The medical information and advice in this article was provided and reviewed by a licensed TELUS Health nurse practitioner.
With the annual transition towards the cold winter days comes the inevitable cold and flu season. The number of cold and flu cases decreased in 2020 as people stayed home from work, school, and social events to help curb the spread of COVID-19, but cases have since gone back up. This year, we are seeing a positivity rate of over 5% in flu cases1, and doctors’ offices, walk-in clinics, and emergency rooms are struggling to keep up with the demand from patients.
Did you know? 80% of cold and flu cases are caused by viruses, not bacteria, which means they will not respond to antibiotics.
Virtual care is a convenient, accessible way to get care without needing to travel to a clinic, without needing an appointment and without needing a family doctor. However, virtual care is not exempt from the pressures of increasing cold, flu, and COVID-related cases: we, too, are seeing a sharp increase in demand2 for care.
As you consider where to seek care for your cold and flu and other respiratory symptoms, it can be helpful to know what can be addressed virtually and what requires an in-person assessment so that you can choose the avenue that best supports your needs.
Below are some examples of symptoms that can be addressed virtually and others that can’t, as well as ways to stay healthy and worsening symptoms that may require immediate attention, as per our TELUS Health Virtual Care clinical team.
Cough and shortness of breath
Coughs are common with upper respiratory infections. Virtual care can help establish the expected duration of your symptoms, offer guidance in self-care treatments, and prescribe you medications (such as inhalers, nasal sprays or antibiotics, when clinically appropriate). Clinicians can also indicate whether there are any over-the-counter medications that could help soothe your cough.
Ways to help.
Adequate hydration can thin out oral secretions, helping reduce the cough for you and/or your child. Additionally, having a humidifier in your bedroom can help with overnight coughs.
When to seek urgent care.
A physical exam may be required when a cough is paired with abnormal breathing, when it causes chest pain or when it lasts beyond the expected period. During that exam, the healthcare professional will listen to the lungs and determine if imaging is necessary.
Signs that a cough needs to be assessed urgently:
- Bloody mucus
- Blue lips
- Chest that appears to sink in, just below the neck or under the breastbone with each breath or both. In children, look for nasal flaring and abdominal muscle retractions as well.
Sinus pressure and congestion
Nasal congestion and sinus pressure are common symptoms of colds and the flu, due to the membranes lining your nasal passages becoming inflamed and irritated. In an effort to flush out what is causing the irritation, our body begins to make more mucus, which can in turn lead to congestion.
Sinus pressure and congestion can present as a few different things, such as:
- Facial pain (around the eyes, forehead and cheekbones)
- Tooth pain
- Headache
- Difficulty breathing through your nose
- Thick and sometimes discoloured nasal secretions.
A virtual care consultation can help provide you with self-care advice for sinus symptoms, prescriptions for nasal sprays or antibiotics (when clinically appropriate), as well as suggest which over-the-counter medications may help control symptoms.
Ways to help.
You can help ease sinus pressure and congestion by keeping your nasal passages moist. Some ways to do this include:
- Using a humidifier or vaporizer.
- Taking long, warm showers or breathe in steam.
- Drinking lots of fluids, such as water and herbal teas, will help thin out your mucus and could help prevent blocked sinuses. Also avoid sugary beverages, caffeine and alcohol, as they may aggravate symptoms.
- Using a nasal saline spray, Neti pot, nasal irrigator, or bulb syringe. To make up the irrigation solution, use distilled, sterile water or water that’s been boiled and cooled. Rinse the irrigation device after each use and let it air dry.
- Prop yourself up at night by sleeping on a couple of pillows: keeping your head elevated may make breathing more comfortable.
When to seek urgent care.
Signs that a sinus pressure / congestion needs to be assessed urgently include:
- Painful swollen eyes or pain with eye movements
- Injected conjunctiva (the whites of the eyes becoming bright red and painful)
- Redness and warm skin around the eyes
- Shortness of breath
- Fever with nasal congestion lasting more than 3 days.
Fever
A fever, which is a rise in the body’s temperature, is usually caused by an infection. Although fevers can be uncomfortable, they are a sign that the body is fighting off that infection.
A fever is defined as a body temperature of 100.4°F (38°C) or higher. Forehead, oral or ear thermometers can be used in adults, while children under the age of 2 should have their temperatures checked with a rectal thermometer for accuracy.
Note that there are many different types of thermometers you can use to measure temperature, so make sure you read and follow the instructions that come with the one you have.
Fevers can often be assessed virtually, and your clinician can help guide you through self-care instructions, tell you what to watch for, help determine the appropriate dose and frequency of antipyretics to help reduce your fever, and either prescribe you medications to control symptoms or suggest over-the-counter medications that may help. Healthcare professionals can also virtually provide guidance in terms of infection control measures, contagion period, and helping reduce the risk of others contracting the illness.
