The Essential (Doctor-Recommended) Cold & Flu Season Survival Guide


Colds, flus and other respiratory infections are probably the most common reasons someone comes to see their doctor during the winter months.

woman holding coat closed against cold weather

“Cold Outside” by the Italian voice, cropped and used under CC BY 2.0, via Flickr

According to the CDC, the typical adult can expect to catch two or three colds each year. Activ Doctors Online’s US Medical Director, Dr. Howard Zahalsky, offers his expert advice to surviving cold and flu season.

When is Flu Season?

Flu season peaks during January and February, with the early range starting in October and ending in May. “If you are feeling sick in August, I can almost say, sight unseen, that you do not have a flu,” explains Dr. Zahalsky, “The flu virus likes a very specific temperature range. It hates warm weather.”

Because of geographic idiosyncrasies, the flu virus that is popular that year usually starts in Asia, then moves out from there, so the east coast of the United States is usually the last to get that year’s strain.

When is it “Just a Cold”?

Cold symptoms can be caused by more than 200 different viruses. Each can bring the sneezing, scratchy throat and runny nose that can be the first signs of a cold.

Symptoms of a cold

  • Sneezing
  • Stuffy nose
  • Temperature less than 101°
  • Mucus draining from your nose down the back of your throat

The colds we catch in winter are usually triggered by the most common viral infections in humans, a group of germs called rhinoviruses. You literally have to “catch” a cold, having been in contact with someone else who was sick.

Secret-doctor’s-secret: the color of your phlegm doesn’t matter. Your phlegm can turn green or yellow during allergy season or other non-bacterial conditions.

Surprised? Here’s another secret-doctor’s-secret: most people don’t run an average temperature of 98.6°.

“98.6° is the high end of the healthy range,” explains Dr. Zahalsky. A fever isn’t relative, he continues, “So if you’re temperature is ‘high for you’ at 99°, that doesn’t mean it’s high – at least not high enough to signal a bacterial infection. Bacteria love 97°, 98° and 99°. Love it. If you have a serious infection, your body will heat itself up to 101° or higher in order to kill the bacteria. Anything below that is most likely just a cold.”

The Flu

The flu is a viral infection, spread by the Influenza family of viruses. There are nearly 100 different types of influenza virus.

Symptoms of the Flu

  • Fever as high as 104°
  • Cough
  • Sore throat
  • Runny or stuffy nose
  • Muscle or body aches over your entire body.
  • Fatigue

The flu is a contagious infection, and requires exposure to someone with the flu – if you’ve been living alone on a mountain for 6 months, you probably don’t have the flu/

Sinus Infection

Sometimes, a cold may cause swelling in the sinuses, hollow spaces in your skull that are connected to each other, preventing the flow of mucus and leading to a sinus infection.

Symptoms of a sinus infection

  • Fever of at least 101°
  • Severe congestion
  • 1 of 4 sinuses, located are along your cheekbones and your forehead, are tender to the touch.
  • Swollen lymph nodes in your neck, usually at least 2 of the 3

These symptoms can also happen with a cold. But if they continue for more than 10 days, you may have a sinus infection.

Lower Respiratory Infections

Lower respiratory infections occur independently of sinus infections, and includes infections like pneumonia and bronchitis.

Symptoms of a lower respiratory infection

  • Short of breath
  • wheezing
  • Coughing
  • Fatigue
  • Fever greater than 101°

Bacterial respiratory infections like bronchitis and pneumonia are NOT contagious.

Cold & Flu Prevention

How are you going to keep yourself safe this flu season?

close up of a man face with en electronic thermometer

Sick” by Claus Rebler, used under CC BY-SA 2.0, via Flickr

Wash Your Hands

The best way to keep yourself safe during cold and flu season is the simplest way – washing you hands.

Cold and flu germs live on your hands. Every time you sneeze, every time you touch your mouth then shake hands or open the door, you are transferring cold and flu germs.

Those antibacterial handwashes are good for touch ups, but it’s hard to get the alcohol into every nook and cranny. Washing hands with soap and water, and the friction of washing your hands is the best prevention.

But sometimes, handwashing isn’t enough, so…

Get Your Flu Shot

The flu shot is very important for children, old people, people with respiratory infections and essential personnel that work with sick people.

But wait, I got the flu shot and I still got the flu…

That can happen. That’s because the flu shot is only 80% effective. You would have to get 2 or more flu shots for it to be 100% effective (That’s why children receive vaccines several times), but that’s just not practical.

Also, remember, there are about 100 different flu viruses, and we can only put 3 or 4 different strains in each shot.

We base the flu shot on the flu virus that starts in Asia – and sometimes (not often) we get it wrong.

There is some overlap in the viruses, and immunities can be built up over time. So, if you have been getting regular flu shots – even if you haven’t been vaccinated against that exact strain, you should enjoy some immunity from similar strains.

