Preventing Cold & Flu: How Doctors Keep Germs at Bay

Doctors give their top tips for avoiding nasty cold and flu germs.

From the WebMD Archives

With cold and flu season in full swing, we wondered how top docs personally battle nasty bugs each winter. Here are their expert tips for keeping pains, aches, sniffles, and sneezes at bay.

Wash your hands to keep germs away

The advice you’ve probably heard dozens of times from your doctor -- wash your hands throughout the day -- really does prevent infections, and all the doctors we talked to said they do it religiously. “I wash my hands or use a hand sanitizer before and after every patient,” says Christopher Tolcher, MD, a pediatrician in the Los Angeles area and clinical assistant professor of pediatrics at the University of Southern California Keck School of Medicine in Los Angeles. “I probably wash my hands 40 to 50 times a day.”

What to use? Warm water and soap will kill the germs, but be sure you don’t rush. “I try to wash for 20 seconds -- sing ‘Happy Birthday’ to myself twice,” says Nancy Hughes, MS, RN, director of the Center for Occupational and Environmental Health in Silver Spring, Md. She’s also careful after she washes. “I use a paper towel to dry my hands and to turn off the faucet, especially in public bathrooms.”

No matter how clean they may be, remember this: Hands are veritable germ factories, so keep them away from your nose and mouth. Also keep them away from your food during cold and flu season. “I try to bring something I can eat with a spoon or fork, rather than a sandwich I have to handle,” says Sandra Fryhofer, MD, MACP, clinical associate professor at Emory University School of Medicine and a general internist in Atlanta. “If you’re going to eat a sandwich, put a tissue or paper towel around it.”

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Keep cold and flu germs off surfaces

Colds and flu are caused by viruses, which can easily pass from person to person, or from surface to person.

“Computer keyboards, telephones, doorknobs, pens that are given to you when you sign for a credit card purchase or in a doctor’s office -- all of these are surfaces that have great potential for harboring germs,” says Neil Schachter, MD, professor of medicine at Mount Sinai School of Medicine in New York City and author of The Good Doctor’s Guide to Colds and Flu.

“I make it a point of carrying around little bottles of alcohol-based cleansers, and I use them liberally after I suspect that I’ve been exposed,” he says.

“I have antiseptic wipes, and I regularly clean my desktop and my phone,” Tolcher says. “I clean my stethoscope and even my pens with alcohol every day.”

Exercise for immunity

A jog around the block a few times a week not only can do wonders for your physique -- it also might prevent you from getting sick. “I try to get 20 to 30 minutes of cardio every morning before I go to work,” Fryhofer says. “There’s something about making your heart pump that’s good for your body. It strengthens your heart and strengthens your immune system.”

The research seems to agree -- one study found that postmenopausal women who exercised for a year had one-third the colds of women who didn’t work out.

What about exercise if you’re already sick? The general rule is if your symptoms are above the neck (stuffy nose, sneezing), go ahead. But if you have a fever higher than 100 degrees, a cough, or chills, hold off on the workout front for a few days until you feel better.

Colds, flus, and herbal medicine

There’s been a lot of buzz about herbal remedies for preventing and shortening the duration of colds. Although the research on whether they work shows mixed results, some of the doctors we spoke with said they do find relief from natural remedies.

“I use echinacea and goldenseal because they help boost the immune system and fight off microbes,” says Lauren Richter, DO, assistant professor of family and community medicine at the University of Maryland Center for Integrative Medicine. “I like the teas, but a lot of people don’t like the taste, so pills are fine.”

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Even so, studies haven’t found much evidence that echinacea prevents upper respiratory infections, but some of its extracts (such as E. pallida and E. purpurea) may help you feel better if you are already sick.

“Sometimes when I have been exposed to someone who has a very obvious cold or the flu, or if I’m feeling just a little bit off, I’ll take a zinc lozenge,” Schachter says. “That’s my protective shield.” He says he limits himself to one or two a day, because they can cause an upset stomach and dry mouth.

Does zinc actually work? Some studies show it can shorten the duration and reduce the severity of colds, while others have found the evidence isn’t strong enough yet to recommend it.

Most of the doctors we spoke with aren’t convinced that using herbal remedies is worth the effort.

“I do not take echinacea or zinc,” Tolcher says. “I’m just not a believer in them, and the research on them is not impressive.”

One note of caution if you do take herbal remedies: Check with your doctor first. Just because they’re all-natural doesn’t mean they don’t have side effects; for example, some studies have shown that zinc nasal sprays and swabs may reduce your sense of smell.

More important, herbal remedies may interfere with medicines you’re already taking.

Does vitamin C help colds?

The jury is out on whether vitamin C can prevent a cold. And according to the latest research, vitamin C doesn’t make a cold shorter or less severe.

Although experts do not recommend upping your dosage for that purpose, some say it may help ward off germs if you’ve been exposed to physical or environmental stress -- for example, with especially strenuous exercise or exposure to bitter cold weather.

Even so, some people swear by it. “I have some vitamin C in my diet every day, but I bump the dose up when I get sick,” Richter says.

“Generally it will reduce the length of the symptoms by at least a day or two and also will help with the severity,” she says. An extra 500 milligrams a day is about all you need.

