Coughs & colds during a pandemic

Dealing with a cough, sore throat and sneezing can be tiresome at the best of times, so what about during the COVID-19 pandemic?

Coughs and colds are common, but they can greatly disrupt a person’s day-to-day life. Yet with so many cough and cold treatments to choose from, finding the most appropriate solution can be tricky.

Pharmacists can assist customers to relieve their cough and cold symptoms by offering advice, support and product guidance.

“Most adults understand coughs and colds are self-limiting. The common cold will often start with a sore throat in the morning, move into the back of the nose perhaps bringing forth some of those common upper respiratory tract symptoms and maybe end in a cough,” explains Taren Gill, pharmacist and owner of Priceline Pharmacy in Maryborough, Victoria.

However, several consumer studies have shown there are misconceptions regarding the best way to treat cough and cold symptoms. People are also frequently concerned over the safety of some medicines, particularly where children are involved.

Is it just a cough or COVID-19?

Given the fear and uncertainty surrounding the coronavirus pandemic, and the fact that cough has be identified as a common symptom, it’s likely that some people who develop a cough might suspect they have COVID-19.

“Treating coughs and colds has certainly been a bit different this year,” Ms Gill told the AJP.

“If a person is feeling unwell, the advice is to not leave their home. Even if it is a common cold or flu, when they present at the pharmacy door there’s a sign asking them to not come in. In this instance a telehealth conversation and a home delivery may be used.

“In the early stages of the COVID-19 pandemic when we felt it was really coming from overseas, rather than being community acquired, we still had people presenting with cold and flu symptoms,” she said.

“In that instance the questions really centred on asking if the person had been overseas recently or if they thought they might have come into contact with someone who is COVID positive. If the answers were no, it was simply a case of addressing the symptoms, be it a sore throat, cough, headache, blocked or runny nose.”

As we continue to navigate our way through the pandemic, pharmacists can help reassure people and educate on the differences between cold and COVID-19 symptoms.

Common cold symptoms include:

  • cough;
  • sore throat;
  • headache;
  • runny or congested nose;
  • sneezing; and
  • fatigue (sometimes)

The common symptoms of COVID-19 include:

  • fever;
  • cough;
  • shortness of breath; and
  • fatigue

Less common symptoms of COVID-19 are:

  • sore throat;
  • aches and pains;
  • headaches;
  • runny or congested nose;
  • loss of taste or smell; and
  • diarrhea (rare)

Discussing the symptoms of both COVID-19 and a cold can help reassure people that the main overlapping symptom is a cough.

It also highlights the differences. According to the Centers for Disease Control and Prevention, a cold is typically preceded by a sore throat and runny nose, which are less common symptoms of COVID-19.

Treating coughs and colds

There is no cure for the common cold, yet there’s a wide range of over-the-counter products that may help to ease and manage the symptoms.

Certainly, not everyone will experience the same symptoms—however, the most common signs of a cold include a sore throat, nasal congestion, runny nose, cough, sneezing, slight body aches and mild headache.

“While it’s not uncommon for people to self-select cough and cold products, pharmacies will generally have a sign up during winter that prompts people to talk to the pharmacist if they want a more effective treatment.

“This opens up the conversation to talk about more effective, pharmacist-prescribed items. However, general advertising, for example by brands such as Codral, can also guide a person’s product choice.

“Nonetheless, the advice of a pharmacist is vital. We’re a rural pharmacy where it can take six weeks to get in to see a doctor, so the triaging that occurs on the pharmacy floor is important and people respect that. They also appreciate that if they’re feeling particularly unwell we can provide them with a leave consultation and give them up to 48-hours away from work,” says Ms Gill.

“Before discussing products, we use the traditional ‘What, Stop, Go’ questions to find out who the person is shopping for; is it for their six-month-old baby or their 85-year-old mother?

“What exactly are their symptoms and how long have they had them? Is it acute or has it been going on for six weeks? Also, what have they tried already? We don’t want to resell a nasal spray when clearly they’ve already tried it to no avail.

“We also need to know if they have any medical conditions and whether they’re pregnant or breastfeeding, as this may prevent them from using certain treatments.

“A full solution might include a symptomatic cold and flu tablet, a pain reliever like paracetamol, maybe a decongestant, a sore throat lozenge, a salt water nasal rinse and cough mixture—as well as zinc, echinacea and a box of tissues. However, it depends on the person’s budget and what they want, as well as how many people they are treating. For example, is it just for them, or is the whole family sick?”

Janet Sluggett, pharmacist and research fellow at the Centre for Medicine Use and Safety, Monash University, says, “People may seek a cough or cold product with the expectation that it will provide a cure. Pharmacists can address these misconceptions by educating consumers about the etiology of the common cold and explaining that cough and cold preparations will not cure the underlying illness; at best, they may provide some symptom relief.”

