Viral respiratory infections are the commonest cause of days off work and school in the world. Influenza was the top fatal infectious disease in the 20th century, not quite pipped by AIDS. Most people get 2 or 3 bouts of cough and cold per year. In Kampala due to more international movement of people there are often 6 or more bouts a year. It is a more common cause of fever than malaria. So what is ‘Flu? What’s the difference between ‘flu and a cold? Does it matter?
(Simple: Women get a cold. Men get ‘flu!)

Influenza is a disease due to a specific influenza virus. So if you have an electron microscope it’s easy to spot the difference! It has interesting connections with pigs and ducks, and there is a new strain every year or 2.

Real ‘Flu can be a very serious disease, it killed 20 million people in the early 1920’s and left thousands paralysed or with the disease encephalitis lethargica, subject of the movie and book “awakenings”. Other viruses can in theory do that, but ‘Flu does it more often.

‘Flu usually comes as a high fever, headache, aching joints, sweating, etc, indistinguishable from Malaria or a host of other fevers. (e.g. dengue or Ebola starts exactly the same way!). This is often followed by respiratory symptoms i.e. sore throat, cough. The fever usually goes up and down for a few days, leaving you exhausted and ill. It gets better on it’s own after 5 or 6 days, but most people remain tired for weeks afterwards. It can be very mild. At the other end of the spectrum it can have countless weird complications, ranging from fatal viral pneumonitis to encephalitis. It still kills a lot of people each year, which is why at risk people especially the old should get the vaccine if there is one.

After a bout of ‘flu we are immune to that strain and partially immune to related ones. Some strains are worse than others. Scaremongers predict that we are “due” for a major pandemic from a totally new species, hence the recent slaughter of sick ducks, or was it chickens (?) in Hong Kong.

The common cold by contrast can be due to a large number of different viruses, which mutate continually giving no limit to the number of “colds” we can get. Whereas you may get a real ‘flu once every 2 years you can get a cold every 3 weeks. Most people with a cold say “I have ‘flu” and without an electron microscope or sophisticated antibody tests you can’t tell the difference.

A bad cold can be like a mild flu. On the whole, a typical cold starts with a sore throat and a dry burning feeling in the nose. There may be quite a high fever, up to 39 either at the beginning or later. You may get aching, headache and stiff neck like a ‘flu but upper respiratory symptoms predominate. Each day the symptoms seem to move a few inches up or down; it starts in the throat, the next day your nose is on fire, and it moves onto the trachea, and it burns all down your chest. The next day your nose runs like a tap and you cough continually and painfully. Then the throat and nose clear up and it seems to be producing mucous deep in your chest, and you cough a cupful of custard every morning. By about day 5 you feel better, the fever goes and you don’t need a box of tissues every day anymore, but the dry niggling cough can go on for weeks.

Children will often get spasms of coughing which sounds like the old never-seen-today whooping cough. They will often cough until they can’t breathe then vomit. And always, of course, at 4 o’clock in the morning.

Because you really can’t tell the difference between a bad cold and a mild ‘flu, and because the word “cold” is such a silly word anyway, doctors just lump them all together as Upper Respiratory Tract Infection, or URTI. Except that the same virus goes down into the chest and causes bronchitis, which is the lower respiratory tract. So there is no simple, accurate word to describe them in English!

Whatever we call these viral infections, they all get better on their own. However for the unlucky few there are complications.

Every time a new virus hits town, everyone with no immunity will probably go down with it. Some will get it worse than others. Children actually get less severe symptoms than adults and get better faster. The only treatment that has any affect at all on how bad you are and how long you are sick is rest. The smart go to bed. Doctors of course heroically struggle on.

Antibiotics are no use at all. Antibiotics kill sensitive bacteria: viruses are not affected. By killing off the harmless bugs that normally live all over us and replacing them with resistant ones they probably do more harm than good. Lots of people start antibiotics as soon as they get a sore throat and are very disappointed when their cold/’flu continues regardless. Others get better as expected and are convinced it was the antibiotic that did the trick. Overuse of antibiotics is worldwide. Splashing around the latest broad-spectrum antibiotics like smarties is particularly worrying. A meeting of European Ministers of Health last year had as a major agenda item the misuse of antibiotics. It was estimated that 80% of antibiotics prescribed in Europe were for no good reason.

Fact: People with viral infections get fever and cough yellow and green phlegm. It gets better. Antibiotics don’t help.

