General Travel Health

Common Colds: A Common Problem.
--Frank Gillingham, MD

Catching a cold is certainly not the worst health problem a traveler can experience but it's one of the most common and can throw a monkey-wrench into a carefully planned business trip. Viral respiratory illnesses are second only to Travelers' Diarrhea as the most common cause of infection among travelers. Adults generally experience 3-4 such illnesses per year, which in turn account for 30-50% of lost time from work.

While the common belief is that colds peak in winter, the most common cause of the common cold, the rhinovirus, peaks in early fall and spring. Other viruses that cause colds--coronaviruses, for example -- are common throughout the fall, winter and spring.

Colds are spread through infected secretions--and hand-to-hand contact appears to be the most efficient method of transmission. Inoculation then occurs through the mouth, nose or conjunctiva (the mucous membranes of the eyes). Viruses persist on plastic surfaces for several hours--so using a telephone that someone with a cold has used even hours before can potentially lead to infection. Droplets in the air can also spread colds but this method of transmission isn't nearly as effective as hand-to-hand spread.

It is a myth that respiratory infections are caused by cold weather. If this were true, people in Maine would get more colds than people in Florida--which is not the case. In addition, there is little strong scientific evidence that fatigue or sleep deprivation contribute to the common cold.

Viral respiratory symptoms are well known: runny nose and nasal congestion, sneezing, sore throat, fatigue and possibly headache and fever, though this should be low if present. If your symptoms are different (e.g. you have a very severe sore throat but no runny nose) you may not have a viral respiratory infection and should consider a visit to a doctor (see below).

Here are some specific points to keep in mind to avoid and treat common colds:

• Wash your hands.Do so thoroughly and frequently with soap and water. Drying with a paper towel may help remove additional viruses.
  
  
• Keep your hands away from your face. Cold viruses on your hands won't cause any problem if you don't inoculate yourself. Use a napkin to get that annoying itch on your nose. Wash your hands before you remove your contact lens.
  
  
• Get a Flu shot. Flu shots are a safe, effective way of preventing influenza, which can be a serious illness. Avoiding influenza will also help you avoid getting misdiagnosed with SARS.
  
  
• Drink lots of fluids. Mucous membranes in your mouth and nose are a terrific line of defense against colds--but they only work if they're well hydrated. Dry aircraft cabins are particularly tough on mucous membranes so bring a bottle of water on board, or ask the flight attendant for one. On long flights consider using saline nose drops. Smoke can also contribute to mucous membrane irritation so avoid it if possible.
  
  
• Avoid people with colds. . It's perfectly reasonable to move to an empty airplane seat if your row-mate is coughing and sneezing.
  
  
• Decongestants can help with nasal symptoms. Pseudoephedrine (brand name: Sudafed, and others) generally does not cause the drowsiness that is common with other decongestants. You should NOT use Sudafed or similar agents if you have ever had high blood pressure, otherwise known as hypertension. My recommendation is to use a decongestant that you've used safely at home. Best to bring the trusted remedy with you on all your trips.
  
  
• Vitamin C and Zinc Lozenges are believed by some to reduce the severity and duration of a cold, though the available scientific evidence is not convincing. They do appear to be safe when used as directed. I would avoid very large doses of Vitamin C (greater than 2 grams a day). Zinc Lozenges seem to be terrific at distracting people from their symptoms--keep in mind that they can cause nausea when taken on an empty stomach.
  
  
• Echinacea, Airborne, garlic, oscillococcinum and Yin qiao are other agents that some people swear by for treating or preventing common colds, though again the proof of their effectiveness is scant. I have limited experience with them and would recommend a common sense approach: try them if you feel you must, but first identify a reputable manufacturer, follow the instructions carefully, and stop them if you experience anything unusual.
  
  
• Antibiotics are effective only against bacteria and therefore are not helpful in the treatment of common colds due to viral infection. Sometimes common colds lead to bacterial infections (such as an ear, sinus or lung infections)--in which case antibiotics are indicated.
  
  
• Get plenty of rest but don't beat yourself up if you don't. As I noted above it's not clear this will help prevent colds.
  
  
• Seek medical care if your symptoms are particularly severe or unusual, if they last a long time, if they improve and then worsen again, or if you experience chest pain, shortness of breath or other breathing difficulties, severe headache, stiff neck, confusion, skin rash, high fever, or cough (especially with mucous production). Don't try to tough it out if you symptoms are severe. In most experimental models of bacterial infections, the number of bacteria double every hour. So the sooner you begin treatment the better off you'll be.