A cold, the flu, bronchitis, a sinus infection – they all make you feel lousy, right?  So what’s the difference between all of these winter ailments, and do you need to see a doctor? Family physician Donald Ford, MD, fills you in on what’s behind the myriad infections that can make you miserable this time of year.

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Fighting Winter Colds, Fevers and the Flu with Dr. Donald Ford

Podcast Transcript

Nada Youssef:   There's so much health advice floating around, online, among friends, but who can you really trust? Trust the experts. Listen to the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them real questions, tough and intimate health questions, and we get real answers. All originally recorded live.

Nada Youssef:   Hi. Thank you for joining us. I'm your host, Nada Youssef, and today we're back with Cleveland Clinic family physician, Dr. Donald Ford. Happy to have you back.

Donald Ford:     Thank you.

Nada Youssef:   This time we're here to talk about cold, fevers, and the flu. Before we begin, please remember this is for informational purposes only and it's not intended to replace your own physician's advice. So, since it's flu season, I figured you'd be the perfect doctor for this Facebook Live. I also have some flu facts that I wanted to read out loud for our audience.

The flu may cause cold symptoms, but is a serious disease that can be fatal, even for healthy people. The flu virus changes every year, so getting vaccinated yearly is very important. The flu virus can survive on hard surfaces for 48 hours. Is that true?

Donald Ford:     That's true, that's all true.

Nada Youssef:   That's a long, long time.

Donald Ford:     Yeah.

Nada Youssef:   And then the viruses used in flu shots cannot cause the flu, and I know I hear a lot about that.

Donald Ford:     Hundred percent correct, yeah.

Nada Youssef:   Good, good.

Donald Ford:     Yeah.

Nada Youssef:   Well, let's go ahead and just start with the difference between a cold and a flu.

Donald Ford:     That's a great question, Nada. There are literally dozens of different viruses that are around us, especially during the wintertime, that can cause cold and flu-like symptoms. Now, that's a big category 'cause a lot of them, there's a lot of gray area between what's what. Some of these more benign viruses, we call them adenoviruses, arboviruses. There's a handful of other ones. Well, we don't actually have testing for them so we don't really know a hundred percent of the time what exactly is causing your upper-respiratory symptoms. But they're all viruses, they all have in common that they cause inflammation of the mucus membranes and they run about anywhere from three days to a week typically and then clear out. You're-

Nada Youssef:   So, both cold and flu are three days to a week?

Donald Ford:     No, so that's the cold.

Nada Youssef:   Oh, that's the cold, okay.

Donald Ford:     So, that's for the cold. There's one particular family of viruses called influenza, and those are the viruses that cause the flu. Now, that is a more serious thing. It's typically characterized by a high fever. It can be a very serious illness as you said. So even for health people, the flu can be a dangerous thing. Historically, if anybody is a student of history, you might know that in 1918, which was just before the First World War, there was an outbreak of influenza across the world. It killed 18 million people worldwide. We haven't seen anything like that since then, thank God, but we can't forget that last year in the United States alone 80,000 people died of influenza. So, it's a real serious thing.

Nada Youssef:   Sure.

Donald Ford:     Colds we can deal with, we can talk about and I'd love to talk about what the difference is so people understand what's going on.

Nada Youssef:   Great, perfect. Well, let's talk about when you're most contagious 'cause that's an important one.

Donald Ford:     This is a tricky thing about viruses because the most contagious time for any virus is before you actually get sick. So, that makes it really difficult, so how do you know? Well, I've been around people who have been sick, they've been sneezing on me, perhaps we've been shaking hands and stuff. In those first two to three days before the symptoms you're actually developing and starting to shed the virus.

So, in my world, where I go in and see a lot of people, some of whom are sick, some of whom are okay, that's why I wash my hands every time. It's partly for my own protection but it's also for your protection, because I don't know if a person I saw two days ago was sick with a virus, gave me a virus that I haven't even started to get symptomatic from and I can communicate it to you. So, you see doctors, nurses, healthcare workers, always washing their hands, that's the real reason why.

Nada Youssef:   And you're saying that you can get the virus in your system two to three days before you feel anything?

Donald Ford:     There's usually a period of anywhere from a few days to even a week with some viruses before you even feel the first symptoms where you're actually starting to develop the virus and develop the immune response in your own body.

Nada Youssef:   And then you're contagious the whole time.

Donald Ford:     Typically, with a couple of exceptions. We'll talk about this I know in a little bit, but there is medication that we can prescribe for influenza. And after you get the medication into your body that typically stops the reproduction of the virus so you may not be as contagious after starting medication specifically for influenza.

Nada Youssef:   Okay, great to know. Okay, so let's talk a little bit about fevers 'cause that's the scary part. So, what causes the fever and what is actually happening to my body when I'm feeling really warm?

Donald Ford:     So, a fever, we talk, colloquially we talk around any time you feel hot, you feel warm and sweaty, that's a fever. Now, in medicine we quantify that. So, a fever has to be 101 degrees or higher. And the reason we put that kind of specification on it is because we really see that there's different meaning for temperatures that may be above normal but not quite up there. So what we call a low-grade fever may actually represent a different set of illnesses than something that gives the high fever.

High fever is characteristic of influenza and we'll get into that more. What's happening in your body is it's actually part of the body's immune response. So, we think of fever as something bad and of course we wanna bring down the fever and people will put on cold packs and people will even stand in the shower, of course we give Tylenol or anti-inflammatory medications. All of which are designed just to bring down the fever, they may have other effects like muscle aches and things like that.

But having a fever is very uncomfortable but the funny thing is it's our own body starting to fight off what's invading us. So, if a virus gets into our system, it's in the mucus membranes, it starts to show up in the bloodstream, our immune systems release chemicals called bradykinins and other types of inflammatory chemicals that actually start to increase the heat in the body, start to increase our core temperature. And part of what happens is it makes is very uncomfortable for the virus to live. So, we're literally trying to cook the virus out of our bodies.

