The common cold: How sick is too sick to work?

By Jessica Stevenson, M.D.
Hallmark Health Medical Associates

Dr. Jessica Stevenson

Getting a cold is pretty miserable. You have to miss out on fun with family and friends, and you may feel compelled to stay home from work. But the good news is taking a sick day may not be necessary.

The common cold is one of the most common reasons for missing work across the United States. According to the Centers for Disease Control, Americans suffer millions of cases of the common cold each year.

I see many people in my office each week who took the day off to come see me for a common cold. A new Massachusetts law, which went into effect in July 2015, allows workers in companies of 11 employees or more to earn paid sick leave to help ease the financial burden of illness.

But how do you know if you should use your paid sick time? The tips below can help you decide whether you should tough it out at work or take it easy at home.

Regular cold symptoms

American adults typically come down with two to three colds per year. If you have asthma or COPD or if you take steroids for a medical condition, you have an increased risk of complications from the common cold.

Many people come see me because they’ve had a sore throat for a day or two. But that’s how many colds start, and it’s often nothing to worry about.

If you’re experiencing these symptoms and fewer than 10 days have passed since you started feeling sick, you’re likely experiencing a common cold and not something worse:

• Sore throat and nasal congestion
• Mild body aches
• Low-grade fever (below 100.4)
• Cough

Unfortunately, the common cold is viral, with rhinovirus the most common culprit. This means that, unlike bacterial infections, the only way to get rid of a cold is to let it run its course.

You can treat your symptoms with over-the-counter products to help you feel better, but it won’t shorten the duration of your illness. It’s really about focusing on symptom based therapy, meaning that you can treat the cold symptoms that are the most bothersome for you.

There are three common over-the-counter cold remedies I often recommend:

• Nasal spray: There are several kinds. Afrin (oxymetazoline) offers the fastest relief for nasal congestion. It works by constricting the blood vessels to reduce swelling, but if used for longer than 3 days, it can cause rebound congestion. A nasal steroid spray such as Flonase or fluticasone takes longer to work but helps if you are having post-nasal drip (mucous dripping down the back of your throat). Lastly, nasal saline is a safe option for all ages and can be used for any length of time to help cleanse the nasal passages.
• Pseudoephedrine: Oral decongestants can help relieve the pressure in your sinuses. I often recommend the medication that is kept behind the counter at the pharmacy as it is the strongest. If you have high blood pressure, check with your physician before purchasing pseudoephedrine.
• Neti pot: This treatment may look and feel weird, but it’s very effective for cleaning out your sinuses to help with congestion and sinusitis. You use a little pot of warm water with powder dissolved in it to physically flush mucous out of your sinuses.

I used a neti pot for the first time last year, and it felt like water going up my nose. That said, it was quite effective. You literally can see the gunk coming out of your sinuses, so it’s obvious that it’s working. People with chronic sinus infections can really benefit from this over-the-counter treatment.

Dr. Stevenson discusses the neti pot treatment for colds.

Cough is the symptom that tends to linger for the longest time (up to 3-4 weeks). Honey (2 tsp every 6 hours) has been shown to be as effective as many over the counter cough suppressants. I also recommend a humidifier or steam to help ease chest congestion. For generalized muscle aches, over the counter anti-inflammatory medications such as ibuprofen or acetaminophen are very helpful and can be alternated.

When to see your doctor

For most people, cold symptoms will last up to 10 days. If your symptoms persist longer than that without any improvement, you may have a more serious infection.

If you experience any of these symptoms, it may be time to cash in a few sick days:

• A cough that lingers for a month or more
• A fever of 100.4 degrees Fahrenheit or higher, especially one that doesn’t go down with Tylenol or Advil
• Severe muscle aches
• Trouble taking in fluids
• Difficulty breathing
• Coughing up mucous with blood in it
• Feeling incredibly sick with no improvement in symptoms

If you’re struggling to feel better after 10 days, your doctor can help you determine the best treatment options for you. But don’t expect to automatically get antibiotics. Antibiotics treat specific bacteria. They aren’t going to make you feel better any faster if you have a virus, and they’re not going to help your immune system. In fact, if you take antibiotics and you don’t need them, you can develop bacteria that are resistant to those antibiotics and as a result, they may not help you in the future.

Even worse, you may contribute to widespread antibiotic resistance which can make it harder to treat illnesses in others. Additionally, antibiotics can cause yeast infections, nausea, vomiting, diarrhea, and abdominal pain. It’s not worth taking antibiotics unless you really need them.

Instead of antibiotics, your doctor likely will suggest that you take off a day or two from work to get more sleep and drink plenty of fluids. It’s really important to get the rest you need so that your body can fight the infection. If you have a fever, it’s best to stay home until you’ve gone 24 hours without one, without having to take medication.

Every time I get a cold, I think, “Wow, this is actually awful!” I forget how terrible it is and how sick a cold can make you feel. But I know it’s just a virus and I’m going to feel better in a few days.

If you’ve had cold symptoms for 10 days or fewer and you’ve been fever-free for 24 hours, you’re probably safe to go to work. Keep your tissues, over-the-counter remedies, and hand sanitizer close by, and try to remember that even though you’re miserable now, you’ll likely feel better in a few days.