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Sore throat remedies

When their throats are scratchy and raw, doctors often find relief from items stocked in their pantry and fridge. “I’m a big believer in herbal tea with honey and lemon,” Fryhofer says. “It’s easy to get down because it’s warm and comforting.” Honey may also help if you have a cough. One study showed that buckwheat honey relieved children’s coughs even better than the cough suppressant dextromethorphan.

Chicken soup for colds and flu

Doctors say they use over-the-counter decongestants and antihistamines only when their symptoms are severe, and even then only sparingly. Many prefer natural alternatives, such as saline (salt and water) solution, which helps clear out nasal mucus. “One time when I had a cold I used it 18 times in one day,” says Marcella Bothwell, MD, FAAP, a pediatric otolaryngologist at Rady Children’s Hospital in San Diego. “You won’t get side effects from saline. Your body is mostly water, so you’re just putting into it what’s already there.”

Grandma’s good old-fashioned “penicillin” is another great soother of stuffed noses. “I’ve enjoyed chicken soup for years,” says Schachter. “The vapor alone clears nasal passages and relieves the throbbing in the sinuses.” Recently researchers have discovered what grandmothers have suspected all along -- that the ingredients in chicken soup (including the chicken stock, carrot, onion, and celery) might actually have a medicinal effect on the body’s immune system, easing the inflammation caused by cold viruses.

Preventing colds and flu with acupuncture

The ancient Chinese medical tradition of using hair-thin needles to stimulate pressure points around the body has been used to treat everything from headaches to arthritis, and there’s some suggestion it might help with colds as well.

“I’m a huge fan of acupuncture, and I use it for prevention because there are many studies that show acupuncture boosts your immune system,” Richter says. “I get it about every six to eight weeks, and then more frequently if I get sick.” There isn’t any real evidence that acupuncture relieves colds, but considering the few side effects, trying it probably can’t hurt.

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Over-the-counter medications for colds and flus

Our docs agree: When they’re feeling really awful, they turn to over-the-counter pain relievers. “The thing that I take most regularly is Tylenol, aspirin, or Advil,” Schachter says. “It’s that sick feeling -- that achy, blah feeling you have when you get sick -- that really bothers me.”

While cold and flu remedies can ease the most severe symptoms, many doctors say they avoid overmedicating themselves. “I don’t like the feeling of taking a lot of medication, where my head feels fuzzy,” Hughes says.

When she feels sick enough to need a cold remedy, Bothwell buys them individually, taking acetaminophen for a fever and a cough suppressant for a cough, instead of a multisymptom cold and flu medication. Bothwell also chooses generics over the brand-name varieties. “One of my pet peeves is spending so much money on these cold preparations,” she says. “Sometimes those combination drugs give you a lot more medicine than you need, and they’re more expensive.”

Because doctors can’t afford to use sick days, staying healthy is essential. “I think I’ve taken two or three days in the last 10 to 15 years,” says Schachter. “With the kind of job I have, it’s hard for me to stay home.”

Bottom line

Prevention is the key. Our experts all say a flu shot is essential and they advise staying in the best possible health year-round. “Do the basics -- eat right, sleep right, exercise, and wash your hands,” Richter says. “I work in a pretty high-risk profession, and I rarely get sick because I do those things.”

WebMD Magazine - Feature Reviewed by Brunilda Nazario, MD on October 05, 2009

Sources

Sandra Fryhofer, MD, MACP, clinical associate professor at the Emory University School of Medicine, and practicing general internist, Atlanta, GA. Christopher Tolcher, MD, pediatrician in the Los Angeles area and clinical assistant professor of Pediatrics at the University of Southern California School of Medicine. Nancy Hughes, MS, RN, Director, Center for Occupational and Environmental Health in Silver Spring, Maryland. Neil Schachter, MD, professor of Medicine at the Mount Sinai School of Medicine, and medical director of the Respiratory Care Department at Mount Sinai Hospital. Lauren Richter, DO, MAc, clinical assistant professor of medicine in family practice at the Center for Integrative Medicine, University of Maryland School of Medicine. Marcella Bothwell, MD, FAAP, pediatric otolaryngologist and director of the Pediatric Airway and Aerodigestive Team at at Rady Children’s Hospital in San Diego. Chubak J, McTiernan A, et al., The American Journal of Medicine. 2006;119:937-942. Paul IM, Beiler J, et al., Arch Peddiatr Adolesc Med. 2007;161:1140-1146. Rennard BO, Ertl RF, Gossman GL, et al., Chest. 2000; 118:1150-1157. Fugh-Berman, A.,Seminars in Integrative Medicine. 2003;1:106-111. Hulisz D., J Am Pharm Assoc. 2004;44:594-603. Caruso TJ, Prober CG, et al., Clin Infect Dis. 2007;45:569-574. Alexander TH, Davidson TM., Laryngoscope. 2006;116:217-220. Simasek M, Blandino DM., et al., Am Fam Physician. 2007;75:515-520. Douglas RM, Hemila H, Chalker E, et al., Cochrane Database Syst Rev. 2007Jul 18;(3):CD000980.

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