When your nose is running all over the documents on your desk decongestants make you more socially acceptable. When your face feels like lead and you can’t think with that heavy headache, an anti-inflammatory like aspirin or brufen makes you feel intelligent again. If you are not at work a “hot whisky” is as good as anything: half a lemon, a spoonful of honey and a tot of whisky, filled up with hot water. (I find Bushmills 16yr old single malt works best….)

Complications
Most people, probably 95% get better on their own in a few days.
A few get problems. So when should you see the doctor?
The simple answer is “when you are worried”. These are the classic complications.
Pneumonia
We saw half a dozen in the Feb./march epidemic. None so far this time. Usually children are getting better then suddenly the fever goes back up, they get short of breath and painful cough. Signs to look for: difficult breathing, too short of breath to cry, rattling noises, generally “off”. The classic 5 signs are breathing faster than 60 times a minute, insuction, widening of the nostrils with each breath, audible noises from the chest and fever.

Croup
Children under 3 can get a frightening condition called croup. Put simply when I get a cold my nose is blocked with swollen mucosa and mucous and I can’t breathe. So I breathe through my mouth instead. When a small child gets a cold, his nose, throat larynx and trachea, are all blocked with snot and swelling, and there is no alternative airway to breathe through. So they make that awful noise as they try and get enough air through the narrow tubes. Croup and asthma are the 2 conditions that quite rightly get Doctors out at 4.00am!

Asthma
Asthmatics often get an attack when they get a virus, and need to use their medication more often. A lot of children get an asthmatic reaction to a chest infection, wheeze every time they have a cold, and improve on asthma medication. You can’t really label them asthmatics, as they grow out of it as their tubes grow wider, and they never have a problem when they don’t have a cold. You could call it bronchitis, but the term is usually reserved for those with a secondary bacterial infection. The Americans coined the term “fat happy wheezers”, meaning they don’t lose weight, get better quickly and don’t get distressed. Most parents are quite happy to have a FHW so it’s a good label!

Bronchitis
Literally means inflammation of the bronchi. So fairly meaningless, as everyone with a viral respiratory infection has inflammation of everything from the nose on down. If someone has fever, pain, coughs pus and does not have the localising signs of pneumonia then they can be labelled “bronchitis”. Plenty of evidence to show that antibiotics don’t help, but are traditionally given to people with chronic bad chests, e.g. exacerbations of chronic bronchitis, emphysema, old people with heart failure etc.

Ear infections
Some children get Otitis every time they get a cold. It is 3 times more common in children whose parents smoke. (So is asthma). The child can be recognised from the waiting room: It’s a particular I’ve-got-a-pain-somewhere-and-I-can’t-scratch-it-and-I-feel-b….y-miserable wail!

In many parts of Europe the preferred treatment is anti-inflammatories and decongestants only, and it gets better. However we usually give simple narrow spectrum antibiotics, they may prevent chronic infection and glue ear.

Tonsillitis
Like any word ending in “itis” means inflammation of the tonsils. So once again fairly meaningless as everything is inflamed when you have a cold, and it all gets better in time.

Fact: virus infections can give extremely painful throats!

We reserve the name for people with pus on the tonsils due to secondary bacterial infection. The only important bug is the streptococcus, which responds to plain old-fashioned penicillin. Broad-spectrum antibiotics are not necessary.

Every now and again we see “glandular fever” or “mono”. Nasty, makes you ill and very tired for a long time; it’s usually easily diagnosed if you know what to look for.

Fatigue
Colds make you tired. Go to bed! If you go to work you are going to be bad tempered, make bad decisions and take longer to get better. So, take the brufen, suck some lozenges, put decongestant drops up your nose and do what has to be done in the office, then go home, try and look as miserable as possible and if you are lucky your wife will take pity on you and make you a hot whisky.

Really nasty complications
You don’t have to be a doctor to realize something is horribly wrong when someone goes unconscious or gets partially paralysed. Encephalitis can be a complication of any flu virus, but every now and again a new strain comes along that is particularly viscous. Right now I only know one case, but international flu watchers are genuinely worried that the next strain may be a bad one. Other weird complications include inflammation of the heart muscle, or the lining of the heart or lung, or almost anything. Think of a piece of anatomy; add “itis” and you can make up your own! Remember this year one of the Welsh international rugby players died suddenly during training? Does rest prevent complications? Probably. So if you have flu, don’t run on the hash this week, and give your regular workout a miss.

Summary
Coughs colds and flu are common in Kampala.
Most of them get better on their own.
Antibiotics do not help.
If you worried about your child’s breathing, call the Doctor.
Take a day off and go to bed.

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