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Ask a Doctor is a series of physician-authored columns offering insights and advice on common health topics. It is not a substitute for seeking medical care.
Fall is here, which means so are respiratory viruses. As an emergency physician, I see the same pattern every year: waiting rooms packed with patients of all ages, exhausted parents, and individuals requiring admission to hospital due to severe complications from breathing issues related to viral infections. While most infections are mild and can be managed at home, infections such as COVID-19 or influenza are more likely to lead to serious illness and hospitalization.
Respiratory virus season is longer than you might think. In Canada, activity typically starts to rise in October, peaks between December and February, then tapers off by early spring. Influenza and COVID-19 tend to surge around the holiday season, when indoor gatherings and travel increase transmission.
As we head further into the season, here are some reminders about what you can do to stay healthy and out of the ER.
What viruses are going around?
Each year, we see a familiar group of viruses circulating in the community:
- Influenza (flu): A seasonal heavyweight, the flu is no joke and rarely has just mild symptoms. Even individuals without underlying health conditions can be knocked off their feet for days.
- COVID-19: Although this is talked about less and less, we are still seeing significant numbers of cases throughout the year, especially in the winter months.
- Respiratory syncytial virus (RSV): This common virus is particularly dangerous for infants and older adults.
- Rhinovirus: The common cold – it usually causes mild symptoms but can still be disruptive.
- Adenovirus, parainfluenza and human metapneumovirus: These viruses are less well known but common culprits of respiratory symptoms.
Symptoms and complications
Most respiratory viruses share similar symptoms, including fever, cough, sore throat, nasal congestion, runny nose, fatigue and muscle aches. But some viruses have telltale signs.
For example, influenza tends to cause more severe fatigue and muscle aches, and can also cause gastrointestinal symptoms such as nausea, vomiting and diarrhea. COVID-19 also tends to cause severe symptoms beyond what people generally associate with a normal cold. It can cause a loss of taste or smell and lead to long COVID symptoms lasting weeks to months after the initial infection.
For its part, RSV usually causes wheezing and difficulty breathing in infants.
While most cases of these common viruses are mild, complications can include pneumonia, worsening of asthma or chronic obstructive pulmonary disease symptoms, dehydration and heart issues, all of which can require admission to hospital.
Vaccines: Your best defence
Vaccines remain one of the most effective tools to prevent serious illness and reduce complications from the three most serious respiratory viruses. Although they don’t guarantee you won’t get sick, they dramatically reduce the risk of hospitalization, severe symptoms and death.
- Influenza: This vaccine is updated annually to match circulating strains and recommended for all people older than six months. According to the Canadian Immunization Guide, a high–dose vaccine is recommended for adults aged 65 and older, to address the age-related decrease in immune response, as well as the higher risk of complications in this group.
- COVID-19: This vaccine is recommended for high-risk groups, including adults aged 65 and older and individuals older than six months with underlying medical conditions. Canada’s National Advisory Committee on Immunization adds that all those over six months may receive a COVID-19 vaccine.
- RSV: RSV immunization is recommended for infants under eight months old in their first RSV season, as well as adults age 75 and over, and those who are 60 and over and living in long-term or continuing care.
What to know about this fall’s COVID-19 vaccine
What to do at home
In general, respiratory illnesses can be managed effectively at home with the following:
- Rest and hydration: Your body needs energy to fight off infection.
- Fever and pain relief: Acetaminophen or ibuprofen can help with both of these symptoms.
- Humidifiers and saline sprays: these are useful for congestion and dry cough. Saline sprays in particular may actually help reduce symptom duration and even virus transmission.
- Avoid spreading illness: Stay home when sick, wear a mask, avoid touching your face and wash hands frequently.
I still get asked about whether at-home COVID-19 testing is valuable. The short answer is no. Although we do still test for COVID-19 in hospitals for those being admitted, those who are well enough to be at home aren’t managed any differently with COVID-19 vs. any other respiratory virus. The exception to this is for those who are considered high risk and could be eligible for antiviral therapy. Eligibility varies slightly from province to province and is best discussed with your primary care provider.
When to see a doctor
Not every sniffle or cough needs a trip to the ER, but some symptoms warrant medical attention:
- Difficulty breathing or shortness of breath
- Persistent high fever (especially in young children or older adults)
- Chest pain
- Confusion
- Persistent or worsening symptoms
- A fever in an infant under three months or someone who is immunocompromised
- Anyone with chronic conditions who isn’t improving
- You’re worried and something doesn’t feel right
If you’re unsure, call your primary care provider or your local health information and advice line (811) for guidance.
Dr. Shazma Mithani is an emergency physician working with adult and pediatric patients in Edmonton. Dr. Mithani is actively involved with the Canadian Medical Association, Alberta Medical Association and Sexual Assault Centre of Edmonton. She is also co-host of The Doc Talk Podcast.
