Selected Podcast

Special Edition - The Differences Between COVID, Flu, Cold and Allergies.

Today's episode comes from Back to Health. Aaron Pearlman, M.D. and Moitri Chowdhury Savard, M.D., discuss COVID-19, Flu, Cold and Allergies. They share the most common questions they receive and what people can do at home for self-care and symptom relief.
Special Edition - The Differences Between COVID, Flu, Cold and Allergies.
Featured Speaker:
Aaron Pearlman, MD | Moitri Chowdhury Savard, M.D., FAAFP
Dr. Aaron N. Pearlman is an Associate Professor of Clinical Otorhinolaryngology at Weill Cornell Medical College. His clinical interests include the medical and surgical management of sinonasal disorders in adults and children, including acute and chronic rhinosinusitis and diseases of the skull base. 

Learn more about Aaron Pearlman, MD 

Dr. Savard received her A.B. cum laude from Harvard University. She received her MD with Distinction in Humanities from the State University of New York at Stony Brook and completed her board certified training in Family Medicine with added qualifications in Public Health at the University of New Mexico. She is a Fellow of the American Academy of Family Physicians.

Learn more about Moitri Chowdhury Savard, M.D.

Melanie Cole (Host):  Welcome to a special edition of Kids Health Cast. Today, we are featuring a popular episode from our Back to Health channel that we think you would love to listen to. To learn more about Back to Health and our other podcast channels, please search for "Weill Cornell Medicine" wherever you listen to podcasts!I am Melanie Cole and our topic today is COVID, Flu, Cold and Allergies and my guests in this panel are Dr Aaron Pearlman M.D. an Associate Professor of Clinical Otolaryngology, Weill Cornell Medicine and Associate Attending Otolaryngologist - NewYork-Presbyterian/Weill Cornell Medical Center` and Dr Moitri Chowedhury Savard, MD the Medical Director, Long Island City Primary Care and Assistant Attending Pediatrician and internist at New York-Presbyterian/Weill Cornell Medical Center Dr Savard, what is the difference between allergies, a cold and the flu and COVID -19?
Moitri Chowdhury Savard, MD (Guest):  Thank you so much Melanie. This is a great question and really important as we are getting into seasonal allergies. So, let’s start with allergies. The most common symptoms are sneezing, clear runny nose, itchy, watery eyes, nose and throat. You can often feel it in your nose when you feel that little like scratch that you can’t get to. Sometimes, there might be shortness of breath when you come into contact with a particular allergen for example, you go to visit a friend and she’s just adopted a kitten. So, often that will be more of an allergic response. They are often seasonal due to pollen from trees, flowers, grass and weeds but some people do have year round symptoms due to things like mold, and dust or animals.

But when a patient acquires a viral infection, the symptoms tend to have more of a rapid onset. Typical viruses including the flu have a time course of about seven to ten days with somewhere in day two, three, four being the most severe. Interestingly, flu and COVID-19 have a few very similar symptoms such as cough, fever, shortness of breath and muscle aches. But COVID-19 can also have multiple other symptoms such as sore throat, chest tightness, nausea, perhaps vomiting or loose stools, headache, and loss of smell and taste which are much less common in the flu.

COVID-19 also seems to get worse after a longer time course. With COVID-19, it seems that after about seven to eight days, is when people who are going to have real problems tend to have respiratory issues.

Host:  Well thank you so much for that answer and Dr. Pearlman, would you expand a little bit on the smell and taste loss that we’re hearing about for COVID and some of the specific symptoms? Is there a context? Are we still screening, asking what the person’s doing or if they suffered this before every season or tell us a little bit more. Expand a little more for us.

Aaron Pearlman, MD (Guest):  Yeah Melanie. Thank you so much for that question. As an otolaryngologist, and someone who specializes in Sino nasal diseases, the fact that smell and taste loss is so prevalent in COVID-19 is something that I find particularly interesting. And it really differentiates COVID-19 from the flu. We know that common respiratory viruses can cause smell loss but the rates of smell loss in COVID-19 are much higher than have been reported in the past with other viral infections. So, as this is a new disease, there’s not a lot of data for us to look at but a recent paper from a respected group of European ENTs was just published and it showed that up to 88% of patients that were polled who had COVID-19 had a smell or taste complaint. So, fortunately, we think that a lot of these people are going to recover and rarely will the smell loss be long term. But patients are definitely concerned when it’s occurring.