Nada Youssef:   Wow. So our bodies are actually fighting off the virus when this is happening?

Donald Ford:     Correct. Yeah.

Nada Youssef:   But when is it like, "Okay, this is enough of this heat that's happening in my body, I need to see a doctor"?

Donald Ford:     Well, that's part of it. So, it can be very uncomfortable and we recommend that you take something like acetaminophen, which is Tylenol, or anti-inflammatory medications to bring down the temperature. Part of the problem is you can get dehydrated really easily.

Nada Youssef:   I see.

Donald Ford:     So when your body is that warm you're sweating more, you're releasing more fluids, you're releasing it through your mucus membranes, people with a fever, if you haven't noticed, they tend to go to the bathroom more. So, you lose fluids, you gotta keep-

Nada Youssef:   Drink a lot of water.

Donald Ford:     ... drinking a lot of water. And it's also a smart idea to do something like take some medicine to keep the fever down.

So, how do you know when to go to the doctor? Well, we use that cut-off really as 101. If you're just looking at the fever below that you're probably okay. Above that, definitely should get checked out.

Nada Youssef:   Okay. So, if your fever is over 101 go see a physician?

Donald Ford:     Yeah.

Nada Youssef:   Okay. Now ... Go ahead.

Donald Ford:     There are other things too because in terms of what I've just said, you wanna make sure you're able to keep up on the fluids. So, if you've got a lower temperature than 101 but you're throwing up, you're not able to drink-

Nada Youssef:   Can't keep it in.

Donald Ford:     ... can't keep things down, can't take that Tylenol or that Motrin, that might be a good time to go see the doctor as well.

Nada Youssef:   Okay, okay. What about for kids? Now, when my kids get a fever that's like the world kind of ends for me.

Donald Ford:     Yeah.

Nada Youssef:   And again, sometimes you call the physician or the nurse on call and she tells you, "If she's not throwing up, if she's fine, she's not dehydrated, let her go through the fever."

Donald Ford:     So, kids tend to get higher temperatures than grown-ups. Their temperatures are gonna go up much faster and down much faster. Now, the things that we have to watch out, which is super-fast elevation of temperatures in kids, it's possible, it's very rare, but it's possible that that can actually cause a fever in some children. So, we are telling parents to really do what you can to keep the temperature down. You wanna moderate it, you don't want that temperature to shoot through the roof.

But on the other hand, the temperature by itself isn't the criterion. What I said before, and what you said, are really what's important, can they keep down fluids, are they eating, are they drinking? You see a kid, he's got a temperature of 102 and he's sitting there playing with blocks on the floor and he's looking happy and smiling at you-

Nada Youssef:   Just leave him there as-

Donald Ford:     ... that's an okay kid.

Nada Youssef:   Yeah, okay. And if they can't keep it down and they're issues, now is 101 still the magic number for kids as well?

Donald Ford:     It's a cut-off so I'm actually hesitant to say that's the magic number because again really what it has to do with is much more of what I described about overall behavior and energy level, attentiveness, responsiveness, that sort of thing. When you talk about what we call a fever, that's what doctors a fever.

Nada Youssef:   Okay, great. Now, I wanna give you symptoms that people get confused with.

Donald Ford:     You wanna give me symptoms?

Nada Youssef:   I'm gonna give you the symptoms.

Donald Ford:     Oh all right, okay.

Nada Youssef:   I'll read off these symptoms to you-

Donald Ford:     All right.

Nada Youssef:   ... and then you tell me if it's a cold or flu because I think a lot of people get confused.

Donald Ford:     Very good.

Nada Youssef:   And then you can tell me how it feels for a cold or for a flu. So, let's start with the fever.

Donald Ford:     Okay.

Nada Youssef:   Is it a cold or a flu?

Donald Ford:     Okay, can't tell. Now-

Nada Youssef:   Can't tell.

Donald Ford:     Can't tell, but when I defined a fever as being over 101, that is much more typically seen with influenza so that really should be in the flu. But when we talk about these low-grade fevers and stuff, you can get that with any virus.

Nada Youssef:   You can get that with just a cold, you can get a fever?

Donald Ford:     Yeah.

Nada Youssef:   I always thought if you had a fever it's definitely the flu.

Donald Ford:     Yeah.

Nada Youssef:   Okay.

Donald Ford:     There are other things that can cause fever as well; mononucleosis and ear infections, strep throat.

Nada Youssef:   I see.

Donald Ford:     That sort of thing.

Nada Youssef:   Right.

Donald Ford:     It's sort of out of the stuff that we're talking about here today. I would never say it's just the flu but if you're gonna compare those two more likely the flu, less likely a cold.

Nada Youssef:   A cold.

Donald Ford:     Yeah.

Nada Youssef:   Okay, great. How about headaches?

Donald Ford:     Characteristic of influenza, very common, and can occur with colds as well.

Nada Youssef:   Okay. How about general aches and pains?

Donald Ford:     That can occur with both. It's often related to the fever, so you'll see those going hand in hand. Worse with the flu, but still possible to be present with the cold.

Nada Youssef:   Would you say that's same thing with fatigue and weakness?

Donald Ford:     I would say so, yeah.

Nada Youssef:   How about stuffy nose, sneezing, sore throat?

Donald Ford:     Now that's a good one. Okay. So, stuffy nose, the nasal congestion is almost always the cold, not the flu. So, the flu doesn't cause you to be congested.

Nada Youssef:   Interesting.

Donald Ford:     And that's something we can hear talking to patients on the phone, they're coming in and say, "I think I've got the flu, I'm sneezing, I've got a runny nose." I can tell just right there it's probably not the flu.

Nada Youssef:   Very interesting.

Donald Ford:     Now, I can't tell you exactly what it is, but I can tell you it's unlikely to be influenza.

Nada Youssef:   Okay. How about any chest discomfort or coughing?

