A story that is true from a very long time ago, but still perfectly relevant. When I was in college, my annoying younger brother not only skipped his last year in high school, he also came to Harvard and was now just one instead of two years behind me. Well, in the winter he got sick with a respiratory bug. Fever, chills, sweats, but all low grade, and cough. After a couple of weeks of this, friends started to tell him to go to the doctor. I did, too. But he just said, “It’s just a chest cold. I’ll be fine.”
Another month went by. He started to worry. What if it’s cancer? What about tuberculosis? So he booked an appointment with a doc at the infirmary, staffed by physicians from Harvard Medical School, of course. The doc takes his history, does his physical exam. No Xray ordered, no lab tests.
“Well, kid, do you want the good news or the bad news?
“Just tell me!”
“Well, you have walking pneumonia. Bacterial illness, easy to treat, responds well to a standard course of inexpensive antibiotics.”
“Oh, whew! What a relief!.......What’s the BAD news?”
“You should have come in weeks ago. But now you’re over it.”
“What? You’re not gonna give me anything?”
“No. Like I said, you’re already over it. Next time come in sooner!”
Now some facts. The vast majority of chest colds are viral. Covid is just the latest virus. Influenza, famously, and RSV, the “croup” virus commonly causes “bronchitis.” Bronchitis is coughing up phlegm, sick, mostly in the chest, without persistent fever, at least not past, say, day 5. When a patient still has a fever on day 6, I always suspect pneumonia. So what’s walking pneumonia? Mild enough that you aren’t bedridden! The traditional bug is still around, making up about 30-35% of pneumoniasL “mycoplasma pneumoniae”. 7 days of erythromycin or tetracycline, generic inexpensive antibiotics around since the 1950s, still work. Usually the cough is pretty dry, little “production” of mucus, or phlegm. Classic pneumococcal pneumonia in healthy folks commonly is from their own nasal germs invading the lungs AFTER a viral infection. So it goes from a cold with fever to no fever, back to fever. That’s the pattern for a second infection. The first one never comes back. That idea is fiction. Influenza is easy to distinguish most of the time in healthy teens to adults. It looks like this:
“Doc, I don’t know what happened, I was fine until about 5:30 on Friday (an onset so abrupt you can remember the time?), then I came down with chills, then a fever, and a cough all at once. (chills always precede, not follow, fever, and cough at the beginning is unusual but typical for influenza). Also the worst body aches. I hurt so much even my hair hurts. (Rarely reported in ANY other context). I’ve never been this sick in my life!!” (Now I’m sure it’s influenza)
“So, you didn’t get a flu shot, did you?!
“No. Is that what this is?”
“Yeah. Nobody who had their flu shot would tell me your story, because while they might GET the flu, it would be MUCH milder.”
On a personal note, I had influenza in the 1957 pandemic “Asian” flu, and again the pandemic 1968 “Hong Kong” flu. But as of 1974, when I entered medical school and flu shots became a professional requirement, I have never missed my annual flu shot, nor have I had the flu! I did once come down with the abrupt onset of chills, fever, body aches, and cough. But it only lasted about 12 hours, and then I was over it. I believe I was so immune that I caught the flu and killed it in half a day!
Somewhere around 1 in 100 persons who get influenza will need to be hospitalized due to severity. Same with Covid. As of June 2024, more with Covid die than with influenza: 5-6% of those hospitalized.
So, today we have flu shots for everyone over 6 months of age. Only half of America does what they’re told and gets it. Of course, half of us are, after all, below average! You, too, qualify if you don’t get one! We also have Covid vaccine, and now RSV vaccine for children and folks over 60. We have pneumococcal vaccine with 20 different species (I got that one last summer at my physical. Never met a shot I was eligible for and didn’t get!). No vaccines yet for the common cold, bronchitis, nor walking pneumonia. But do be smarter than my brother: if that fever persists past day 5, see a doctor. If they don’t want to give you antibiotics and the fever persists, ask them how they know you DON’T have walking pneumonia. You might get an Xray and another visit, but you’re also likely to get the cheap antibiotic cure. Don’t be like MY brother!
Great, logical advice! I started getting flu shots while visiting my father in law
who was in an assisted living environment. If not for yourself, think of others.
Bravo, Patty. Too few think of others at all these days, it seems!