Abigail Trafford (The Post)

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Welcome to Second Opinion, a weekly column and Health Talk discussion with Post Health columnist Abigail Trafford.

With the change in weather and various viruses passing through the air, the cold season is upon us. Often, as soon as you get over one kind of cold, you end up catching a different strain. Some common cold symptoms are coughing, sniffling, sore throats or fevers. What are the basics of the common cold and can we prevent colds? How many types are out there?

To discuss the common cold is Linda Lambert, Ph.D. who is in charge of cold and flu viruses at the National Institute of Allergy and Infectious Diseases.

The transcript follows.

Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.

Abigail Trafford: Hello and welcome! Let's start with some basics: what is the common cold?

Linda Lambert, Ph.D.: When we think of a common cold, we think of a mild, self-limiting upper respiratory tract infection that starts with a stuffy nose, sore throat, and sneezing. Common colds usually last anywhere from a few days up to a week or ten days.

Abigail Trafford: How can you tell if you have a cold--or it's the flu or something else that's nasty?

Linda Lambert, Ph.D.: Good question! Especially this time of year when we have both cold viruses and flu viruses circulating in the community. If you have a cold, you may start out with a sore throat, sneezing, and a stuffy nose. You may develop a runny nose or sneezing and possibly very mild aches and pain. In contrast, the flu has much more severe symptoms. With the flu, people usually experience a high fever--may be as high as 102-104 degrees F, severe aches and pain, headache, and fatigue and weakness that can last for several days to a few weeks. With the flu, one can also develop chest discomfort and difficulty breathing.

Abigail Trafford: Billion dollar question: what's the best treatment for a cold? How long do colds usually last?

Linda Lambert, Ph.D.: Typically a cold is "self-limiting" which means we will feel better within a few days. Unfortunately, right now, there is no cure for the common cold, but you can treat the symptoms. This includes over the counter medications which include antihistamines, cough suppressants, plenty of fluids and bed rest.

Columbia, Md.: Sore throat, unproductive cough and pounding headache... no congestion. Cold? Flu? I can't tell. Please explain the different types of colds! Currently just taking aspirin for the headache. Don't know what else to do!

Linda Lambert, Ph.D.: It's true that there are no exact rules for diagnosing a cold versus having the flu. Classic influenza is characterized by a high fever, headache, exhaustion. With the flu you may also have a cough which can become severe. Sore throat is more frequently associated with a cold virus but can also occur with the flu. While I can't diagnose you, if you suspect you have the flu, the best thing is to see your doctor.

Rockville, Md.: Could you please answer, in brief, some of the most common questions people still raise about the common cold: How many colds does the average child get in a year? How many colds does the average adult get in a year? How long should the average cold last? Four days, a week or two weeks? And when you do get an average cold, what exactly is the best medicine to take, and what are the best foods to eat and not to eat? Last one: So many people report that soda helps them when they have a cold. Just why is this, exactly -- the carbonation, the sugar, the caffeine, or all three? Thank you very much.

Abigail Trafford: Here's what one doctor said: "Acute bronchitis is a common sequence of catching cold and is often nothing more than the extension downward of an ordinary coryza. . . The cough is rough at first, cutting and sore. . . it comes on in paroxysms which rack and distress the patient extremely . . . at first the cough is dry but in a few days the secretion becomes muco-purulent and abundant, and finally purulent . . . In healthy adults, by the end of a week, the fever subsides and the cough loosens. In another week or ten days convalescence is fully established." Well this doctor was Sir William Osler, MD, and he was writing in 1892! Long before modern medicine and antibiotics. Linda, tell us what more than a century has done in our knowledge of the common cold? And what are the best medicines and foods to take?

Linda Lambert, Ph.D.: That's a great question, because we knew nothing about flu viruses until they were identified in the 1930s and cold viruses weren't identified until the 1950s. Over the past 80 or so years we have learned a lot about these viruses! How flu viruses cause disease and how many different viruses there are that cause the common cold--more than 200!

Ah-CHOOO!: Very well timed discussion, as just over the course of today what started as just some congestion from the last few days has turned into what I would definitely call a head cold. Any suggestions about keeping my wits about me for the next few days while my sinuses start to choke off my brain, since comp time isn't an option at the moment? I generally go for pseudoephedrine, but is there a better option?

Linda Lambert, Ph.D.: Yes, cold viruses start off making us feel just a bit under the weather and gradually build so we realize we're sick! Again, the best remedy for a cold is to treat the symptoms--and if we have to be at the office...try not to spread the virus around to our coworkers. That means keeping a box of tissues handy and using them when we cough or sneeze to prevent the spreading the virus. Lots of fluids and try not to over exert yourself while your body is fighting the infection.