Ways to help.
If you have a fever, focus on resting and drinking plenty of fluids. You should also avoid caffeine and alcohol.
For adults and healthy children over 6 months of age, a dose of weight-based acetaminophen (such as Tylenol) or ibuprofen (such as Advil) may help reduce the fever and the discomfort associated with it. Your virtual care provider can help confirm the appropriate dose of each medication, which is also available on the product monograph of the bottle for your reference.
When to seek urgent care.
Signs that a fever needs an urgent physical exam include:
- A fever in a child under the age of 3 months
- When a child develops a rash that does not turn white when you push on it
- Fever lasting greater than 3 days
- A severe headache (comes on suddenly and is explosive or violent)
- Stiff or sore neck
- Slurred speech
- A change in vision
- Problems moving your arms or legs, loss of balance
- Shortness of breath
- Abdominal pain
- Seizure, confusion, lethargy or other unusual signs or symptoms.
Sore throat
The most common cause of a sore throat (pharyngitis) is a viral infection, such as a cold or the flu. In cases where a sore throat is caused by a virus, the sore throat will resolve on its own over time.
Strep throat (streptococcal infection), a less common type of sore throat that is caused by bacteria, requires treatment with antibiotics to prevent complications.
To assess the situation and whether you need antibiotics, your virtual care clinician will ask you a series of questions and ask you for clear photos of the affected throat. They can also support you with pain medications (both prescription and over-the-counter, as needed), medicated throat gargles, self-care recommendations and guidance for observation and “red flags”.
Ways to help.
There are a few things you can do to help soothe a sore throat and shorten how long it lasts, including:
- Gargling with warm, salty water by mixing ½ teaspoon (2.5 g) of salt in 1 cup (250 mL) of warm water
- Have your child gargle with warm salt water several times a day to help reduce swelling and relieve pain. Most children can gargle when they are 6 years old
- Drinking plenty of water and herbal teas, while also avoiding sugary drinks, caffeine and alcohol
- Eating cool or soft foods, which may be soothing
- Avoiding smoking or smoky places
- Getting plenty of rest to allow the body to fight the infection.
When to seek urgent care.
You should consult urgently if you experience any of the following in addition to your sore throat:
- Difficulty swallowing or breathing
- Drooling, which can be a sign of not being able to swallow
- A high-pitched sound as you breathe (called stridor)
- Any persistent growing lump in your throat
- Any other severe symptoms and you are getting worse quickly.
Ear ache
Congestion associated with colds and flus can lead to pain and pressure in the ears. Middle ear infections currently cannot be assessed or treated virtually because clinicians cannot look at the eardrum without an otoscope to confirm the diagnosis. Ear discomfort often goes away on its own and doesn't need medical attention, so in many cases pain control is all that is needed while your body fights off the infection.
To help avoid ear infections, make sure your child washes their hands well and often, especially if they are near other sick children. Also keep your child away from secondhand smoke and make sure they get a flu shot every year.
Ways to help.
Your virtual care clinician can help guide which of the interventions below are most appropriate for you:
- Applying a warm compress over the affected ear
- Taking a dose of pain medicine, such as acetaminophen (Tylenol) or Ibuprofen (Advil), that is appropriate a certain age and weight
- Suggesting over the counter ear drops or prescribed topical anaesthetic ear drops
- Prescribing a nasal spray to help eustachian tube dysfunction that may be causing ear pain or pressure
- Ear wax removal if this could be the cause of the symptoms.
When to seek urgent care.
Signs that an earache needs an urgent physical exam include:
- When your child had a significant fall/injury before the ear ache
- Active drainage or bleeding from the ear
- Sudden onset or rapidly progressive hearing loss or ringing in the ears (tinnitus)
- If there is pain, swelling or redness of the bone behind the ear.
Nausea, vomiting and diarrhea
There are a number of bacteria, viruses, and parasites that can cause gastrointestinal (GI) infections. Pathogens can be spread through contaminated food or water, or via person-to-person transmission. Children specifically can also get infected when they touch virus-contaminated objects and then put their fingers in their mouths.
In most cases, self-care measures are the recommended treatment and your virtual care professional can help recommend the best course of treatment. They can also determine whether a prescription or over-the-counter medication is appropriate for your symptoms
Ways to help.
- It is most important to keep drinking fluids to replace the fluid that is lost. Do not eat or drink anything for a few hours when the symptoms begin, then begin sips of clear fluids such as ginger ale, broth, tea and gelatin for the first 24 hours or until diarrhea and vomiting stop.