Donald Ford:     Coughing is entirely characteristic of influenza but it can occur with colds as well. Now, it's a interesting thing, 'cause we didn't really talk about this, but with the sore throats, one of the things that we listen for as we're talking to people about their symptoms, if you have a sore throat and a cough, probably not strep. Sore throat without a cough, very likely could be strep.

Nada Youssef:   Very likely could be strep-

Donald Ford:     Yeah.

Nada Youssef:   ... if you have a sore throat and not a cough?

Donald Ford:     Yeah, but you still have to come in and get a test, get a swab.

Nada Youssef:   Oh very interesting.

Donald Ford:     Yeah.

Nada Youssef:   Now, how about other complications, especially with kids, that can cause a fever. I know you talked a little bit about that. Can we talk about RSV, what that is and the complications?

Donald Ford:     Sure. Yeah. I'm not sure if I can say it, but I'll try.

Nada Youssef:   Yeah, that's why I gave it to you.

Donald Ford:     Yeah. RSV stands for respiratory syncytial virus.

Nada Youssef:   Syncytial virus.

Donald Ford:     Respiratory is a breathing system, syncytia is a Latin word for the tissue of the lungs itself, and of course a virus is a virus.

Nada Youssef:   Right.

Donald Ford:     RSV is very common both in adults and kids, but most adults have been exposed to it enough that they don't get sick from it anymore. So, we typically see illness from RSV more in children than in adults. Now, the illness caused by RSV is a respiratory illness, by the name of the virus. It's in the chest. It has that in common with influenza. Typically causes a more barky cough or wheezing. And the treatment for it, they will often give an aerosol treatment of something called epinephrine which tends to help that.

RSV is usually a pretty brief illness, two to three days. By all means, I've seen cases longer than that and you can get complications from it. If a child is really sick with it, they can be in the hospital even longer. But for the most part it's a two to three-day illness, which is briefer than what we usually see with influenza.

Nada Youssef:   Okay. And then with strep throat, I know we talked about this a little bit.

Donald Ford:     Now, strep throat is the odd man out of everything we've talked about today.

Nada Youssef:   Why's that?

Donald Ford:     Because strep throat is caused by a bacteria.

Nada Youssef:   Okay, I see, verus a virus.

Donald Ford:     Very few upper-respiratory symptoms are caused by bacteria. That's a good thing because we're covered with bacteria. Bacteria is all around us in the world, every place we touch, everything. If these bacteria were causing us illness, we'd be in trouble because we're exposed to them constantly. Most of them just live with us perfectly peacefully and don't cause any symptoms.

Strep is a family of bacteria and one member of that family, Group A Strep, is the one that causes strep throat.

Nada Youssef:   I see.

Donald Ford:     And it does go from person to person, which is all fairly unusual for this, for bacteria that cause illness. So, we do have to watch out for it. I already told you a couple of the things that we look for. So, almost always characterized by characterized by sore throat and almost never by cough.

Nada Youssef:   Interesting.

Donald Ford:     Now, it can cause a fever, doesn't cause the stuffy nose. So, a few things in there are enough to help us start to distinguish, but we really do encourage folks to go in and get a rapid strep test. We can do it right in the office.

Nada Youssef:   That's the only way you can find out if it's strep, is if you go to the doctor's office and get the swab?

Donald Ford:     Is the test, right.

Nada Youssef:   Okay.

Donald Ford:     Because as much as I've said strep is the odd person out and it's an unusual bacteria, people who come in with sore throat and fever, 90% of them it's a virus and it's not strep.

Nada Youssef:   Very interesting.

Donald Ford:     Yeah.

Nada Youssef:   Okay. Let's talk about ear infection or teething. Especially, obviously we're talking about kids here. 'Cause it can have a lot of the same symptoms as fever, so how could you tell if someone has a newborn or an infant?

Donald Ford:     Yeah, it's tough. I'm the father of three and I remember when my kids were little, and that was actually before I became a doctor. So you look at them, "Boy, is he tugging on his ear?" That sort of thing. It isn't an easy call because some kids don't seem to be pulling on their ear at all and unless you're qualified in look in somebody's ear it's really hard to tell. As a doctor, I can look in a kid's quickly and know if it's an ear infection or not.

So, we usually look at the overall comfort level of the child. Same things I talked about before, are they eating, are they drinking? And a very important thing with ear infections that's a relatively new discover, historically we've always treated them with antibiotics. Kids will get over ear infections without antibiotics if you let them.

Nada Youssef:   Wow.

Donald Ford:     Most of the time.

Nada Youssef:   Yeah.

Donald Ford:     I'm giving a lot of qualifications in there because there are all sorts of reasons why, maybe the kid is really not looking well and you really wanna do something to help them, or maybe there are other people in the house that you wanna protect. There are all sorts of reasons why you would go ahead and treat. But we always wanna give the parents the option. "If you're comfortable with this, we can just watch this young person and see."

Nada Youssef:   How long is an ear infection usually?

Donald Ford:     Three to five days.

Nada Youssef:   Three to five days?

Donald Ford:     A lot of the times. So, that's one of the things we'll do, we'll say, "Watch him for three to five days and if he does okay maybe we don't need anything."

Nada Youssef:   On day four or something.

Donald Ford:     "If he's still sick after a week call me." Or a lot of times I'll just give people a prescription and print it out, not sent electronically.

Nada Youssef:   Until needed?

Donald Ford:     Yeah.

Nada Youssef:   Right.

Donald Ford:     So, "Hold onto that and see if you need it."

Nada Youssef:   Very good.

Donald Ford:     Yeah.

Nada Youssef:   Okay, besides kids, they're still building their immune system, who else is at high risk for developing any kind of flu complications?

Donald Ford:     So, from the flu, the people that we worry about the most are the young and the old. So, people over 65 and children, young children. People over 65 are more vulnerable to disease. I don't wanna say it's because they're lacking the immune system, it's really just an effect of aging that you're just more vulnerable. So, as an older person gets secretions in their chest, they may have a harder time clearing them. They have less body fat so less storage of nutrients and so forth so they can get dehydrated more easily. So, those are part of the things that we see in the elderly.

