend!

    Also a second wave has resumed in Victoria, Australia recently!

    Fyi, some cases of bubonic plague have now been reported from Mongolian province of China!
    Fact is we cannot hide from the facts but have to face the consequences!!

    DisAgree Agree Reply Report Abuse

  • Dr. Edward Nazareth, Mangalore

    Sat, Jul 4 2020

    The latest data suggest that about 15.34% of the positive cases require treatment in the intensive care and about 4.16% of the positive cases require ventilatory support. If the number of testing and poitive cases increase these data may show changes.
    The reports from China, the United Kingdom and Seattle found mortality rates as high as 90% among patients on ventilators. And more recently, a study of some New York hospitals seemed to show a mortality rate of 88%. We have no clear data on how many have recovered after ventilatory support, but our data may not be different from other countries. Official figures show that the mortality in India is about 2.87% of the total positive cases reported. These include all those died with or without ventilatory support.

    DisAgree [1] Agree [4] Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Mon, Jul 6 2020

    Doc,
    then you can imagine the mortality rate in our country???

    DisAgree Agree Reply Report Abuse

  • Rudolf Rodrigues, Mumbai

    Tue, Jul 7 2020

    Dear Doc,
    I would wish to give you a plethora of horrific incidents from Mumbai where poorest of poor people have been
    chewed to their bones in the name of ventilator support, but I stop here!

    DisAgree Agree Reply Report Abuse

  • Dr. Ben Rebello, Elinje/Sunkasale

    Sat, Jul 4 2020

    Namaskar ( no hand shake ! )

    Dr. Edward.

    Well written and precise.
    Need of the hour
    When people fumble in the jungle of misinformation.

    It will be complete and fitting if due information is given of the available corona treatment facility offered in the private sector of health care in Mangalore.

    Precisely if Fr. Mullers, K.M.C. or any other private hospital is offering to diagnose and treat infected and serious patients.

    Friendly regards,
    Ben.

    DisAgree [4] Agree [8] Reply Report Abuse

  • Francis, Shirva/UK

    Sat, Jul 4 2020

    Article of the hour, as invisible killer bug taking extra mile each and every day around the world and especially growing cases in India. Although virus is not discriminating anyone people with underlying health conditions and older people mostly effected. Follow the government guidelines, seek medical advice and stay safe. Thank you Dr Nazareth for bringing up this article.

    DisAgree [2] Agree [7] Reply Report Abuse

  • Cynthia, Kirem

    Sat, Jul 4 2020

    Thank you so much doctor.....where you are there, we don't have any fear... Your articles are really of great help to us when we don't understand what to to be done and what not to... Your imparting knowledge to us... God bless you abundantly... ... 🙏

    DisAgree [3] Agree [15] Reply Report Abuse

  • Langoolacharya., Belman / Washington, DC.

    Sat, Jul 4 2020

    Cynthi,

    Indeed good article by Dr Edward as usual....

    ...Tak...Takk...

    DisAgree [3] Agree [7] Reply Report Abuse

  • Jossey Saldanha, Mumbai

    Sat, Jul 4 2020

    All three have the same symptoms but breathlessness happens only with Covid-19 ...

    DisAgree [4] Agree [11] Reply Report Abuse

  • Charan, Mangaluru

    Sat, Jul 4 2020

    Thank you doctor

    DisAgree [2] Agree [5] Reply Report Abuse

  • Subhash Chandra, Mangalore

    Sat, Jul 4 2020

    Good point agreed but scary thing is to wait till breathlessness comes to effect only then it's too late to realise that earlier symptoms were of covid 19

    DisAgree Agree [7] Reply Report Abuse

  • Jossey Saldanha, Mumbai

    Sat, Jul 4 2020

    Subhash Chandra, Mangalore
    Breathlessness is the only indicator for Corona.
    I know many people who got themselves admitted for common flu & got infected with Corona ...

    DisAgree [3] Agree [8] Reply Report Abuse

  • Edward Nazareth, Mangalore

    Sat, Jul 4 2020

    As explained above, in mild cases of COVID 19 infection, breathlessness may not be there . The oxygen level in the blood of these people is normal and they do not find difficulty to breathe.
    Breathlessness is the feature of moderate and severe COVID 19 infection. It may be also there if pneumonia has complicated the influenza infection. Basically breathlessness indicates involvement of the lungs. So breathlessness is not 'the feature' of COVID 19 infection.
    The oxygen saturation in the blood is the real indicator of the involvement of lungs. That is the reason, the people with mild infection opting for home isolation are required to have a pulse oxymeter with them and record the saturation of oxygen in their blood and inform the health authorities periodically. The mild infection can turn to moderate or to severe or may remain as mild and disappear in the course of time.
    The most important point is not to make a 'self diagnosis' based on the symptoms and land up in complication. If there are symptoms, it is safer to go for test and follow the advice of the professionals.

    DisAgree [1] Agree [9] Reply Report Abuse

  • Cynthia, Kirem

    Sat, Jul 4 2020

    🙏🙏

    DisAgree Agree [5] Reply Report Abuse

  • Rayan, Mangalore

    Sat, Jul 4 2020

    Thank You Doctor.

    I've been reading your articles for a long time and they are very informative. We need to learn to live with Covid19 because its going to be here like AIDS, Malaria, Cancer. Influenza...etc

    I believe, if the government allow people to buy over the counter medicine for cold, fever and cough most of the new cases can be avoided. Most of the people suffering with these problems are currently reluctant to go to hospital because its almost certain that they may be tested as positive.

    Also, Govt should allow the respective families of deceased to perform cremation / last rites of individuals as the virus will not be active after a certain time in the body.

    DisAgree [1] Agree [7] Reply Report Abuse

  • Jossey Saldanha, Mumbai

    Sat, Jul 4 2020

    Edward Nazareth, Mangalore
    Thank you Doctor ...

    DisAgree [1] Agree [5] Reply Report Abuse

  • Langoolacharya., Belman / Washington, DC.

    Sat, Jul 4 2020

    Dr Edward.

    Most Physicians in Hospitals in US say more than 90% COVID-19 patients going to Ventilators don't come back alive...Just death is postponed for some time...

    Is this true in Indian hospitals too....or Indians have 'Mritunjaya ' ( Success over Death) prowess??...

    ...Tak...Takk...

    DisAgree [3] Agree [10] Reply Report Abuse

  • Jossey Saldanha, Mumbai

    Sat, Jul 4 2020

    Langoolacharya., Belman / Washington, DC.
    All over the World ventilators is a big racket.
    Even after death, Patient is kept on ventilator to play withe emotions of Dependents ...

    DisAgree [1] Agree [8] Report Abuse

  • Rudolf Rodrigues, Mumbai

    Mon, Jul 6 2020

    Doc,
    There have been many cases of diarrhoea as the main symptom, also there have been many deaths due to happy hypoxia?

    DisAgree Agree Reply Report Abuse

  • Francis, Shirva/UK

    Sat, Jul 4 2020

    As per health professionals, here in the UK main symptoms are
    New and continues cough
    High temperature
    Loss of and or change in your normal sense of taste and smell

    DisAgree Agree [3] Reply Report Abuse


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Title : Common cold, common flu or COVID-19 - What next? - By Dr Edward Nazareth


 
 
 
 

 
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