Our Definitive Guide to Cold and Flu

Updated February 4, 2025.

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 a week or two, although some symptoms (like coughing) can take weeks to go away completely.

This is the typical progression of symptoms for upper respiratory infections:

• Days 1-3: Fever (if any), body aches, headache, sore throat, and fatigue.
• Day 4-7: Other symptoms commonly worsen or peak around this time. Nasal and sinus congestion may worsen, and mucus may turn yellow or green (this is normal!). A cough may develop.
• Days 7+: Most symptoms will improve by this time, but a cough may linger for up to a few weeks. Nasal symptoms should be getting better, but they may also take a couple of weeks to resolve completely.

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.

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.

Consider testing for COVID-19 and influenza any time you have symptoms of a cold or flu. Testing helps us understand better what may be causing your symptoms and which treatments may be helpful.

COVID-19 testing: It’s important to know that you may test negative during the first few days of symptoms even if you have COVID-19. If your first test is negative, take another test after 48 hours. If you take your second test before day 4 or 5 of symptoms, consider taking an additional test on day 4 or 5.

Influenza testing: At-home tests are more likely to be accurate if you test within the first 72 hours of symptoms. False negative results are a little more common with at-home tests than tests performed at a healthcare facility, so you may want to consider an in-person visit for testing if you need the most accurate results possible.

Positive results for both influenza and COVID-19 are up to 99% accurate, meaning that false positives are uncommon.

Here are some things you can try at home to feel better:

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.

If you take medications at home or have any medical conditions, check with your healthcare provider to make sure it's safe for you to take over-the-counter medications.

Almost all URIs are caused by viruses, and antibiotics are only effective against bacteria.

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.

While most people with upper respiratory infections get better on their own, COVID-19 and influenza have specific antiviral treatments that may be needed under certain circumstances.

Antiviral medication for COVID-19 is available to reduce the likelihood of developing COVID-19 complications among people at increased risk. For those at low risk for severe infection, these medications have not been shown to significantly improve symptoms or reduce the risk of complications, including long COVID.

As for flu, several prescription antiviral drugs have been approved by the FDA. They may be helpful for individuals at high risk of complications from the flu, but need to be started within two days after symptoms begin. Side effects include vomiting, diarrhea, and rarely, neuropsychiatric effects like hallucinations, so antivirals aren't the best choice for everyone.

If you have COVID-19 and or influenza and have one or more medical conditions that puts you at high risk for complications, reach out to your medical provider.

The best way to avoid passing on a URI is to stay home until your symptoms significantly improve. Once your symptoms improve, take additional precautions for 5 more days just in case you’re still contagious - this means washing your hands frequently, covering your mouth with your arm when you cough or sneeze, and wearing a mask that fully covers your mouth and nose.

Occasionally, viral infections be severe or cause complications. If you experience any of the following, call your healthcare provider:

• Shortness of breath or chest pain
• Coughing up blood or coughing to the point of vomiting
• Fevers uncontrolled with fever-reducers
• Severe headache or a stiff neck in which you’re unable to touch your chin to your chest
• Symptoms that worsen significantly after 7 days
• Symptoms that show no sign of improvement after 10 days

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