And also just somebody with a lot of chronic illnesses, perhaps somebody with heart disease or lung disease, they're just gonna be more vulnerable.

Nada Youssef:   Sure, sure.

Donald Ford:     So, again, it's not to try to scare people at all, but we did see a lot of deaths in the United States last year from influenza and most of them were the very young and the very old.

Nada Youssef:   I see. Yeah. 'Cause it sounds like we take the flu shot, you wouldn't think that that many people are still dying from this disease.

Donald Ford:     Yeah.

Nada Youssef:   So, let's talk about prevention and treatments.

Donald Ford:     Yeah.

Nada Youssef:   How do you treat the cold versus the flu?

Donald Ford:     Yeah. Well, the treatment for a cold is entirely supportive and what that means, another way of saying that is symptomatic treatment. So, you just try to give people suggestions for things that they can do to help the symptoms because it's gonna run its course. It doesn't matter what you do, if you've got the cold, if you've got an adenovirus or one of the other viruses that cause colds, we don't have any medicine that can make it go away.

Nada Youssef:   The cold?

Donald Ford:     Yeah.

Nada Youssef:   So, we're just treating the cough or sore throat or something like that?

Donald Ford:     Yeah. So, cough medicine is perfectly legitimate to give. There's a lot of good ones that are over the counter. There are ones that can be given by prescription. I have a couple of things that are not narcotics. The narcotics, I'm a little cautious with that, we know everything in the world, the dangers of narcotic medication. So, I do try to stay away from that wherever possible. But sometimes, if somebody really can't sleep, sleep is very helpful to get over and illness so I'm not gonna not prescribe something if it's-

Nada Youssef:   If it's gonna help.

Donald Ford:     ... gonna help them sleep.

Nada Youssef:   Sure.

Donald Ford:     Decongestants are another thing for treatment. And here's the one that I am a huge fan of, saline spray. Because you can get that for just a few bucks or you can even whip it up in your own kitchen with just a little saltwater and, salt and water mixed up and put it in a little spray bottle. That's what our bodies crave, hydration. We're trying to get something to wash all the mucus out, hydrate the tissues, shrink them up and start to restore the balance in our mucus membranes.

Nada Youssef:   What is the home remedy again, that's salt and water?

Donald Ford:     The proportions are about drinking glass full of warm water and a teaspoon salt. Mix that up together. You can pour some into a little spray bottle, like the medicated nasal sprays are in?

Nada Youssef:   Sure.

Donald Ford:     Which you can get in the drugstore, you can use an old one that you've emptied and cleaned out. And then just use that, because you can spray it into your nostrils 10 times a day if you want?

Nada Youssef:   It's not harmful in any way, there's no ill effects?

Donald Ford:     It's not harmful, yeah.

Nada Youssef:   That's excellent.

Donald Ford:     Yeah.

Nada Youssef:   That's very good to know.

Donald Ford:     And it'll make you think you're at the ocean, right?

Nada Youssef:   Is it gonna burn? It might. Okay, well let's talk about vaccines. First of all, there are people that may be allergic to eggs and I know there's some eggs in the vaccine, is that right?

Donald Ford:     The vaccine has to be essentially cultured, it's grown.

Nada Youssef:   It's a protein.

Donald Ford:     So, they do that in a medium that contains materials from eggs. So, an egg allergy is challenging because if it's true, serious allergy, we really can't use that type of vaccine for you.

Nada Youssef:   Okay, okay. So, we're at the end of January-ish, is it too late to get my flu shot if I didn't?

Donald Ford:     No. Because we think that the flu season typically will go through March, maybe even into April.

Nada Youssef:   Really?

Donald Ford:     So, given that we think that the effectiveness of the flu shot, it takes about two weeks after you get the flu shot for it to be fully effective.

Nada Youssef:   Oh, I didn't-

Donald Ford:     Although there's some protection even the next day. It gradually builds up over about two weeks as your body is bringing the vaccine in. So, given that we've got at least two and a half, three months left of the flu season, by all means go get it.

Nada Youssef:   How about pregnant women, does it protect them and the baby?

Donald Ford:     Pregnant women are the most important part of our population that we wanna immunize because it protects them and their baby.

Nada Youssef:   It does protect and their baby.

Donald Ford:     Yeah.

Nada Youssef:   Okay. So, going back to, well, the nasal spray you said to do at home-

Donald Ford:     Yeah.

Nada Youssef:   ... but I know the nasal spray was available for my kids-

Donald Ford:     Okay.

Nada Youssef:   ... but not last year. Talk about that.

Donald Ford:     So, two different nasal sprays we'll talk about. So, what I was talking about was the home remedy of how to clear out the mucus from your nasal passages if you have a cold. The nasal spray vaccine has been on the market for a number of years. Anybody who's ever tried to give a vaccine to a kid will know kids will much rather take a spray-

Nada Youssef:   Absolutely.

Donald Ford:     ... than get a shot-

Nada Youssef:   Absolutely.

Donald Ford:     ... in their arm.

Nada Youssef:   Right.

Donald Ford:     So, it's been a real benefit to getting a lot of kids immunized. Now, the problem is there have been some times when the message has been, "Don't use the nasal spray this year." And it's not because the nasal spray is bad, it's not because there was a recall. It's because, we haven't really gotten into this, but I said initially influenza's family of viruses, it's a family of them. So, we never know from one year to the next exactly which one's gonna show up until we start to get some clues.

So, there are groups who are constantly tracking what type of flu, what strain of flu is appearing in different places. We will typically get strains that have already started to appear in parts of the Orient and parts of Asia, typically will appear there before they come to the United States. So, we have a little bit of time, on the order of about six months, to try and figure out what the best vaccine is gonna be and to formulate that vaccine.

So, there have been some years, many years, when either the shot or the nasal spray were perfectly appropriate treatments. But there have been some years, and I believe last year was one of them, when they said, "This year, that nasal spray is going to be effective against this year's flu."

