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Frank Bures: All that coughs is not COVID

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All that coughs is not COVID.

In these days of COVID, it is crucial not to lose sight of the larger medical perspective that other infections still happen as well. Fever and cough are the early hallmarks of almost all COVID variants, especially the original one from China. The majority of COVID infections begin as upper respiratory infections (URIs), conditions that include a bushel of different causative viruses and bacteria.

With the infamous delta variant the initial presentation symptoms became more like what is generally called a cold, with not so much high fever before the cough. In general a URI starts as running nose (getting its exercise?), nasal congestion, coughing, sneezing (which is not included in most COVID descriptions), and phlegm or mucus production (also not characteristic of the original COVID cough).

Our upper respiratory tract includes nose, throat, pharynx, larynx and bronchi or tubular airways to lungs. The multiple locations where infections can lodge may produce sinusitis, pharyngitis, laryngitis, or tracheobronchitis. A true influenza may begin as a URI, but usually becomes a lower respiratory infection/lungs, and systemic illness. COVID itself has shown evidence that it is a systemic disease also.

The list of viruses that could possibly bring on a cold or URI includes over 200 different ones. The categories include rhinoviruses, which are the true cold viruses (rhino- is from the Greek for nose), adenoviruses, the 4 already commonly known coronaviruses, respiratory syncytial viruses, parainfluenza viruses, coxsackie viruses (which are really classed as bowel viruses but first infect upper airways before their southern migration), influenza viruses (which initially begin as URIs) and human metapneumoviruses.

Some bacteria that may create the same medical picture can include group A beta hemolytic Streptococci, group C beta hemolytic streptococci, Corynebacterium diphtheriae (diphtheria), Neisseria gonorrhoeae (gonorrhea), and Chlamydia pneumoniae. These names are listed not to impress you, but should impress you with the spectrum and variety of microscopic critters that can cause such similar symptoms. It illustrates the complexity of making the correct diagnosis to allow the most appropriate treatment. It’s amazing how “bugged” we really are.

In our current environment perhaps the best advice to give is, if you begin coughing and develop a fever but not shortness of breath, get a COVID test while the symptoms are present. That time period has the best chance of finding viral evidence. If shortness of breath also develops, go the hospital immediately. Differentiating the levels of the URI is a challenge since the infection is not static like a photo. It is evolving, and the picture keeps changing. The history is so important for deciding where it may be focusing, like your throat for a pharyngitis, voice box for a laryngitis, sinuses for a sinusitis, even your epiglottis, which covers your airway when you swallow for an epiglottitis especially in wee ones, or in airways for a bronchitis. This is all “doctorthink” for diagnosing your URI.

Since we have been living with and dying from the SARS-CoV-2 virus for 2 years, we have tended to forget the rest of our microbial milieu. In the beginning, when we were all hunkered down in terrified medical isolation, we didn’t socialize and share our various viral contagions, Hence the main mental microbe we had to manage was COVID. Now we have returned in part to sharing airborne viral vermin via coughs, sneezes and soupy snoots. We have to bear in mind the bigger buggy picture. All that coughs is not COVID. Coughs are not to be sneezed at, you could say.

Dr. Bures, a semi-retired dermatologist, since 1978 has worked Winona, La Crosse, Viroqua and Red Wing. He also plays clarinet in the Winona Municipal Band and a couple dixieland groups. And he does enjoy a good pun.


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