Our Definitive Guide to Cold and Flu

Updated December 23, 2021.

So you’ve come down with a nasty virus that’s been making the rounds. The good news? You probably don’t need to go into the doctor’s office. The bad news? You still feel awful.

If you think you have an upper respiratory infection (URI) — which includes the common cold, most sinus infections, chest colds (bronchitis), the flu (caused by the influenza virus), and COVID-19 — there’s a lot you can do at home to feel better faster. You’ll have infections like these many times throughout your life, so learning what helps the most (and the least) is worth your time.

More than 90 percent of upper respiratory infections are caused by viruses. These infections create different symptoms at each stage. Most colds, flus and COVID-19 resolve in about a week, although some symptoms (like coughing) can take weeks to go away completely.

Helen (Eleni) Xenos, a One Medical doctor in Chicago, describes the typical progression of the common cold:

• Day 1: Fatigue, headache, sore or scratchy throat.
• Day 2: Sore throat worsens, low fever, mild nasal congestion.
• Day 3: Congestion worsens, sinus and ear pressure become very uncomfortable. It may be difficult to sleep.
• Day 4: Mucus may turn yellow or green (this is normal). Sore throat improves, but coughing begins.
• Days 5-7: Energy and congestion improve.
• 1 week+: Cough usually tapers off after a week, but can take up to 3-6 weeks to fully resolve.

If your symptoms are much worse than these, such as coughing so hard you throw up, coughing up bloody mucus, difficulty breathing, or if you have a fever over 102°F, you might have something more serious going on, like pertussis (whooping cough) or bacterial pneumonia.

If a cold drags on for more than 2 weeks, it can turn into a sinus infection that causes pain around the eyes, nose and/or sinus headaches. Chest colds (bronchitis) cause chest congestion and a hacking cough that drag on for a few weeks.

The flu comes with similar symptoms but features a prominent fever, chills, headache, and body aches that usually last several days.

COVID-19 can feel very similar to other colds and can sometimes have additional symptoms like loss of taste or smell which can help distinguish this virus. It’s important for folks to get tested and stay home with cold symptoms to help prevent the spread of COVID-19, keep everyone safe, and help end the pandemic. For more on COVID-19, see here.

Treating the symptoms and supporting your immune system is the best course of action to feel better faster. Everyone’s experience of a cold is slightly different from the next person’s, and there are many options in the cold and flu aisle at the drugstore. How do you know which symptom remedies are right for you?

The key is to find what works best for you personally, for your symptoms, whether it’s over-the-counter cold and flu remedies or soothing herbal tea. If, for example, you experience bad sinus pressure when you have an upper respiratory infection, a decongestant like pseudoephedrine or a nasal sinus rinse might be good to have on hand. If it’s coughing that usually makes your life miserable during a chest cold, you could try inhaling hot steam from the sink or shower a few times a day to help break things up.

Your immune system’s job is to eradicate viral and bacterial infections from your body. It’s very effective as long as you provide it with the proper support. The best way to do that is to rest. Being stressed out or not getting enough sleep releases hormones that suppress your immune system.

In addition, taking one to two grams a day of vitamin C during cold season may lessen the severity and duration of your colds, although it won’t prevent you from catching them in the first place. Taking zinc lozenges during a cold also supports your immune system, but you have to start within 24 hours of symptom onset for them to work. Take one zinc lozenge or melt-away every two hours on a full stomach to avoid nausea.

Almost all URIs are caused by viruses, and at present we don’t have medications that work against them. (One notable exception: There are antiviral medications for the flu. If you start them in the first 24 to 48 hours of symptoms, it might reduce the duration of your illness by about a day.)

As for the small percentage of upper respiratory infections caused by bacteria, most go away on their own — and often just as quickly — even if you don’t take antibiotics. So if there’s a chance antibiotics can help, what’s the harm?

There are many reasons to be conscientious about taking antibiotics, including breeding resistant superbugs or making your health care cost more. However, there’s another reason that’s of immediate concern: diarrhea. Antibiotics can wreak havoc in your intestines and upset the normal balance of bacteria — including the bacteria that help you digest food, which can lead to abdominal pain, bloating, gas, and alternating diarrhea and constipation. Taking multiple courses of antibiotics puts you at risk of potentially long-lasting effects on your gut.

Like everything health-related, the decision about whether to take antibiotics for a bacterial infection comes down to weighing the risks and benefits. Your provider will be happy to discuss the decision with you in detail.