Nada Youssef:   Depending on the strain of the actual flu?

Donald Ford:     Yeah, depending on the strain.

Nada Youssef:   Very interesting.

Donald Ford:     Yeah.

Nada Youssef:   Did not know that. Okay, good. So, let's talk about, give us five more minutes we're gonna go into live questions-

Donald Ford:     Okay.

Nada Youssef:   ... but till then, tell our audience how to stop spreading the infections?

Donald Ford:     Okay.

Nada Youssef:   Important.

Donald Ford:     This is good.

Nada Youssef:   Yeah.

Donald Ford:     Well, there are two options really. You can wrap yourself in plastic. No.

Nada Youssef:   Bubble wraps.

Donald Ford:     It's not that, that's got its own downside. Hand-washing is the most important thing. If you come into any hospital, into any medical clinic, you'll see people right and left washing their hands. I could do a close-up and show you how chapped my hands are, which is another issue entirely. But if I see 25 patients in a day, I guarantee you I'm washing my hands 50 times in a day because I wash before and after. It is the most effective way of preventing the transmission of wintertime viruses, both the cold and the flu.

Now, influenza can also transfer through the air so you may see people who have the flu wearing masks, you may see people in the hospital wearing masks, because that is a courtesy, because you're also helping that from spreading as well.

Nada Youssef:   Right. And just like I tell my kids, use your elbow when you're sneezing.

Donald Ford:     Use your elbow when you're sneezing.

Nada Youssef:   Wash your hands, avoid crowds if you can.

Donald Ford:     Yeah, yeah.

Nada Youssef:   Okay. And-

Donald Ford:     And services too. Remember you said-

Nada Youssef:   Oh, yeah, 48 hours.

Donald Ford:     ... at the start, 48 hours on surfaces.

Nada Youssef:   Okay.

Donald Ford:     If you're in a place where it's just you, just your family, at home, and you know nobody there is sick you're probably okay. You don't need to be completely obsessive about washing the surfaces. But if you're in a public space or in a medical facility like this-

Nada Youssef:   Sanitizing.

Donald Ford:     ... you'll see us sanitizing and washing the surfaces all the time.

Nada Youssef:   Speaking of sanitizers, what do you think about hand sanitizers and antibacterial soap?

Donald Ford:     Yeah. So depending on exactly what type of bacteria or virus you're talking about, they're usually both effective. Now, part of the problem, we tend to encourage people to use the soap and water more than the hand sanitizers. There does seem to be a slightly higher effectiveness in terms of washing your hands with soap and water. And I think part of that is sort of technique, if you will. Because people just put a little dab in their hand and they just kind of-

Nada Youssef:   Just center of their palm?

Donald Ford:     Yeah.

Nada Youssef:   Yeah, yeah.

Donald Ford:     You're not really getting it where you need to around your-

Nada Youssef:   The water will get-

Donald Ford:     ... fingers which are gonna be taut and touching everything, yeah.

Nada Youssef:   So, when I hear something about the antibacterial or sanitizer can kill all the good germs and good-

Donald Ford:     Yeah.

Nada Youssef:   ... bacteria on our hand, what do you say about that?

Donald Ford:     Would that it were that powerful but it's not.

Nada Youssef:   It's not that powerful?

Donald Ford:     It's not that powerful. We have bacteria all over us and when we wash our hands we will remove the surface bacteria, within minutes it'll be back there.

Nada Youssef:   Okay. So, to keep your immune system strong and to keep building it up, I'm gonna tell you three truths and a lie.

Donald Ford:     Okay.

Nada Youssef:   So, you're gonna tell me which one it is.

Donald Ford:     Okay.

Nada Youssef:   So, take your Vitamin C, eat a good diet, and sleep. What is the lie?

Donald Ford:     Vitamin C.

Nada Youssef:   Why is that?

Donald Ford:     It's never been proven to have any effectiveness in terms of raising your immune system. It doesn't prevent colds, it doesn't prevent the flu. It's a necessary vitamin and there's a terrible disease called scurvy that happens to people who are-

Nada Youssef:   Deficient.

Donald Ford:     ... deficient in vitamin C. So, don't get me wrong, I'm not saying it's not important. But taking mega doses of vitamin C, you hear a lot of people saying, "Yeah, well I thought I was getting sick, took a bunch of vitamin C, it went away." That's good luck unfortunately, it's not good science.

Nada Youssef:   Okay, so that's a myth.

Donald Ford:     Yeah.

Nada Youssef:   That's very good to know.

Donald Ford:     Yeah.

Nada Youssef:   All right, well I'm done with my questions.

Donald Ford:     Okay.

Nada Youssef:   I'm gonna go to our audience with their questions.

Donald Ford:     Beautiful.

Nada Youssef:   So, we're gonna start with Darlene. "Do antivirus shots work when symptoms start?"

Donald Ford:     Do antivirus shots work when symptoms start?

Nada Youssef:   When symptoms start?

Donald Ford:     So, I'm gonna assume you're talking about a flu shot.

Nada Youssef:   Yeah.

Donald Ford:     So, that's the main antiviral shot that we have. We usually say to people it's never too late to get the flu shot. We really don't know. We have testing where we can identify the flu. But if you're starting to get sick, it's not a reason not to get your flu shot if you haven't had it so far. We could question whether it truly would be effective. I said before it takes about two weeks for the vaccine to get really effective, so if you literally had the flu that day and got the vaccine that day it might make no difference. But the truth is, we don't know going in if it all is the flu so we always encourage people to go ahead and get it if they feel okay.

Nada Youssef:   Perfect. And then Sandra. "I have read and watched videos on how the flu vaccines mess with the immune system and is causing many other issues, how true are these?"

Donald Ford:     I'm afraid I can't give a lot of credence to that. I don't know exactly what you mean in terms of mess with the immune system." Any vaccine is meant to have an effect on the immune system. That's how they work. What vaccines are, are basically false viruses or bacteria, ones that are not able to make you sick, that you put into your body to make your body think that you've actually been exposed to it. Our body's immune system has a memory, if you will, so that the next time we're exposed to that thing, the real thing, we're able to fight it off.

