The Bad Bugs of Winter
Some diagnoses are easy -- a broken arm or a positive strep test. Others are a little more tricky. When is a cold a virus and when is it a bacterial infection? Is fever part of the body's way of fighting an illness? If so, should you treat it? Who needs a flu shot?
Several physicians at Anne Arundel Medical Center respond to these commonly asked questions. Here is what they said.
Flu To inoculate or not to inoculate? Flu season starts in late fall and flu shots are available for anyone who wants one. But who needs one?
Ira Weinstein, M.D., an Annapolis pulmonologist, recommends that anyone at risk for catching flu should get a vaccine this fall, and perhaps a second one in the spring ? if the Centers for Disease Control recommends it.
People at risk are children, anyone older than 65, healthcare workers and those with respiratory problems or compromised immune systems. As for the rest of the population, Dr. Weinstein says it's a gamble. If you get the flu and are strong and healthy, you'll recover in a week to 10 days, but can you afford to miss that much work? There is little risk to the vaccine except for people who have had a previous reaction to a vaccine or are allergic to eggs. (Vaccines are developed in hen eggs, according to the Centers for Disease Control.)
Flu Can Be Deadly
Dr. Weinstein said that many people shrug off warnings of flu because they don't understand what "flu" -- short for influenza -- really means. "We call lots of things flu. But my rule of thumb is this: if you have to ask me if you have it, then you don't. Real flu is dangerous and we tend to forget it can be a killer. An epidemic of influenza in 1918 killed 20 million people--more people than died in World War I," he said. "Once you contract it, there's not much you can do except treat the symptoms, so it's better not to get it."
Symptoms of flu are high fever, headache, severe muscle aches, general malaise and dry cough. Annapolis internist David Barnes, M.D., who specializes in infectious disease, said a new, but expensive, treatment is available to counteract the flu, but it must be administered in the first 24-48 hours after contracting the virus, and most people don't know they have the flu until it's too late. Rest, acetaminophen, and lots of fluids are the only way to treat it.
Dr. Weinstein said, "In the U.S., we're lucky that nature selects the Far East for the debut of the annual flu viruses," he said. "As the viruses migrate across the continents, researchers here are able to create vaccines based on the strains of flu they project will make it to the U.S." Most flu shots are boosters that include several strains of flu viruses. However, some strains mutate along the way, making that particular strain impervious to the vaccine.
Dr. Weinstein recommends that people get vaccinated as soon as possible -- by the end of November. If it looks like a late flu may infiltrate the U.S., then a second vaccine is recommended in February or March. People at risk should check with their primary care physicians about whether a second shot is needed. For free flu shots, call the Anne Arundel County Health Department at (410) 222-7343.
Fever Fever is the body's natural response to an infection. It has a direct effect by damaging some bacteria and also helps intensify our immune response. So doesn't it seem counter-intuitive to reduce a fever when you are sick? A country doctor, who was against taking fever reducers, once remarked that treating fever is like sending your soldiers into battle without their weapons.
Is this true?
Dr. Barnes says yes and no. "Fever does play a role in the body's fight against an infection. Your immune system has reacted to the infection by raising your normal internal temperature to help fight the infection. When you reduce a fever, you're essentially ?resetting' your internal thermometer back to normal, which incidentally isn't the same for everyone. Lowering a fever will make you feel better and you may as a result lose some of the benefits of the fever, but frankly, it really doesn't alter the course of the infection in a significant way," he said.
"What you don't want to do is get on a roller coaster. You lower your temperature, then your body's natural response is to heat it again with chills and shivering, so then you take more fever reducer," he said. "The best thing to do is use good judgment. If you're really uncomfortable, use acetaminophen or ibuprofen to make yourself more comfortable; then get some rest and take plenty of fluids."
Colds Editor's Note: Last cold season, in a Vital Signs article that addressed cold remedies, we said green or yellow mucus is indicative of a bacterial infection that should be treated with antibiotics if unresolved after five days. We had several responses from the community — physicians and non-physicians — who disagreed. They said colored mucus is not indicative of a bacterial infection and should not be treated with antibiotics. Interviews with a few local experts produced these responses.
Dr. Barnes said "You really can't tell with certainty by looking at the color of the mucus whether you've got a viral or bacterial infection, but in most cases, colored mucus seems to indicate that bacteria are contributing. In many cases, the major cause is viral and once the virus gets better, the associated bacterial infection will resolve itself without antibiotics. Do you need an antibiotic if the mucus is yellow or green? As much as the public would like to hear a clear cut answer, there isn't always one."
Dr. Barnes added, "Twenty years ago pediatricians prescribed antibiotics too frequently. Now we're paying for that with parents who want antibiotics for their children as soon as they catch a bad cold. They remember taking medicine and feeling better the next day. They don't remember all the times they took antibiotics that didn't work."
Arnold pediatrician and Chief of Pediatrics at AAMC Jacqueline Kelly, M.D., said she doesn't consider prescribing antibiotics for cold symptoms unless they persist longer than two weeks. She added that young children usually have about six colds a year. If, after two weeks, symptoms still persist, then it's perhaps time to look to antibiotics, she said.
Arthur Schwartz, M.D., chief of Ear, Nose and Throat for AAMC, who was interviewed for the original article, said he, too, discourages the overuse of antibiotics. "However," he said, "I have 20 years of experience telling me that if you give a sick person who has been producing green or yellow mucus an antibiotic, within a day or two, the mucus turns clear, and the patient is feeling much better."
While there may be some disagreement on what mucus color really means, one thing is perfectly clear. All three doctors agree that antibiotics should be used sparingly to keep people free from antibiotic-resistant bacteria, and the course of treatment for a bad cold is to let nature give it a try first. If it doesn't go away in several days and is accompanied by a high fever, then it's time to go to the doctor.