What Medicine Should You Take for a Cold or the Flu?

In the cold and flu aisle, there are literally hundreds of over the counter medicines to choose from. How do you decide which medicine is right for you?

cold medicine display at the store

Image by Mark Buckawicki, Public Domain, via Wikimedia Commons


Start by reading the labels. Here are the most common ingredients found in over the counter cold medicines.


The most significant symptom of a cold is nasal congestion. Nasal congestion makes it more difficult to breath, plus can make it hard to sleep and can lead to a slew of other problems, like sinus infections.

Dr. Zahalsky recommends pseudoephedrine. “It used to be a part of Sudafed, but since they’ve had to move it behind the pharmacy counter, the makers of Sudafed replaced it with phenylephrine, which, in my personal opinion, is essentially useless.”

Decongestants can be dangerous for people with high blood pressure and certain cardiac conditions, so while symptomatically helpful, you should consult your doctors in you have certain pre-existing conditions.


“If your coughing badly with a cold, use a cough suppressant,” recommends Dr. Zahalsky.

But I need to get the phlegm out…

Ready for another secret-doctor’s-secret (that’s 3 in one day, for those of you counting)? You don’t need to get the phlegm out. Your body has systems in places to deal with that.

“What coughing does is tear up your throat, which then scabs over, which tickles, making you cough, which tears up your throat again…see where I’m going with this?” illustrates Dr. Zahalsky, “This is how people end up still coughing weeks after a simple cold.”


Guaifenesin is loosens up the phlegm. The only problem with that?

Where does the phlegm go?

Right down the back of your throat. “It actually causes a lot of panic in my patients,” explains Dr. Zahalsky, “because they cough more when they take it.” For this reason, it should be used in conjunction with other medicines, especially a cough suppressant.

It doesn’t make you better any quicker.


A lot of cold and flu medicines also include an antihistamine, like diphenhydramine or bromocriptine. They are advertised as “relieving congestion,” but they do nothing for cold congestion. So why do they use them in cold remedies?

Because they put you to sleep.

Now, if you’re sick with a cold or the flu, there are worse things than falling asleep for a couple days… But, if you’re like most people, you have stuff to do. So stay away from antihistamine-combo medications, except at night time.


Zinc has been shown to inhibit the growth of the cold virus and speed up recovery.

But there’s a catch…

In order to get the concentration that you need to actually fight the cold virus, you have to get toxic levels of zinc in your nose. “There used to be products that contained enough zinc to fight the cold,” explains Dr. Zahalsky, “but they were pulled off the shelves because they were destroying nerve ending in people’s noses.” The ones that are available now, while they won’t damage your sense of smell, they do not contain enough zinc to be effective against the cold.



Tamiflu is the most popular medicine prescribed to shorten the flu. The average flu lasts 7-10 days of high fevers, and this will shave about 3 days off that, and lessen the intensity of symptoms over the remaining days.

It has to be started within 48 hours within the onset of symptoms, for it to be anywhere close to effective. “This is where being aware of the symptoms and conditions that make having the flu a real possibility is important,” explains Dr. Zahalsky, “so you can run to you doctor within those first 48 hours.”

Antibiotics do ABSOLUTELY NOTHING for a cold or a flu.

Unless you think you have a bacterial infection (sinus or bronchitis), then you do not need antibiotics.

Here’s the tricky thing – some antibiotics have anti-inflammatory properties. So despite the fact that it is not the right medicine for the cold or flu, if you take it will actually make you feel a little better.

What’s the big deal with taking antibiotics?

Every time we use an antibiotic to treat inflammation, rather than infection, you risk becoming resistant to that antibiotic. We only have so many antibiotics, so if your bacteria become resistant to the antibiotic, it may not be available to you when you need it.

Smokers are the only group of people that will get antibiotics for colds, because it can be very difficult to tell the difference between a cold and a bacteria infection in a smoker and they are much more susceptible having a cold or flu turn into pneumonia because their lungs are weak. The same is true for people with congenital lung problems would also be treated with antibiotics where other people would not need them

How Can Activ Doctors Online Help During Cold and Flu Season

Personal Health Records

Did you remember your flu shot? Activ Doctors Personal Health Record can remind you. We can also track any medicine you are taking, thereby helping avoid adverse drug interactions.

Second Medical Opinions

If you are concerned that your cold or flu symptoms might be something more serious, you have can a second medical opinion with our medical experts around the country or around the world.


If you doctor participates, you can have a secure e-consultation from the comfort of your home or office and not risk unnecessary exposure (both for yourself and others).

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One Response to “The Essential (Doctor-Recommended) Cold & Flu Season Survival Guide”

  1. Cyndie Says:

    Great advice!

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