Immunizations are the heart and soul of how we live long, healthy lives today. The world was different a hundred years ago, and none of us were here a hundred years ago, I encourage everybody to really read the history because I talked about 1918 when 18 million people died across the world from the influenza. We haven't seen that recently and a big part of why we haven't seen that recently is because of-

Nada Youssef:   Vaccinations.

Donald Ford:     ... immunizations, right?

Nada Youssef:   Yeah, sure. Great.

Donald Ford:     Yeah.

Nada Youssef:   And then Sue. "How do you know if an illness is viral or bacterial?"

Donald Ford:     Yeah. It's tricky. I don't have any easy way. That's why we typically will invite people into the clinic to come and see us or go to one of our express carers. Because I can't tell easily if there could be something in the ear, something up in the sinuses.

Nada Youssef:   You have to be checked.

Donald Ford:     You have to be checked, yeah. We're doing more and more with telehealth these days, so we have some doctors who are really training themselves to be able to do that through a video interface. But frankly it's a tricky skill because sometimes, I would say I could tell within a couple of minutes of taking a look at somebody quite easily if it's bacterial or viral, whereas if I'm talking to them on the phone I don't really know the difference.

What I can say is that over 90% of illnesses during the winter months are gonna be viral and it's actually the exceptions that are bacterial.

Nada Youssef:   And then Kyle wants to know if a virus is a living organism like bacteria?

Donald Ford:     That's a good question-

Nada Youssef:   It is.

Donald Ford:     ... and a hard question because even philosophers have debated this one. We typically define something that's alive as something that's able to reproduce, that has a genetic code. Now, viruses qualify on both those fronts because viruses can reproduce and they have genes. Usually a virus is just a little tiny protein packet full of genes. What separates it from what we usually think of as living stuff is that viruses have no organs at all, they have nothing. And in fact they don't even have the reproductive means of reproducing themselves. They just have the DNA code.

Nada Youssef:   Very interesting.

Donald Ford:     What viruses do is they find a host, either a person, a bacteria, an animal, and they literally insert themselves into the jeans of that host and then the host actually starts producing, reproducing the virus.

Nada Youssef:   Yeah.

Donald Ford:     So, it's always been an argument philosophically whether that actually means-

Nada Youssef:   It's alive or not, yeah, yeah.

Donald Ford:     ... viruses are alive or not, because without a host the virus couldn't reproduce and couldn't do anything.

Nada Youssef:   That's very good information, I had no idea.

Donald Ford:     No.

Nada Youssef:   And then Laverne. "What is the difference in a severe cold and an actual flu?"

Donald Ford:     There really is no similarity between a severe cold and a flu because if it's not caused by the influenza virus it's not the flu. Now, we use these terms a lot, cold or flu, cold, flu-like illness, that sort of thing, without testing we can't tell you a hundred percent sure whether it is or it isn't. And we do have testing for the flu. Most of these other virus that I had mentioned, we don't have a test for. Even if I wanted to, I couldn't run one off to the lab.

So, you can be very sick with a cold. You can get a virus that is not the influenza that can lead to complications like a pneumonia, people can end up in the hospital, all that is possible. We simply single out the flu because, A, it's typically more severe, B, we have typically seen complications, particularly in these more vulnerable groups, the young and the old, and frankly because we also have some other weapons, testing and immunization, against it.

Nada Youssef:   All right. And then Annette. "How long does the flu last?"

Donald Ford:     Flu can typically be five to 10 days we'll say. I talked about three-day illnesses, I've never seen a flu that only lasted three days.

Nada Youssef:   Okay.

Donald Ford:     So, for most people it's gonna be about a week, sometimes a little shorter, sometimes a little bit longer.

Nada Youssef:   And symptoms vary?

Donald Ford:     Yeah.

Nada Youssef:   Makes it really hard for you. It's a hard job.

Donald Ford:     Yeah.

Nada Youssef:   And then Barb. "Why are sinus infections so bad this time of year?"

Donald Ford:     Sinus infections are a bacterial infection and we haven't really talked about that much except a little bit of compare and contrast with some of these viral illnesses. Big important point about bacterial illnesses like sinus infections, you can't catch them from anybody. You start out with a cold. What happens is you get a cold, it causes the nasal congestion. Remember, that doesn't happening as often with the flu.

And if your anatomy and your sinuses is such, you may end up starting to get fluid building up in your sinus spaces. Sinuses are cavities in the bones of the face. Those cavities fill with fluid, bacteria that's already there, all that good bacteria starts to grow in that warm, wet environment, and then can become what we would medically talk about as an overgrowth phenomenon.

So, the bacteria that's causing sinus infections is your own normal bacteria-

Nada Youssef:   Bacteria.

Donald Ford:     ... that's in an abnormal state of growth. One of the things that I try to help patients understand is, you know, I'll have someone come in and say, "Well, my wife just had experience the same symptoms that I did and she was treated with antibiotics for a sinus infections. Now, I got the same symptoms." I say, "Well, whatever it is, you didn't get it from her. Now, you may have gotten the original virus from her, but you can't get a sinus infection from somebody else." You can't get an ear infection from somebody else. You can get strep and you can get all of these viruses from someone else.

Nada Youssef:   So, sinus infection, ear infection, is not a contagious-

Donald Ford:     Correct.

Nada Youssef:   Cool. And then Bonnie. "I've had reoccurring sinus infections. Do automatic cleaners for PAP machines work? Any recommendations?"

Donald Ford:     So, I assume you're talking about then the CPAP. So, some people have to wear a mask-type device to help them breathe at night for sleep apnea.

Nada Youssef:   Oh, I see, okay.

Donald Ford:     So, yeah. So, any time that you have water sitting in a static well, so, you know, a cup of water, a container of water, the reservoir on a CPAP machine, reservoir on a humidifier which happens for a lot of people, that has to be cleaned regularly otherwise bacteria will grow in there. And it's actually not just bacteria this time, it's funguses which we haven't even talked about.

