’Tis the season of respiratory illnesses. As we spend more time indoors and gather with friends and family to celebrate the holidays, cases of flu, COVID and respiratory syncytial virus (RSV) are steadily increasing around the country.
There’s also been an uptick in anecdotal reports of a brutal, long-lasting cough going around. As one TikTok user put it: everyone seems to have “a hacking cough that’s been going on for weeks.”
Doctors around the country have noticed it, too. “We have been seeing an unusually large number of patients who had typical viral upper respiratory infections, but have had a lingering cough that has lasted weeks to months,” Dr. Scott Braunstein, a double-board certified internal medicine and emergency medicine physician and the national medical director of Sollis Health, told HuffPost.
It doesn’t appear to be the flu or COVID, but another pathogen that’s attacking and irritating our respiratory systems, according to experts.
Dr. Janet O’Mahony, an internal medicine physician at Mercy Medical Center in Baltimore, Maryland, said many of her patients have recently come into her practice with a nasty cough that’s lingered for two weeks or so. Some people have also had sinus congestion, a sore throat and post-nasal drip.
“This chest cold has a real junky and persistent cough,” O’Mahony told HuffPost. They’ve tested negative for the flu and COVID. Plus, they aren’t responding to antibiotics, which suggests it’s “purely viral,” she said.
O’Mahony suspects the sickness is “caused by the regular viruses that cause colds like rhinovirus, non-COVID coronaviruses or adenoviruses.”
The reason we don’t know exactly what’s causing it is because primary care doctors and urgent care clinics don’t routinely test for these other viruses unless someone is hospitalized with severe symptoms, according to Dr. Theodore Strange, an internal medicine physician with Northwell Health. He also thinks an adenovirus or rhinovirus may be the culprit.
These viruses cause flu and cold-like symptoms that can last for a while, according to the Cleveland Clinic. When a virus enters our airways, it infects our cells and replicates. This can trigger a lot of inflammation and irritation in your throat, nose, and chest, which takes time to clear up.
In fact, Braunstein said the persistent cough is most likely due to prolonged inflammation in the airways — even after the virus is gone, the body continues to produce mucus and have bronchospasms, which is when the muscles in the airways tighten and cause a cough. For some people, this inflammation can persist anywhere from two weeks to two months, he explained.
How long are you contagious if you’re coughing for weeks?
With upper respiratory infections, it’s difficult to determine exactly how long people are contagious for. According to Strange, people are likely extremely contagious in the 24 hours before symptoms take hold.
This heightened contagiousness tends to last for a few days. “With colds, we usually consider the first three days to be the worst for spreading but contagiousness can linger longer than that,” O’Mahony said.
In general, people remain contagious for approximately five to seven days, says Strange. As is the case with COVID, after 10 days, it’s believed people aren’t contagious anymore, Braunstein added. Some individuals may be infectious for longer. For example, people with weakened immune systems can shed adenoviruses for months, despite being asymptomatic.
How to treat your cough
If you have any upper respiratory symptoms, it’s a good idea to test yourself for the flu and COVID. Both are on the rise, and although COVID has more of a dry cough plus a headache, it can be mistaken for the common cold.
“Both have cough, both can have sore throat,” O’Mahony said. If you know you have COVID, for example, you may benefit from taking Paxlovid. Those diagnosed with the flu can take an antiviral such as Tamiflu, Relenza, Rapivab, or Xofluza.
If you test negative for the flu and COVID, it’s still worth checking in with a healthcare provider, such as a primary care doctor, urgent care doctor or telehealth physician.
We don’t have specific treatments for rhinovirus, adenoviruses and RSV, Strange said, but your provider can make recommendations to help you recover — rest, stay hydrated, and take over-the-counter medications like Mucinex DM and Robitussin DM (as long as you don’t have any contraindications). They may also prescribe medications, such as cough medicines or corticosteroids, which can improve symptoms by reducing inflammation in the airways.
If your symptoms persist for a couple weeks, you’ll want to continue following up with your physician. There are some serious bacterial infections, including mycoplasma (aka walking pneumonia), legionella and pneunococcal pneumonia, that can cause a hacking cough.
If your doctor suspects any of these, they can run tests and prescribe the appropriate antibiotics, Strange said. In addition, some people may develop a secondary bacterial or new viral infection, according to Braunstein. Warning signs of this include a new fever and darker or more severe phlegm.
Outside of that, you want to wash your hands frequently and cover your mouth and nose when you cough, Strange said, to avoid spreading it to others. Listen to your body: if you’re really sick, stay indoors until you feel better. We’re officially in the thick of cold and flu season — these viruses aren’t going anywhere, for the next few months at least.
Now’s the time to take extra precautions, and as Strange pointed out, use common sense if you or others around you get sick.