With flu season approaching and cold season already well underway, we asked Dr. Steve Pergam, an assistant member of Fred Hutch’s Vaccine and Infectious Disease Division and director of infection control at Seattle Cancer Care Alliance, to offer tips on how to stay healthy – and, failing that – how not to infect others when germs are on the march.  We also asked him to bust some common cold and flu myths, like:

1. Can you catch a cold from being cold?

I don’t think there’s any data to support that. It has more to do with being indoors, congregating together. People get runny noses from the cold, but that’s not a true respiratory virus.

2. Is it true that people are most contagious before they know they’re sick?

You’re probably not the most contagious then, but it’s true that you can be asymptomatic and still shed virus that can infect others. Sneezing and coughing, however, increase the risks of spread. A lot of viruses are really well engineered to spread when you have physical symptoms.

3. So how long are people contagious?

For most people, it’s one day before symptoms, five to seven days after the onset of symptoms. It can be as long as 10 days.  Young children and patients with altered immune systems can shed the virus for longer periods of time.

4. If you have just a mild cold, are you less infectious?

You may have very mild symptoms not because the virus is mild but just because your immune system controls the infection well. It’s important to remember that you can still infect others, and they may not control it as well. Any mild symptoms can make other people really sick, especially if they are high-risk, immunocompromised people.

5. What is the general radius that people can spread their cold or flu germs? If I’m in a work pod three feet from someone with a cold, am I toast?

When you sneeze or cough, you’re producing thousands of particles that can transmit influenza. A study done at Wake Forest School of Medicine looked at the distance sneeze and cough particles can travel. It was about 6 feet. You can transmit these things quite a distance. That’s one of the reasons we tell people to cover their mouths when they cough or sneeze.

6. What’s the best way to cover your mouth when you cough or sneeze?

You want to cough into the crook of your elbow or preferably into a Kleenex, which you toss and then wash your hands afterwards. We also tell people to just stay home when they’re sick.  

7. What about facial masks? Do they help at all?

Clinics recommend that patients with active symptoms wear them. But you have to wear them correctly. And their effectiveness is limited once they get wet from coughing, sneezing or the humidification in airways.  As for wearing a mask in public places to avoid getting the flu, it’s not clear that provides a lot of benefit.

8. Hands are bad, right?

What’s more important than anything else is washing your hands on a regular basis. Particularly during high-risk cold and flu season when you’re out at the mall and shopping for Christmas, bring hand sanitizer with you and use it on a regular basis.

9. How far does avoiding touching bathroom doors get you?

You never know what the person before you did: did they wash their hands or not? If you ever watch anyone wash their hands, it can be quite cursory. Sometimes they don’t even use soap or take just three seconds. Whenever you can, when you’re washing your hands, use a paper towel to turn off the sink, open the door, and then toss the towel away. That’s the ideal.

10. How long should you wash your hands? I’ve heard you should sing “Row, Row, Row Your Boat,” but I suspect I sing it too fast.

Try “Happy Birthday to You.” Sing it twice. Most people rub two hands together and think they’re done. We miss our thumbs, our wrists, under rings and jewelry, under fingernails, the backs of our hands. There are multiple steps.  There are videos out there that show you how to wash your hands. It’s the same with hand gel. Make sure you get enough hand gel to cover your hands.

11. Why do people often get a cold after flying on a plane?

When you’re sitting in proximity for 12 hours, you’re more than likely going to breathe air that’s similar. But it’s limited to the seats around the person, not the whole plane. 

12. In what way is having kids like flying on a plane?

For the majority of people who get colds and flu, it’s from being in close proximity to someone with an active cold, who’s sneezing and coughing. That’s why with young kids in a family, the cold goes through the whole family. Kids are viral factories: [they] often have viral loads that are higher than adults. They’re not as good at covering their nose and mouth, don’t have good hand hygiene, they hang out together at day care and school. They’re the starting and ending place for lots of respiratory viruses during the cold season. We see the season happening in kids first.

13. Is there any treatment for a cold or flu?

For most respiratory viruses, there are no treatments. If you have influenza, then there’s Tamiflu (oseltamivir) or Relenza (zanamivir) [prescription antiviral drugs]. We don’t recommend them for everyone but for people with chronic health conditions, cancer or a transplant patient at risk for complications.

14. Is there anything you can do?

The biggest thing you can do is rest, get adequate fluids. Take it easy, don’t exert yourself.  And stay home so you don’t infect others. Also, get your flu shot.

15. How can you tell if whether you’ve got a cold or if it’s the flu?

People think if they have a cold or sore throat that it’s the flu.  But it could be a rhinovirus, coronavirus, paraflu virus – a bunch of different viruses can cause these symptoms. Influenza is different from a bad cold. It often includes a fever and a feeling of malaise or muscle pains. You feel really wiped out. It’s OK to see your doctor for a quick test to see if you have flu or if it’s beneficial to receive one of the [prescription antiviral medications].

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