Nada Youssef:   Yeah, that's a whole other story.

Donald Ford:     But they can get in ... That's a whole other story.

Nada Youssef:   Yeah.

Donald Ford:     And these machines are designed to move that water into the air, humidify the air that they're blowing through, and then they literally blow it right into your airway. So, you gotta clean it.

Nada Youssef:   Keep it clean.

Donald Ford:     Yeah.

Nada Youssef:   Okay. And then Louis. "How do you diagnose a sinus infection, and if you have one does it need to be treated or will it clear on its own?"

Donald Ford:     Great question. So, I just talked about sinus infections being our own spontaneous response to another type of infection. So, it would always start with a virus, cold, other type of viral infection. So, you develop the nasal congestion. In the wrong set of circumstances it may start to build up in the sinuses.

One of the clues we get, and this is a really important one that I don't know that a lot of people really think about outside of medicine, what we'll see is we'll see that virus causes the symptoms, it starts to get worse, actually starts to get better and then a few days later that bacteria starts to overgrow. So, there's usually a gap and what this causes is you get ill for a few days, think you're on the upswing, think you're getting better, and then you start to get sick again. Often with a lot of pressure in the sinuses, that nasal congestion is thick and may have an odor to it.

One myth I like to bust all the time is that the color of the mucus doesn't mean a thing because mucus-

Nada Youssef:   You're saying it does or it does not?

Donald Ford:     It does not.

Nada Youssef:   It does not mean a thing?

Donald Ford:     It does not mean a thing 'cause if you have somebody who's had a cold for a week, their mucus is gonna be green.

Nada Youssef:   I see, I see.

Donald Ford:     But it doesn't tell us what it's from.

Nada Youssef:   It doesn't mean anything, okay.

Donald Ford:     But what I just described is that illness that gets worse, gets better, and then gets worse again, that's very characteristic of a sinus infection.

Nada Youssef:   Of a sinus infection.

Donald Ford:     Yeah.

Nada Youssef:   Very, very interesting.

Donald Ford:     To the second part of your question. Just like with kids and ear infections, we're learning that we don't always have to treat those with antibiotics, we're learning we don't have to treat sinus infections with antibiotics as well. What's the advantage of that? Well, antibiotics can cause a lot of problems. Sometimes it's yeast infections, sometimes it's that you're building up a immunity. It's not you building up immunity, it's the bacteria-

Nada Youssef:   Bacteria, right.

Donald Ford:     ... building up immunity to that particular antibiotic. Causes diarrhea, it can cause skin rashes, it can cause all sorts of other things. So, there's always a good reason to at least stop and think, "Do I need this antibiotic?" Everybody wants to get better, we want people to get better, we don't want people to suffer, most of us got into this business because we're trying to help people, relieve their pain and suffering. But sometimes we should take a minute and think, "Is that really going to help me or is that possibly gonna cause more complications?"

Nada Youssef:   Sure. And people don't know that.

Donald Ford:     Yeah.

Nada Youssef:   They think they want medicine to feel-

Donald Ford:     Yeah.

Nada Youssef:   ... better.

Donald Ford:     Understood.

Nada Youssef:   That's why it very important what you're doing right now to inform-

Donald Ford:     Understood.

Nada Youssef:   ... patients and our audience about what to take and what not to.

Donald Ford:     Yeah.

Nada Youssef:   "Why do so many doctors treat bronchitis with antibiotics when most of the times it's a viral cause?"

Donald Ford:     Well-

Nada Youssef:   Sounds like you know what you're talking about.

Donald Ford:     Yes. Welcome to my world. So, yeah, bronchitis has been proven to be a viral infection. It is a viral phenomenon. There actually was some early research that was a little bit misguided so people with the symptoms of bronchitis were cultured, they'd put culture swabs down their throat and swab out their large airways. They grew bacteria and went, "Aha, it's bacterial." Well, if you swab anything you're gonna get some bacteria.

Nada Youssef:   You're gonna get bacteria, right.

Donald Ford:     So, really it was a misguided effort in medicine. Bronchitis, the itis means inflammation and then usually in medical terms it's preceded by part of the anatomy.

So, the bronchi, which are the large airways, not the little, tiny, microscopic airways that are in the lungs but the big tubes that lead from the lungs to the trachea, to the largest airway, that's all called the bronchial tree. And if you get a virus that manages to get past your upper-respiratory area down into the bronchial tree, it's gonna cause inflammation, it's a virus like anything else.

There's a big difference though when it gets down here, and it's not that it all of a sudden decides to become bacterial because it can't, a virus can't transform into a bacteria. What happens is it inflames the linings of those large airways, they get swollen, they get thick, and as they get swollen and thick they secrete mucus which is why you start to cough stuff up, so it becomes a productive cough. Part of the body's response is that it actually sheds the entire lining of your airway, more stuff to cough up.

Nada Youssef:   Sheds?

Donald Ford:     Sheds.

Nada Youssef:   Like more fluid-

Donald Ford:     Yeah.

Nada Youssef:   ... adding on? Okay.

Donald Ford:     Yeah. And so every time that happens, more stuff, you have to keep clearing it out, coughing, coughing, coughing. And what you're left with is essentially a naked airway. Its outer layer of cells have all been shed off, so it's very sensitive to cold. You see a lot of people, they've had bronchitis and they can't go out in the cold without a reactive cough. And it can take weeks to get better from. So, I tell people, if they've got bronchitis it's gonna last four to six weeks at a minimum.

Nada Youssef:   Wow.

Donald Ford:     And-

Nada Youssef:   Contagious?

Donald Ford:     "Don't worry." Well, it's contagious like any virus. At the early parts, probably most before you even get sick. But after a week or two weeks, not at all. And people are very disturbed, understandably so, they think they've got this persistent cough, it's gotta be something terrible. But if you know going in, "This is bronchitis, you're not gonna feel well and you're gonna be coughing for four to six weeks," sometimes it just helps and people can say, "Okay, I just gotta take my time and get better."