- As the initial symptoms subside, drink 8 to 12 glasses of liquid daily to prevent dehydration through diarrhea or vomiting.
- Eat bland foods for the second 24 hours, such as crackers, rice, eggs, soup, bread, bananas, applesauce or cooked cereal.
- Avoid spicy foods, high-fibre vegetables, fruits and bran. Also avoid milk or other dairy products, fried foods, candy or alcohol.
- Take an appropriate dose of acetaminophen (Tylenol) for fever, headache and aches. Avoid aspirin and ibuprofen (Advil) since these medications may irritate the gastrointestinal system.
When to seek urgent care.
You should seek urgent in-person care if you notice any of the following:
- When your child has diarrhea and vomiting, and has no tears, a dry mouth, or is not urinating
- When older children and adults have excessive thirst, dry mouth, little or no urine (or deep yellow urine), extreme weakness, lightheadedness or dizziness.
- If you or the child have an inability to keep liquids down for 24 hours
- Vomiting for more than 48 hours
- Vomiting blood or if emesis (vomit) has a green or bright yellow colour
- Having blood in your bowel movements.
Rashes
Exanthem is a medical term that describes a widespread rash. A viral exanthem rash accompanies a viral infection, such as a cold and flu, and causes spots, bumps or blotches on the skin. It may be accompanied by additional viral symptoms such as fever, fatigue and body aches.
The viruses that cause viral exanthem rashes are contagious and can spread easily from person to person. It is important to be especially careful around those who are pregnant and people who are immunocompromised (those with compromised immune systems), and your virtual healthcare professional can let you know when you or your child can go back to work, school, daycare or other activities around people.
An exanthem can also accompany a bacterial infection, or it may be a reaction to a medication.
A clinician can virtually help identify the cause of the rash, suggest an oral or topical medication/creams to reduce itchiness (e.g. hydrocortisone cream and calamine lotion), indicate the contagious period, and provide you with instructions for self-care and signs of deterioration to watch for. They can also suggest ways to reduce scratching, which can cause scars or skin infections, and may occasionally order a blood test or a swab of your nose or throat to identify the virus.
Ways to help.
- Apply a cool, wet cloth on the skin for 15 to 30 minutes several times a day
- Acetaminophen (tylenol) or ibuprofen (Advil) can help lower fever and relieve body aches
- Keep affected skin well hydrated using a barrier cream, as long as there are no open areas.
When to seek urgent care.
You should seek in-person care when you notice any of the following symptoms:
- A rash that does not turn white when you push on it
- High fever and rash lasting longer than 3 days, or getting worse rapidly
- Pus draining from the rash
- Red streaks on the skin in a linear pattern
- The rash is sudden and spreads rapidly
- Rash in a child who is inconsolable or extremely irritable
- Rash with either respiratory distress or lethargy.
How you can stay healthy.
We are all susceptible to catching a cold or the flu, but there are things that can be done in a preventive manner to stay healthy:
- Get lots of rest and drink plenty of liquids
- Eat a healthy, balanced diet, including a variety of nutrient-rich foods from all food groups
- Avoid touching your eyes, nose and mouth, as they are entry points for viruses and other germs
- Clean surfaces that you and other people touch frequently, such as doorknobs, faucets and countertops
- Get vaccinated against viruses for which vaccines are available
- Keep your distance from people who are sick, and don’t touch objects they’ve touched
- Wash your hands frequently, especially before handling food.
Other signs that you or someone you are caring for may need urgent care.
If you experience any of the following, or if someone you are with has these symptoms, you should seek in-person care as quickly as possible. These are considered emergencies, which are not appropriate for virtual care.
- An increase in the number of breaths per minute, or struggling to take complete breaths
- Blue lips (inside or out) and/or blue fingernails
- Change to pale or grey-coloured skin
- Emitting an involuntary grunting sound when trying to exhale, or a whistling sound when breathing in
- Nostrils flaring when trying to breathe in, which is a sign that breathing has become difficult
- Difficulty swallowing
- The chest appears to sink in just below the neck or under the breastbone with each breath or both
- Increased sweat on the head without any increase in your body temperature
- Muscle weakness, inability to remain upright, or torso collapsing forward.
The cold and flu season can be challenging, whether you are sick or caring for someone who is unwell. Speaking to a healthcare professional on TELUS Health Virtual Care can help obtain answers about what you or your loved one are experiencing, but remember that many symptoms of colds and the flu can be alleviated with rest and drinking lots of fluids. Also remember to seek urgent in-person care for symptoms listed above, without first seeking care virtually.
Sources
1. Canada is seeing an early rise in flu cases. Is a 'tidal wave' of infection coming? CBC News
2. Canadian health-care system struggling amid 'multi-demic' of flu, COVID-19 and RSV. CTV News