Colds, flus, and COVID-19 are contagious from the time you get them (even before you have symptoms) up to ten days after your symptoms start. They’re usually not contagious after ten days, even if you’re still coughing or congested.

The best way to avoid passing on a URI (or catching one in the first place) is to wash your hands frequently, cover your mouth with your arm when you cough or sneeze and wear a mask that fully covers your mouth and nose. It’s also best to take at least a couple of days off work or school while you’re most contagious.

Occasionally, viral infections can set the stage for more complicated bacterial infections. If you experience any of the following, call your healthcare provider:

• High fever (over 102°F)
• Shortness of breath or wheezing
• Coughing up bloody mucus
• Coughing so hard that you throw up
• Feeling worse after 7-10 days of symptoms, especially if you have worsening headache, congestion, or sinus pain
• If you don’t start to feel better after 10 days of symptoms

To speak with a One Medical provider, sign up today and book an in-person or virtual visit.

Cough and Chest Congestion

• Antihistamine/decongestant combo (e.g., brompheniramine/pseudoephedrine)
• Cough suppressant: Dextromethorphan (Delsym)
• Expectorant (mucus thinner): Guaifenesin (Mucinex, Robitussin)
• Gentle hot tea (chamomile, licorice root, peppermint, thyme) with or without honey or lemon juice; Traditional Medicinals “Throat Coat” or “Breathe Easy” teas.
• Honey (1 tablespoon of raw honey 1 to 3 times daily). Note: honey is not safe for infants under 12 months.
• Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.

Sore Throat

• Pain relievers: Acetaminophen (Tylenol). It’s OK to use the maximum dose for 1 or 2 days while your symptoms are at their worst. Follow directions on the packaging.
• Cooling or numbing medicines: Chloraseptic spray, lozenges, gargle echinacea tincture in water.
• Saltwater gargles throughout the day: 1 tablespoon of salt in a glass of warm water.
• Warm tea with honey, Traditional Medicinals “throat coat” or “breathe easy” teas, “sore throat tea“.
• Chicken soup or other clear broth.

Nasal Congestion and Sinus Pressure

• Oral decongestants: Pseudoephedrine (Sudafed) is the most effective choice., Anticipate requesting and showing ID for the medication at the pharmacist counter. Avoid decongestants if you have poorly controlled high blood pressure.
• Nasal spray decongestant: Oxymetazoline (Afrin). Don’t use this for more than 3 days, or your congestion will come back even worse.
• Pain relievers: Acetaminophen (Tylenol). It’s okay to use the maximum dose for 1 or 2 days while your symptoms are at their worst. Follow directions on the packaging.
• Nasal steroid spray: Flonase, Nasonex, Nasacort
• Nasal irrigation twice daily with warm salt water (neti pot, NeilMed Sinus Rinse, Nasaline)
• Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.
• Moist heat compresses over your sinuses for several minutes a few times a day.
• Herbs: Goldenseal, Bi Yan Pian, Sinupret

Runny Nose

• Oral decongestants: Pseudoephedrine (Sudafed) is the most effective choice. Anticipate requesting and showing ID for the medication at the pharmacist counter.. If you have high blood pressure, avoid pseudoephedrine or take care to monitor your blood pressure while you take it.
• Nasal spray decongestant: Oxymetazoline (Afrin) can be used for a short time. Don’t use this for more than 3 days, or your congestion will come back even worse.
• Antihistamines: Allegra, Zyrtec, Claritin, Benadryl (all available in generic formulas) are all effective. Benadryl (diphenhydramine) will make you sleepy; the others won’t. Antihistamines tend to work better for runny noses from allergies, but they can help a bit, and they come in some of the combination cold/flu products.
• Saline nasal spray
• Steam inhalation: Boil 1 inch of water in a pot, remove from the stove, add 5 drops of eucalyptus oil if desired, and inhale slowly for a few minutes twice daily with a towel over your head.

Fever

• Fever reducers: Acetaminophen (Tylenol), ibuprofen (Motrin, Advil)
• Drink lots of water.
• Take a warm or cool shower.
• Warm tea (chamomile, peppermint)

Headache and Body Aches

• Pain relievers: Acetaminophen (Tylenol), ibuprofen (Motrin, Advil). It’s okay to use the maximum dose for 1 or 2 days while your symptoms are at their worst, as long as there are no contraindications. Follow directions on the packaging.
• Moist heat compresses or cold packs.
• Rub on Tiger Balm.
• Take a nap.
• Take a warm bath with Epsom salts.

Have more questions about these symptoms or upper respiratory infections, colds, flus, or COVID-19? Join One Medical today to talk to a provider.