Color & Control:

What you need to know about cold and flu season in the time of COVID-19

Woman sitting on the couch wrapped in a blanket blowing her nose

By Allan Grill and Jerome Leis 

The cold and flu season looks very different this year with the COVID-19 pandemic. When a person has a fever, sore throat, aches and chills, they need to consider when to self isolate, when to be tested for COVID-19, when to be assessed in person and when antibiotics should be considered.

Is it a common cold, the flu, a bacterial infection or the novel coronavirus (COVID-19)?

In a recent article in the British Medical Journal, we provide advice on symptom management and treatment approaches for viral and bacterial infections – as well as when patients need virtual versus in-person assessments.  Such guidance can help both doctors, other primary care providers and patients to use health care resources wisely.

In the past, during the winter months, our medical offices were full of patients with concerns about symptoms caused by seasonal cold and flu viruses. In those pre-COVID-19 days, patients were examined to ensure that the infection was not bacterial and given treatments to manage symptoms.

In the context of the COVID-19 pandemic, cold and flu symptoms now could also be symptoms of COVID-19. Public health advice to Canadians experiencing some of these symptoms is to first get tested for COVID-19 and self isolate at home while awaiting the test result.

Each day, tens of thousands of Canadians with respiratory symptoms get tested for COVID-19. Most will receive a negative result. For those who test negative, but have ongoing symptoms, what to do next can be confusing.

A virtual visit to your doctor may be in order.

Doctors’ offices and clinics now extend beyond the four walls of examination and waiting rooms as patients are accessing more of their care virtually, through phone calls and video visits to reduce the risk of COVID-19 spread. These platforms that allow health care providers to connect with patients without an in-person visit are ideal for the initial assessment of cold and flu-like symptoms. The majority of viral infections can be accurately diagnosed and managed without a physical exam.

Bacterial infections, which are the exception, generally require an in-person visit to assess and confirm.

Making this distinction is important since antibiotics, which are used to treat bacteria, do not improve recovery from viral infections and can have harmful side effects when prescribed unnecessarily.  There’s actually another global health threat which can compound the COVID-19 pandemic: antibiotic resistance. When antibiotics are overused, they create antibiotic-resistant bacteria that make it more difficult to treat common bacterial infections when we need them.

In 2018, approximately 5,400 people in Canada died as a direct result of antibiotic resistance. It is projected that by the year 2050, antibiotic resistant bacteria could lead to 10 million more people dying around the globe each year.

Now, more than ever as we are battling COVID-19, preserving the effectiveness of antibiotics is vital.

Research shows that when antibiotics are prescribed based on virtual visits alone, they may be overused.  This occurs because virtual visits lack the ability to perform physical examinations or obtain additional testing required to make an accurate diagnosis of a bacterial infection.

To address the problem of unnecessary prescribing of antibiotics during this unprecedented cold and flu season, Choosing Wisely Canada and The College of Family Physicians of Canada have created guidance for how to manage common respiratory infections in the time of COVID-19.   Guidelines include symptom management strategies such as taking over the counter medications for fever, drinking fluids to prevent dehydration and getting plenty of rest.

It also provides tips for when an in-person examination may be important to assess if symptoms are caused by viral illness or a bacterial infection.

Right now, patients with cold and flu symptoms are more anxious than in previous years because of the possibility of COVID-19. As in prior years, primary care providers are equipped to support patients. Although the cold and flu season is very different this year, you are not on your own.

Talk to your primary care provider about how to manage your symptoms.


Jerome A Leis is an infectious disease physician at Sunnybrook Health Sciences Centre in Toronto.

Allan Grill is a family physician at Markham Stouffville Hospital.


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