She adds, “While decongestants may help ease a blocked nose, they can exacerbate other medical conditions. When deciding whether a decongestant product is the best option, it’s important to consider co-morbidities such as cardiac disease, diabetes, prostatic hypertrophy, closed-angle glaucoma, hyperthyroidism, and whether the person might be pregnant.

“Double-dosing also needs to be considered. For example, cough mixtures can also contain decongestants and antihistamines, so it’s best to advise people to avoid using combination products if the cough is their only symptom.”

A persistent symptom

Indeed, cough can be one of the most irritating and persistent cold symptoms.

“A post-viral cough can hang around for weeks after the person feels better. In this instance they may just need symptomatic relief that might come from sucking a lozenge and staying well hydrated,” says Ms Gill.

“However, cough can be complicated as a dry cough could be due to a worsening as asthma, a worsening of heart failure or chronic obstructive pulmonary disease. It could also be a side effect of medication, like an ACE inhibitor.

“A chesty, phlegmy cough is a little easier to manage as, providing there’s no fever, it’s probably just viral and doesn’t require antibiotics in most cases. Using symptomatic relief, such as bromhexine, might help to thin the mucus and help clear the cough. Certainly, depending on the co-morbidities of the patient, if the cough doesn’t shift at all, this would warrant referral to a GP to rule out any possible alternative causes.”

Instances that might require referral include:

  • cases where cold symptoms worsen or have been present for longer than three weeks;
  • people with medical conditions, such as diabetes or asthma;
  • if the person is experiencing difficulty breathing or has shortness of breath;
  • intense and recurrent headache; and
  • persistent cough

Cough and cold in children

Ms Gill advises, “When dealing with cough and cold symptoms in a child younger than six years of age we need to assess the symptoms to make sure that something more severe isn’t happening. For example, a high temperature and dehydration really needs to be addressed very quickly.

“Following this we would look at providing symptomatic relief. A saline nasal spray can be helpful in easing congestion and is safe for the whole family, from infants to adults. Getting rid of the nasal mucus will often help with cough symptoms, which are often caused by postnasal drip.

“Common pain relief medicines, like paracetamol or ibuprofen, can address aches and the pain associated with sore throat and headache.

“A humidifier or vapouriser in the home can also be useful to add moisture to the air. If the child has a history of asthma or croup you might also ask if there’s an asthma action plan in place.”

Given that cough and cold medicines are not recommended for younger children, pharmacists can advise on the non-pharmacological treatments for symptom relief.

Products to target a runny or blocked nose include:

  • saline (salt water) sprays or drops to help clear mucus;
  • vaporiser or humidifier; and
  • an ointment, balm or nasal gel to soothe dry or chapped skin around the nose 

Products to soothe a sore throat or cough include:

  • throat lozenges; 
  • honey

Other actions that can help relieve symptoms include:

  • getting adequate rest;
  • staying well hydrated by drinking plenty of water;
  • gargling with salt water for a sore throat or cough; and
  • avoiding exposure to cigarette smoke.

“Overall, the fact that people are washing their hands more rigorously, coughing into their elbows and being vaccinated for influenza means that it’s likely we’ll see far fewer number of cases of the common cold and flu this year,” says Ms Gill.

Winning in winter

Andrew Pattinson, general manager at Instigo, a marketing solutions provider, says there are many ways that pharmacies can promote their winter health offering, but the key is to keep all marketing messaging consistent.

He says window displays should align with the in-store messaging and communication should focus on offering an entire solution.

“People don’t come in to pharmacy for just a product, they’re coming in for a solution to a problem. Solutions are often multi-faceted; they might involve a core product, a preventative product and perhaps even a service offering.

“Certainly when it comes to cough, cold and flu season, there’s the opportunity to treat, prevent with an influenza vaccination and possibly even offer an absence from work certificate.

“You can take what could be a low-margin sale and change it into a much higher solution-based sale that’s going to meet the needs of the consumer.”

Certainly, some marketing campaigns take months to plan. However, there are a few quick wins you can implement. Here are a few ways to help bolster winter sales.

  1. Promote the services you’re already offering and doing well at, for example the flu vaccine.
  2. Showcase your ‘hero’ products. Have a ‘product of the month’ that is relevant and meets the consumers’ needs. Counter units that provide solutions to common winter ailments can work well.
  3. Team up with local businesses or organisations, such as the council or school, to ensure their staff and families have had their winter health check.
  4. Show, don’t tell. Use the pharmacy Facebook page to leverage more sales through videos of patient testimonials, product reviews, demonstrations or pharmacist advice.
  5. Educate customers on the importance of hand hygiene and the simple actions they can take to stay well this winter. Bundle products that make the whole preventative process simple.

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