Thirsty in Lorton, Va.: This ties back to last week's discussion. When I'm suffering from either a head cold, or from just major allergies, I often feel thirstier than usual, to the point of dehydration, despite an increased intake of fluids. Is there any good way to combat these feelings, or any particular beverage that might help assuage them?

Abigail Trafford: Another question--We're always told to drink plenty of fluids. Why is that?

Linda Lambert, Ph.D.: One of the ways our body protects us is by a mucus layer that lines our respiratory tract. This mucus layer traps particles that we inhale--viruses, bacteria, pollen--so they can't attach to the cells that line the respiratory tract and cause infection. Keeping hydrated keeps that mucus layer functioning optimally as well as all of the other defenses in our body--like our immune system. Most beverages are about the same. I'd drink what you like, but hot tea or other hot beverages may also make you feel better.

Alexandria, Va.: Twenty years ago while vacationing in Israel I felt a sore throat coming on.

I got really bummed out that my vacation was about to be ruined, and I bought a bottle of some Israeli distilled spirits type beverage called Slivovitz and drank it until I fell asleep.

When I woke up I was healed! Not like a holy roller healing, but my sore throat was gone.

Is it possible that drinking alcohol can ward off a sore throat? I sometimes seem to be able to ward them off this way, but often it does not work.

Abigail Trafford: Wow! This will be a popular cure. What's behind this, Linda?

Linda Lambert, Ph.D.: I have heard other stories and it seems that a lot of people have their own remedies about what can cure the common cold--and some stories are pretty exotic. In general, I wouldn't recommend alcohol as a way of protecting yourself from a cold.

Chandler, Ariz.: I feel that progress in the treatment of colds is too slow. Can we expect anything to happen? I am a retired pharmacist and there seems to be much promise but that is all.

Abigail Trafford: Well, one problem is that there are hundreds of cold viruses. Scientists would have to develop an anti-viral treatment for each one. And the next day you might get a cold from another virus. There is a drug on the horizon that is supposed to limit the length of colds. Linda, can you tell us more about that?

Linda Lambert, Ph.D.: Although we have learned a lot about cold viruses in the last 50 or so years, finding a cure for the cold is a pretty complex problem! The difficulties are that some cold viruses don't grow well in the laboratory so are hard to study. For some we can only study them in human volunteers. The good news is that one company has submitted a new drug for approval by the FDA and a response from the FDA is expected in the next several months. The drug is called Pleconaril and the company is seeking approval for the treatment of the common cold.

Springfield, Va.: I hardly ever get colds, even when my husbands has them I do not catch the nasty bug. I attribute my running and my hand-washing to my health.

Abigail Trafford: By running, I assume you mean daily exercise. Can exercise and hand-washing ward off colds? Certainly hand-washing can get rid of cold viruses that are everywhere this time of year.

Linda Lambert, Ph.D.: It is true that the single most important think you can do to protect yourself from catching a cold is to wash your hands and do it often! In general staying healthy is important and that includes not smoking, getting plenty of sleep, and keeping your stress level down.

Washington, D.C.: People are always telling me to take Zinc at the first sign of a cold. Does that really work? If so, why?

Linda Lambert, Ph.D.: There has been a lot of interest in Zinc containing products in the last few years. Unfortunately for every scientific study that has shown Zinc helps make people feel better, there is another study that says that Zinc is no better than a placebo. The bottom line is that there is no hard evidence that Zinc is effective in shortening the duration of a cold.

College Station, Texas: Allergy seems dominant over viruses these days as the cause for stuffy and runny noses.
How do you tell em apart?

Linda Lambert, Ph.D.: That can be tough to do. Typically colds occur during the fall and winter months and you certainly may hear other people in your office or neighborhood saying that "there's something going around" which can be an indication of a cold virus circulating. Since allergies can lead to sinus infections, you may wish to consult your doctor.

Maryland: As I understand it, Picovir will only work on colds caused by picornaviruses. Will doctors have to do a culture to determine whether a patient's cold is caused by a picornavirus, or is it safe for them to prescribe it without a culture?

Linda Lambert, Ph.D.: It is true that Picovir/Pleconaril is targeted toward picornaviruses. Right now the data show that Pleconaril will shorten the duration of symptoms by about a day to a day and a half if started within 48 hours of the onset of symptoms. It seems unlikely that there will be time to do cultures to definitively show the cold you have is caused by a picornavirus; however the doctor may know that those types of viruses are circulating in the community. The good news is that scientists continue to try to find more "general" antiviral agents that will work against several different types of cold viruses.