Nada Youssef:   Stella is saying that she had bronchitis in November and then got it again three weeks ago. "The x-ray showed my lungs were inflated. Never heard that before. What is inflated lung?"

Donald Ford:     Well, that description as I understand it has nothing to do with bronchitis, so I don't know anything about your medical conditions and I don't wanna make any assumptions. But that description of an inflated lung, the term would be actually hyper-inflated, is a sign that we see often with COPD or asthma. So, people who have, both of those are called obstructive airway disease, they lead to taking deeper breaths than usual all the time and that you can breathe in more easily than you can breathe out, which is why both of those cause wheezing. That's the result of easy in, hard out.

Nada Youssef:   Hard out. Okay.

Donald Ford:     And so what you see on an x-ray picture is that the lungs have a typical shape with a round diaphragm, and what we'll see is that the chest is slightly expanded, that diaphragm is flat, and then we describe that as hyper-inflated. So, I think that's what they're talking about and I'm afraid I can't answer any more specifically than that.

Nada Youssef:   And then we've got Mary. "Any suggestions for natural remedies for cold and flu?"

Donald Ford:     Well, the one I always go back to is the one I talked about which is the nasal saline spray. A little bit of saltwater goes a long way. I say saltwater because pure water, tap water, it's actually gonna tend to draw out the salt from the tissues. There's nothing wrong with it, it's not harmful, it's not bad to use plain water but it doesn't do as much to allow the water to pull into the tissues. So, chlorinated tap water can be a little drying if you expose it right to your nasal membranes, the saltwater tends to make it a little easier, feel better and actually be more effective. So, that's my number one natural remedy.

There's really not been research that has supported, we already talked about vitamin C, other types of natural products, flower products and so forth. There's nothing wrong with things that make you feel better like menthol. A lot of products for colds are mentholated, the old Vicks VapoRub or other things, nasal inhalers now, aromatherapy. If they make you feel really there's nothing wrong with them and they're not really harmful, they're just not gonna cure anything.

Nada Youssef:   Okay. So, my mom used to make me take a spoonful of raw honey-

Donald Ford:     Okay.

Nada Youssef:   ... and then take a shot of squeezed fresh lemon after.

Donald Ford:     Okay.

Nada Youssef:   Does that work?

Donald Ford:     Yeah, I mean, again, so the honey is soothing so-

Nada Youssef:   For the throat.

Donald Ford:     Yeah. If you have a sore or a raw throat, it's gonna be soothing. Lemon, it cuts through, it's acidic so it cuts through some of the mucus. To me, it's a question of does it make you feel better? If it is and it's safe, by all means. Hydration, of any of these materials, is good. Because you can steam something with a little eucalyptus or a little honey or a little lemon or something like that.

Nada Youssef:   Tea.

Donald Ford:     Or drinking it in tea. Those all feel good and they hydrate so-

Nada Youssef:   Right, okay.

Donald Ford:     So, the honey may be more coating the problem but if you hydrate and coat you're gonna get better.

Nada Youssef:   Maybe just the placebo effect.

Donald Ford:     Maybe, but who's complaining?

Nada Youssef:   Right, not me.

Donald Ford:     Right.

Nada Youssef:   Carl. "Why do we take medication to bring down a fever when the fever's our body's method of defense?"

Donald Ford:     Yeah, so I tried to get into that before. It's a little hard to understand. The biggest risk of a fever, especially if it goes very high, is dehydration. So, your body is literally hotter than it is and it's gonna burn off or it's gonna evaporate more fluid more rapidly. There is a little bit of a risk for kids if that temperature goes up very fast, that could lead to what's called a febrile seizure. So, we always try to mitigate it. Most of the time we're not trying to eradicate 'cause it is part of our immune system, we're trying to get yourself more comfortable so that you're not losing as much fluid and can sleep and rest and therefore get better faster.

Nada Youssef:   Okay. Then Joanne wants to know if strep is unusual in adults.

Donald Ford:     Yeah, we see it less in adults-

Nada Youssef:   We do.

Donald Ford:     ... than we do in kids. I'm afraid I am not a hundred percent clear on the reason for that. It doesn't seem to be an accumulated immunity like we see in some other things. So, there certainly are many illnesses that we see more commonly in children than adults, RSV I gave as an example of one. That seems to be, yeah, you've just been exposed to it enough. I think frankly it has to do with the fact that adults don't stick their fingers in their mouth quite as much as kids do.

Nada Youssef:   The dirt doesn't go-

Donald Ford:     Yeah.

Nada Youssef:   Okay. Then Misty. "Is hand sanitizer as effective as washing hands?"

Donald Ford:     Yeah, well-

Nada Youssef:   We'll say no.

Donald Ford:     We'll say washing the hands gets that one by an edge. It probably isn't actually about what's in the cleansing material, the soap versus the gel, but how effectively you're actually getting every surface as you're washing your hands.

Nada Youssef:   Great. Well-

Donald Ford:     So, okay?

Nada Youssef:   You're out of time, we're all set.

Donald Ford:     Well, that flew by.

Nada Youssef:   Is there anything else you want to add?

Donald Ford:     No, no. Just get your flu shot because-

Nada Youssef:   Yeah, and wash your hands.

Donald Ford:     And wash your hands. We wanna keep each other safe and comfortable this winter season.

Nada Youssef:   Well, it's been a pleasure. And if you do wanna make an appointment and talk to Dr. Ford, you can call 866 320 4573 or you can go to And make sure to check out all of our other interviews for practical health advice from Cleveland Clinic experts on our Health Essentials Podcast at And of course for more health tips and information, keep following us on Facebook, Twitter, Instagram and Snapchat at ClevelandClinic, just one word. Thank you, we'll you again next time.

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Tune in for practical health advice from Cleveland Clinic experts. What's really the healthiest diet for you? How can you safely recover after a heart attack? Can you boost your immune system?

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