Wednesday, 19 January 2022

Common cold is not so ‘super’ and we still haven’t found a cure

THE very first column I wrote for this paper was about the common cold. Needless to say, a lot has changed since then.

What hasn’t changed, of course, is the common cold.

Reports of “super-colds” running rife are a little exaggerated, although not entirely false.

It is certainly the case that people seem to be experiencing longer-lasting and more severe symptoms than usual but, rather than one rogue virus spreading all of that misery, the reality is far less exciting.

A cold was so named due to the historical assumption that one catches it due to low temperatures. This is not strictly true, as I shall address later, but the name stuck and now refers to a common set of symptoms which include blocked or runny nose, sore throat, coughing and sneezing, high temperature, sinus congestion and muscle aches.

This set of symptoms can be caused by any number of different viruses.

The most common type is called a rhinovirus (“rhin” after the Greek for nose). About half of colds are caused by any one of around 100 known types of rhinovirus. This rises to around 80 per cent in the autumn.

Ten to 15 per cent of colds are caused by coronaviruses (not covid) while other culprits include parainfluenza, enterovirus, adenovirus and respiratory syncytial viruses. In fact, there are about 200 virus types that we know of that can cause a cold.

These viruses have been frustrated over the past 18 months by the more vigilant hygiene measures we have all been employing to counter the spread of covid. After all, cold viruses and covid spread in much the same way, via airborne droplets and through direct contact, especially to the nasal passages and also the eyes.

The peak season for colds seems to be around late autumn and early spring, both of which have seen lockdowns over the last year.

Viruses naturally mutate each year, producing slight differences to get past our immune defences. Exposure to the latest viruses allows our immune systems to keep up with those changes.

Having missed a year, in effect our immune systems have missed an update and so the strains of all the usual suspects are proving that much more tricky to get on top of now, hence the longer-lasting and more severe symptoms.

The symptoms of a cold are caused not by the virus directly but by our immune response to them. The extra mucus that clogs up the nose and sinuses is purposely produced in order to get all of the necessary immune cells into the area to fight the infection. This can make the lining of the throat sore and cause a cough.

Immune cells work more efficiently at higher temperatures and so the body raises its temperature to fight those viruses off as well, making you feel pretty unwell as a result.

In general, although taking longer than usual, these colds eventually clear up on their own. There’s no point adding in antibiotics as these only work against bacterial infections.

Occasionally, streptococcal bacteria can mimic the symptoms of a cold but the body will rise to this in just the same way. Antibiotics should be reserved only for serious infections.

Statistics show that adults get two or three colds in a normal year while children get more like five or six. In younger children, it can be as many as 12, simply because their immune systems haven’t yet come across most of the circulating viruses.

Interestingly, women seem to get more colds than men — perhaps, some have suggested, because they spend more time around children.

No one is quite sure exactly why there is this seasonal variation, though. While there is a higher prevalence of rhinoviruses during colder months, other viruses tend to be more active in the summer.

A variety of theories has been suggested, including the simple fact that people gather together indoors more in the winter, making spread more likely. Others think that cold, less humid air allows droplets to spread further.

These theories do not align with the variations between different types of virus, however, and a consensus has yet to be reached.

Over the centuries, people have tried all sorts of things to counter the symptoms of a cold. For 3,000 years, one Chinese remedy consisted of stuffing a plant called ma huang up sufferers’ noses.

This plant actually contains pseudoephedrine, which is known to act as a decongestant and can be found in various over-the-counter tablets and nasal sprays today. Not such a terrible idea then but unlikely to have made much of a difference.

Christians in medieval times were likely to have halted the spread of colds inadvertently through their belief that the soul could be lost by sneezing and so they made sure they covered their mouths.

During the Victorian era, the wildly popular Mrs Beeton’s Book of Home Management suggested a hot toddy of linseed, sun raisins, liquorice and rum. She boldly declared that “If taken in time, [it] is considered infallible”.

I would not dare be so confident about any remedy today. Although a plethora of these cold tonics exist, such as echinacea or vitamin C, there is no good evidence that these are anything other than a placebo.

Vitamin C might possibly reduce the length of a cold by a day or so if taken regularly but going out to buy some if you have just developed a cold is a waste of time and money. The only things that will help with a cold are rest, fluids and time.

This might sound defeatist but there have been myriad attempts to study colds in the hope of finding a cure.

Between 1946 and 1989, a former military base in Salisbury was set up as a common cold centre in which people would voluntarily stay to be infected with colds.

Although they learned a lot about the many viruses that caused the colds and produced some of the remedies we see on the shelves today, they ultimately failed to come up with a cure. The biggest barrier was, and continues to be, the sheer number of different viruses responsible for these symptoms. There has been talk of vaccines but, considering how difficult it is to produce a vaccine for just one virus, dealing with more than 200 is a task not easily undertaken.

In addition, incentives for finding such a solution are not that great. For a start, colds are pretty harmless.

Although they do account for a large amount of sickness absence (26 per cent of all absences in 2020 — down from 33 per cent in 2016, probably due to the social distancing measures), they get better on their own.

More significantly, there is arguably a far more lucrative market for drugs companies if colds are alive and kicking. Cold remedies are big business, even if they don’t really work that well. The cold remedy market is projected to reach more than $12 billion in 2026.

All of this would disappear if we could just stop the common cold dead in its tracks.

I recently stumbled across a market analysis aimed at maximising spend for the average cold. It was concluded that the average person could spend £2.29 for the bare minimum if they had a cold. This would consist of tissues, some lozenges and simple pain killers.

However, you could then spend a further £8.38 on cough liquids, sachets and decongestants. Add in some echinacea and vitamin C for £6.34 and then, if you factor in the comfort eating foods strategically placed next to the medicines along with lip salve and hand sanitiser, you could squeeze around £27.53 out of each victim. As I said, fluids, rest, maybe a bit of honey and lemon to soothe the throat is all you really need.

One fly in the ointment we face at present is the similarity of most colds to the symptoms of covid. As covid evolves and as more people are vaccinated, it has begun to produce a new batch of symptoms often indistinguishable from the common cold.

While you must still get a PCR test (not just a lateral flow) if you have a cough, temperature or a change in taste or smell, it is really very difficult to tell the difference in many cases.

The difference, of course, is that covid has the potential to be far more serious. We now know there are more than 20 other symptoms of covid beyond the core three. Loss of smell and taste is the biggest differentiator but this can sometimes be present in some simple colds too.

The delta variant of covid seems to present more often with a headache than other variants. There is the potential to become a bit blasé about such symptoms but we must remain cautious.

Finally, a word on flu. Just as colds have had a bit of time out, so too has the influenza virus.

We must remember that flu is an altogether different kettle of fish and if, as is feared, we are to see a similar increase in severity of flu this winter, it could spell trouble for a health service already struggling.

In a normal year, we might see in excess of 20,000 deaths involving flu. It has never been more important therefore to get your flu jab.

Otherwise, rather than “super-colds”, we might soon be talking about “super-flu” and that is not an enjoyable prospect.

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