Abigail Trafford: Are there certain foods that you should eat if you have a cold? And what about soda. What's helping here--the fizz? the caffeine? the sugar or artificial sweetener. And why tea with lemon and honey?

Linda Lambert, Ph.D.: When we have a cold and feel pretty miserable, our food choices are probably driven by what we feel like we can eat. It's important to keep your energy level up--so chicken soup is really not a bad idea. It contains broth (liquid), protein, and the steam/warm broth may sooth your throat. As far as beverages, I've not heard that one is better than another. Best bet is to get plenty!

Abigail Trafford: Here's the dilemma. When you are coming down with a cold should you 1. fight it and go to the office and keep working and taking the Metro and going to the movies. 2. surrender and go home to bed. Does the cold last as long as it's going to last no matter what you do?

Linda Lambert, Ph.D.: I understand the dilemma. The bottom line is that we can take over the counter medicines that will treat the symptoms and make us feel better, but the cold pretty much has to run its course. It is always best to take care of yourself and stay in bed, but clearly some folks have to get to the office.

Washington, D.C.: Could you describe the difference between viral infections and bacterial infections? Perhaps the question is: What's the difference between a virus and bacteria? Is one more prevalent than the other? Easier to contract than the other? What is the origin of each?

Linda Lambert, Ph.D.: Typically when we think of catching a cold, we think of a virus. Viruses are small particles that can replicate only when they infect our cells. Typically cold viruses cause infections that don't last long and don't cause us to seek medical attention. Bacteria on the other hand can cause more severe infections that can develop just as we are getting over a cold or the flu. For example, we may have a cold or the flu and finally feel we are getting better. If after a few days we start to develop chest pains or have trouble breathing, this could be a signal that we have a secondary bacterial pneumonia, which means it is time to seek medical attention.

Arlington, Va.: Please tell us about cold prevention. We know we should get enough sleep, exercise, and good nutrition. And that we should reduce stress where we can. What else can we do?

I've found that I catch cold less frequently when I'm vigilant about washing my hands and keeping my hands away from my eyes and nose. Is this generally a good preventive method?

Linda Lambert, Ph.D.: That's exactly right! Cold viruses are transmitted from one infected person to the next usually by hand to hand contact. If I have a cold and sneezing and blowing my nose, virus particles are getting on my hands. If I touch a doorknob or a keyboard and my coworker comes in and touches the same doorknob/keyboard and rubs her eyes the virus can infect her. Children are also the primary "spreadders" of cold viruses within a family. If you have a child who is sick, it's especially important for you to wash your hands frequently.

Hyattsville, Md.: I've seen several ads that tout the wonders of zinc, vitamin C, and herbal remedies for treating the common cold. Is there evidence that those products work? Also, the news reported on the development of a nasal spray vaccine. Will it reach the mass market soon?

Linda Lambert, Ph.D.: Unfortunately, there is no strong scientific evidence that any of the remedies you describe shorten the duration of a cold; however, there are certainly people who have used them and believe that they do. There is a new nasal spray vaccine on the horizon for the prevention of influenza.

Corvallis, Ore.: I and another in my family recently tried Zicon for treatment of what we suspected was a cold. In both of our cases, the treatment appeared to be effective. However, one can not be sure because, we may have misdiagnosed. Do you have any advise?

Linda Lambert, Ph.D.: Again, I think there is a lot of anecdotal evidence that Zinc, vitamin C, Echinacea work to treat the common cold. Unfortunately the scientific studies that have been done suggest that they are not effective.

California: I'm just wondering. I never seem to get sick, cold or flu. Can't remember the last time I had a sore throat or so much as a slight fever. At least five years. I don't exercise regularly, just the right weight, eat whatever I like, and can barely remember to take my vitamins. So I'm not exactly an example to live by (I'm 28, female).

What gives? Youth on my side?

Abigail Trafford: Note: this is why people on the East Coast hate Californians.. . . You can eat whatever you want, skip regular exercise and stay thin! You don't even catch a cold! What is the secret?

Linda Lambert, Ph.D.: Consider yourself lucky! On average adults get 2 to 4 colds a year and children 6 to 10. Women more than men probably because of an increased contact with children.

Alexandria, Va.: My 22 year old daughter says she has a cold, but that her bones "hurt." Especially her hip bones (she is very thin). Should this be a matter of concern? She is better than she was yesterday, but should she see a doctor?

Linda Lambert, Ph.D.: I really can't diagnose her, but the flu is characterized by general aches and pains, some of which can be severe. I'd recommend she see a physician to be sure.

