A week or so ago I had the worst kind of nostalgic feeling.
A lump in my throat that felt like the size of an avocado seed, but with the scratchy texture of a peach pit. Then the sense that someone had painted my sinuses with the neighbor‘s horseradish jalapeno sauce; followed later by chicken feathers ticklishly dusting my lungs — but when I try to cough them up, they transmogrify into burrs. Ouch!
It was a good run. I hadn’t had a “cold” — more accurately, an upper respiratory infection — since before the SARS-CoV-2 pandemic went viral.
Mind you, I thought I was coming down with COVID every time I came home from working at the hospital. A full day of yelling at patients and fellow staff members from behind an N95 mask and a face shield inevitably left me with a sore throat and nasal congestion. But by the next morning, all that was gone. It was back to the trenches, battling the tiny fragment of RNA that had turned the world upside down.
Who knows what the next COVID variants will be capable of, but this much is clear: As we drop the masking and the social distancing and return to normal — gatherings, concerts, crowded shopping centers, sporting events and the like — the common cold and influenza will certainly return. The term “#Tripledemic” is now trending, a reference to rising RSV (respiratory syncytial virus) and influenza rates on top of percolating baseline COVID infection rates. Worn out staff and over-filled and understaffed hospitals are unfortunately in no position to handle a “Tripledemic” surge, or even a “Uni”- or “Doubledemic” surge.
What pathogens make up this “common cold” category? RSV along with parainfluenza viruses are responsible for 20% of colds. Wimpier, non-COVID-19 versions of coronaviruses add another 20% and human rhinoviruses add as much as 40%. Adenovirus and human metapneumovirus (formerly Facebookpneumovirus) round things out.
RSV has a well-deserved reputation for being a pediatric scourge. By the age of 2, almost every child has had it, and an RSV infection can get very serious for infants: 1% to 2% of infants under 6 months will end up being hospitalized. However, RSV is very capable of faking out our immune system by morphing its appearance, and adults get re-infected on average every 3 to 10 years.
One thing influenza and RSV have in common is that they strike the youngest and the oldest hardest, particularly those who have other serious medical problems. They differ in that influenza has vaccines and specific anti-viral treatments, whereas RSV has zero vaccine options (getting close though!) and only supportive treatments.
The symptoms of RSV are indistinguishable from those of any other cold, and the symptoms of the ‘Tripledemic’ have some overlap that can make it challenging to decide which particular infective ilk one is dealing with. A very instructive table from Germany’s Institute for Quality and Efficiency in Health Care does a nifty job of teasing out symptom ‘trendencies.’
Here is the summary of that table:
- Typical COVID-19 symptoms include fever and dry cough.
- Typical ‘Cold’ symptoms include sneezing, runny nose, and sore throat; a cough is a frequent but not typical symptom.
- Typical Flu symptoms include fever, fatigue, achy joints, headache, and dry cough.
Of course, all of us are excited about the idea of putting the COVID pandemic behind us and “getting back to normal,” except that “normal” includes influenza and an average of 2 to 3 colds per year. At that rate, the average Joe or Josephine will spend five years of their life suffering from the common cold, and a year of that sentence is severe enough to land you in bed.
In his recent sendoff address published in the New England Journal of Medicine, titled “It Ain’t Over Till It’s Over … but It’s Never Over — Emerging and Reemerging Infectious Diseases,” Dr. Anthony Fauci suggests it’s unlikely we will ever go back to “normal.” He writes, “Today, there is no reason to believe that the threat of emerging infections will diminish, since their underlying causes are present and most likely increasing.”
Bah humbug, Dr. Tony, but I’m guessing you’re right.
Having mostly recovered from my recent cold, I am left with an occasional cough and the question “Was this a particularly bad cold, or did I forget how bad a cold can be?” I favor the latter, but it’s hard to know. Nostalgia isn’t what it used to be.
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