As for how do you treat this acute smell loss? Well there’s no agreed upon treatment for acute smell loss. People try nasal steroids, oral steroids, or even Omega Fatty 3 acids but the data in all these remedies is weak and there is concern that giving COVID-19 patients steroids, is unclear how it might affect them in terms of their respiratory issues. So we are not really recommending that. So in terms of context, it’s really relatively hard question to answer because in terms of screening COVID-19 is being passed around in the community. So, screening in terms of travel history, or contacts, it’s a relatively difficult thing to ascertain at this point due to the widespread prevalence of COVID-19 in the community.

Host:  Well then let’s talk a little bit about the transmission and the spread Dr. Pearlman. Tell us how they are transmitted and we’re hearing about COVID but as far as the flu or a cold, or even allergies, people sneeze, and they are not really quite sure what just happened. Explain the transmission for us.

Dr. Pearlman:  Well, it’s true, so flu and Covid-19 both spread through droplets from oral and nasal secretions. So, a cough or a sneeze is the most likely way you are going to spread this virus. However, COVID-19 patients are able to spread the virus when they are asymptomatic which is a pretty significant contrast to what we believe flu patients or common cold patients are like. We think they spread the virus when they are symptomatic. So, in both cases, the virus can also spread by coming into contact with the secretions that contain the virus and the infecting yourself by touching your mouth, nose or eyes. So, if droplets end up on a surface, whether it’s your countertop, cardboard or clothing; that surface is then called a fomite and you can infect yourself by touching that surface. This is why we’re also practicing contact precautions as well as droplet precautions and so that’s why it’s important to maintain that social distance of six feet.

Host:  And since so many of those symptoms are similar, Dr. Pearlman, just sticking with you for one more minute; is there a definitive way to tell what’s going on whether somebody has just seasonal allergies because I imagine people are terrified if they sneeze right now or if they cough when it could be something as simple as an allergy, that they might have had before. How can we tell?

Dr.  Pearlman:  Well, I think that most patients with the flu, don’t develop severe respiratory compromise. Certainly, allergic patients aren’t going to have this respiratory compromise. Allergic patients probably have had some of these symptoms in the years past and so they’ll be familiar with their seasonal variation in sneezing and runny nose, itchy eyes. The smell loss is a real strong indicator of a COVID-19 infection. And furthermore, COVID-19 worsens when the flu would be improving. So, that’s a big difference right there as well. But most importantly, we have testing and so with testing you can reliably screen for the flu. Now with COVID-19 testing, there is availability but it’s less available and the sensitivities of some of the tests for COVID-19 are not clearly delineated at this point.

Host:  Dr. Savard, whether we’re suffering a cold, the flu, COVID-19 or allergies, what can we do in terms of self-care at home? What do you recommend that we do when we’re thinking of hydrating and helping ourselves to feel better?

Dr. Savard:  Sure. I think the most important thing to do is what we learned when we were two years old and washing our hands. You can sing Happy Birthday twice. I think most people don’t realize how long it really takes to wash our hands well. You can also keep your tabletop surfaces clean, areas such as door knobs, light switches, faucets and appliances. Wipe those off frequently. If you do come down with some of these viral symptoms, definitely rest, lots of fluids, check your temperature and Tylenol as needed.

Host:  Dr. Pearlman, if people know this is an allergy; should they continue to use their inhaler?

Dr. Pearlman:  The answer to that is absolutely. If you have allergies, you should continue to use all of your normal allergy medications. There is no reason to stop your current medical regimen. In fact, stopping your medical regimen might confuse things even more because your symptoms may increase. So, I strongly recommend people continue to take their normal medicines.

Host:  Well thank you so much both for those answers and Dr. Savard, I want to jump back for just a minute. One thing that I think is on people’s minds is if you have a cold or allergies, you take pseudoephedrine or other over-the-counter medications. Are these not advisable at this time for symptom relief? You mentioned home-care and hydration and rest. What about over-the-counter for any symptoms that we’re experiencing?

