Dr David Bratt

Every Sep­tem­ber we go through the same ex­pe­ri­ence. Whether adult or child, every­one starts cough­ing a cou­ple of weeks af­ter school starts. This con­tin­ues un­til De­cem­ber hol­i­days, when it takes a rest un­til Car­ni­val. This is nor­mal life.

It’s called the cold and flu sea­son and noth­ing stops it. A cold is that acute, short-last­ing col­lec­tion of symp­toms (what you feel) and signs (what you see) char­ac­terised by a run­ny nose, a sore throat, cough and oc­ca­sion­al­ly a low-grade fever. It lasts a week to ten days. The av­er­age child un­der six gets about six colds a year in the trop­ics. Some chil­dren get three, some get nine. It varies ac­cord­ing to the child’s genes and their en­vi­ron­ment. Be­cause of the sud­den clos­er con­tact, chil­dren get more colds when school starts, al­though the virus­es that cause colds live with us all year long.

The study that iden­ti­fied this pat­tern was done in Trinidad in 1965 by an Eng­lish med­ical doc­tor, Dr RNP Sut­ton, who worked at the Trinidad Re­gion­al Virus Lab­o­ra­to­ry. It was a pi­o­neer­ing study, the first of its kind ever done in a de­vel­op­ing trop­i­cal coun­try.

Up to about ten years ago, par­ents, teach­ers and doc­tors took colds in their stride. The child had a Sep­tem­ber or Oc­to­ber cold, stayed home for a cou­ple of days, got rubbed down, drank some gin­ger tea, maybe took some parac­eta­mol and re­turned to school hav­ing not seen a doc­tor and no one thought much of the process.

This has now changed. Ini­tial­ly, it was the numb­ing CNN ef­fect, the ex­ag­ger­a­tion of mi­nor prob­lems. It’s now the smart­phone ef­fect. Smart­phone is a dumb name for a dumb phone, which is mak­ing peo­ple dumb­er and who be­lieve every­thing they see and hear on the phone or TV, in­clud­ing hor­ror sto­ries about chil­dren hos­pi­talised and dy­ing from a cold.

In De­cem­ber, the new strains of flu virus­es ar­rive from the north with the re­turn of Tri­nis for Christ­mas and Car­ni­val. The flu is more se­ri­ous: fever, cough, sore throat, mus­cle aches, headache, and fa­tigue. We get out­breaks of flu be­cause of those new strains, in­door crowd­ing, fam­i­ly gath­er­ings and par­ties, and weak­ened im­mune sys­tems due to over­fet­ing, over­drink­ing, over­smok­ing and overeat­ing.

Flu out­breaks used to be giv­en fun­ny lo­cal names and treat­ed with mul­ti­ple in­fu­sions of rum, hon­ey, lime and boil­ing wa­ter, which made every­one feel ma­cho. A child might stay away from school for a cou­ple days and seam­less­ly fit back in. No big prob­lem. With a bi­o­log­i­cal­ly use­less but psy­cho­log­i­cal­ly stim­u­lat­ing ton­ic to “build up your im­mu­ni­ty” and a good sweat, you were back in ac­tion.

Used to be easy, com­mon­sense and part of the Tri­ni con­di­tion.

To­day, a flu is about doom and gloom. Peo­ple have to be giv­en a spe­cial dis­pen­sa­tion, a med­ical “clear­ance,” to get back in­to work or school. Some do a “flu” test to di­ag­nose flu or a COVID test or an RSV test and soon there will be an Ade­n­ovirus test and a Rhi­novirus test and every­one will be ex­perts on home RATS (Rapid Anti­gen Tests).

Once you give a big name to an in­nocu­ous dis­ease, you big up the dis­ease.

How long are em­ploy­ers and schools and par­ents go­ing to per­sist with these un­nec­es­sary med­ical fears? Are they not al­ready hav­ing a neg­a­tive ef­fect on the econ­o­my and on ed­u­ca­tion?

We should in­stead be em­pha­sis­ing the signs of a dan­ger­ous cough: dif­fi­cul­ty breath­ing, fun­ny sounds (grunt­ing; wheez­ing; bark­ing; whoop­ing), cough­ing up blood or hav­ing chest pain or se­vere throat pain, per­sis­tent vom­it­ing, fever last­ing more than 72 hours, ear­ache, lethar­gy, snor­ing or sleep ap­noea, weight loss, night sweats and a cough last­ing more than two weeks.

All of these are ex­treme­ly rare with the com­mon cold but can oc­ca­sion­al­ly oc­cur with the flu, es­pe­cial­ly in poor­ly nour­ished or obese per­sons.

The three most com­mon caus­es of dan­ger­ous cough­ing in chil­dren are si­nus, fol­lowed by asth­ma and croup. Croup is more com­mon in chil­dren, but the num­ber of par­ents com­ing in with laryn­gi­tis is alarm­ing and COVID is now the most com­mon cause of laryn­gi­tis, which is the adult equiv­a­lent of croup.

Oth­er se­ri­ous caus­es of cough, like pneu­mo­nia, cys­tic fi­bro­sis, AIDS, lung can­cer and lung clots, heart at­tacks and tu­ber­cu­lo­sis, are rare com­pared to the above.

There are two types of med­ica­tions for cough, gen­er­al and spe­cif­ic. The more se­ri­ous con­di­tions have spe­cif­ic med­ica­tions which are ef­fec­tive if di­ag­nosed ear­ly.

Gen­er­al refers to some­thing called “cough med­i­cine” and is usu­al­ly tak­en for colds and flus. But there is no such thing as a cough “med­i­cine.” They are all use­less. At best, they may put you to sleep. At worst, they cause ir­ri­tabil­i­ty. Thank­ful­ly, most colds and flus re­solve spon­ta­neous­ly in healthy peo­ple.