Formerly of Gaithersburg, Md.: At work, after washing my hands in the restroom, I use the paper towel I dry my hands with to open the door on my way out, figuring it's one way to lessen my contact with potential germs. Is my theory a good one, or should I toss it out with my paper towels? I've been doing it about a year, and I seem to have fewer colds now.

Thanks!

Linda Lambert, Ph.D.: Honestly, I do the same thing. I think it's a good idea!

Los Angeles, Calif.: Boyfriend passed his cold on to me. While he was only out of commission for about 48 hours, this thing has me down and out for 3.5 days and counting. What gives?

Thx.

Abigail Trafford: Did you think about getting a new boyfriend? Just kidding. Linda, why does the same virus affect people so differently?

Linda Lambert, Ph.D.: How sick you get can depend on a number of things including your immune system, whether or not you've ever been infected by a similar cold virus before and also how big of a "dose" of virus you got when you got infected.

Virginia: In the last few years I have noticed my colds coming on very quickly--I will wake up and feel a bit off, and within a few hours I will be miserable--runny nose, stuffy head, chest congestion, etc. Why do some colds "come on" faster than others in terms of symptoms?

Linda Lambert, Ph.D.: Again, since there are so many different viruses out there that cause the common cold, this really depends on the type of virus get infected by. It also depends on how healthy you are and how many virus particles you were exposed to. I always think it's interesting that right before vacation as I'm rushing around to pack, run errands, and not getting enough sleep...I get sick.

Virginia: What I did was: eating hot spicy Chinese foods. Always helped me. Are there any cultural differences towards colds?

Abigail Trafford: Hot and sour soup is my favorite. Why do spicy foods seem to clear out the sinuses?

Linda Lambert, Ph.D.: I really don't know why some spicy foods clear out our sinuses, although we can all agree with you. If it makes you feel better and your getting good nutrition, that's a good thing.

Washington, D.C.: Is it dangerous to exercise when you have a cold? Some colds definitely make you feel warn out, but sometimes I will feel like I could exercise despite mild cold symptoms. Thanks for your response.

Linda Lambert, Ph.D.: If you have a mild "head cold", experts agree that modest amounts of exercise are fine. However if you really sick, it's best to rest and give your body time to recover.

Virginia: PLEASEPLEASEPLEASE tell people (I am amazed that people don't know this) that you CANNOT catch a cold simply from being in cold air, or going outside with wet hair, or going from warm to cold environments, etc.

It is a BUG, either a bacteria or a virus! period!

Linda Lambert, Ph.D.: You are absolutely right! Scientists have tested that theory and chilling someone before exposing them to a cold virus does not increase their chances of getting sick! My grandmother also told me wet hair would make me sick.

Washington, D.C.: I'm the "bad guy" around the office. I had no sick leave left (due to an injury late last year) and caught a nasty head cold. I HAD to come to work, where I share an office, consequently infecting my officemates who in turn infected their children, and the result was several other people missing many days of work. Do you have any other suggestions for not spreading the virus, other than staying home unpaid? I think that by the end of this (it's still not over) my boss will agree to let someone stay and work from home even without official sick leave!

Abigail Trafford: You raise a lot of good issues. Starting with the need for flexibility in the office. Companies should understand that the goal is to get the job done, not to have people log hours. But until that day arrives. . . . what do you do if you have to go to work? If you go to work, do you just make it worse for yourself and your co-workers?

Linda Lambert, Ph.D.: I have friends in your situation and they have to go to work too. Best bets are to wash your hands and to always sneeze, cough, blow your nose in a tissue and promptly throw it away. If you can, try to keep your distance.

Washington, D.C.: Could you please address all the people out there who, when they are sick, go to the gym in order to "sweat through" a cold? I think it's rude to go to a place where people are breathing deeply because they are exercising and have someone hacking away on the next exercise machine. Thanks!

Linda Lambert, Ph.D.: Execising when you have a cold will not speed your recovery. I sometimes feel the same way when I'm on an airplane. When we come down with a cold we are really only contagious during the first 2 or 3 days. This is the time that the virus is replicating and we are shedding the largest amounts of virus in our nasal secretions. Sometimes the cough can linger but we aren't still infectious.

SICK AT WORK: Also, you can use that gel to disinfect your hands. You just rub it on like hand lotion.

Linda Lambert, Ph.D.: Good idea!

Abigail Trafford: Our time is up. Thank you Linda Lambert. Thank you all for sharing the pain. Join me next week. We'll look at finding the cure for cancer on "West Wing" and "Law and Order."

washingtonpost.com:

That wraps up today's show. Thanks to everyone who joined the discussion.