Dr. Savard:  There’s no reason to stop or avoid medications that cause you symptom relief for mild upper respiratory infections or allergies. There has been some theoretical concerns about ibuprofen so for the headaches, and muscle aches that accompany some of these illnesses particularly COVID-19, we’re thinking for now if possible, to stick with Tylenol and other over-the-counter medicines in general seem to be totally safe in this disease.

Host:  Well then Dr. Savard, I’d like to stick with you about fever because that seems to be a symptom of both colds, flu and COVID-19. When does a fever indicate a more serious condition? You’re a pediatrician, how high does it have to be for a parent to be concerned? When do they call the doctor about this?

Dr. Savard:  So, it’s interesting. I think people will notice slight elevations in temperature. You can take your child’s temperature but really in medicine, we consider over 100.4 to be a “fever.” Now, when we see a sustained fever of over 102 for a few more days, we’re a little bit more concerned particularly if a patient has other comorbid diseases. For example, a child who is immunocompromised or an adult who has diabetes or COPD or heart disease. We are also concerned if a child or an adult presents with any shortness of breath at rest. How do you know? You’re trying to have a conversation just sitting there and you’re having trouble kind of forming the words and getting the words out. In children, what we’ll see with them is they start using their accessory muscles to breathe. These are muscles of their abdomen or their chest and they will not look normal. They will look like they’re sucking in their chest and their abdomen to be able to breathe. So, that kind of shortness of breath is definitely something that we are concerned about.

But I would say that if your child has a fever of 100.4 with some of these symptoms you can watch them, call your doctor, and then maybe check in again if this fever is going past 102 and staying there for a couple of days to discuss next steps.

Host:  It’s so interesting and Dr. Pearlman, do you have any final thoughts or final words that you would like as an otolaryngologist what would you like the listeners to take away from this segment on COVID, the flu, colds, allergies, the confusion of them all. Do you have some final thoughts for us?

Dr. Pearlman:  Well I guess my final thought would be that it’s all about understanding what symptoms you’re having and following those symptoms over time. Determining whether somebody has a particular type of viral illness, it’s really about the time course and we know predictably from the common respiratory colds and from the flu that patients typically get better within a week, maybe a tiny bit longer. And we’re seeing that with COVID-19 that patients’ symptoms are waxing and waning and in fact worsening after a week when there is severe respiratory compromise on the horizon. So, a patient needs to be very mindful of what the progression of their symptoms are. And I will just say in contrast to allergy, allergy is much more predictable in terms of the symptoms, sneezing, watery eyes, runniness, congestion. Those are very, very particular, sort of reproducible symptoms that patients have over and over again, year after year.

Can patients develop new allergies? Yes. It’s not impossible. But it’s not that likely that you are going to all of the sudden be allergic when you have never had allergies before. So, if you’re having new onset symptoms in a situation where you have never had these types of symptoms before; I would think viral illness over allergies.

Host:  Well thank you and as we wrap up, Dr. Savard, to whom do we turn if we’re unsure of those symptoms and what it might be? Is there anyone we can call? Is Telemedicine available to help us figure it out? Please wrap this up for us with your best advice and information for listeners on where to turn if they’re scared.

Dr. Savard:  So, the first person to turn to is the office of your local healthcare provider. In New York City, we’re providing worldclass Telemedicine to help out patients during this challenging time while maintaining social distancing guidelines. If you search Weill Cornell Video Visits, you can be connected to a trusted physician. It’s an important medium that we’ve been using now because when I’m on the other end of my phone, I can see how the patient is breathing and are they able to have a conversation with me. So, I highly recommend reaching out for these video visits and as a last line, I just want to make sure that people are not scared but are smart about their symptoms. If they have sustained high fever, shortness of breath, please reach out to Weill Cornell Video Visits or your trusted provider in your area.

Host:  Thank you Doctors so much for joining us today in these unprecedented times. Thank you coming on and sharing your expertise with us. For information about COVID-19, including symptoms, prevention and travel advice; please visit / coronavirus or call our hotline at 646-697-4000.

Thank you for listening to this special edition of Kids Health Cast. To learn more about all our offerings, please search for "Weill Cornell Medicine" wherever you listen to podcasts!