CAN'T STOP COUGHING?
Persistent condition has made this virus season exhausting
Coughs are common during every winter virus season. But this year it seems more people than usual are complaining about a cough that just won't go away. On social media — Tiktok, Bluesky and Threads — people are commiserating about their persistent coughs.
Bryan Jun, 26, who lives in New York, complained about his lingering cough on Tiktok last month. “I'm coughing in Georgia,” wrote one viewer. “Everyone is coughing in New Jersey,” wrote another.
Some physicians say they are seeing more lingering coughs than usual. Many of these patients have tested negative for the coronavirus, and the cough may be the aftermath of other circulating respiratory viruses.
Natasha Bhuyan, national medical director and physician at the primary care provider One Medical, said “many of our members” are reporting lingering coughs that they “just can't shake.”
“This winter, it felt like a lot of these circulating illnesses were all peaking at the same time,” she said. “Everywhere you turned somebody around you had a cold or had COVID or the flu.”
Michael Stephen, a pulmonary physician at Penn Medicine in Philadelphia, said his practice “has basically been taken over” by patients who have persistent coughs.
Stephen, who's also the author of Breath Taking: The Power, Fragility and Future of Our Extraordinary Lungs, said his patients have been coughing for one or two months at a time, which can strain chest muscles.
“It's beating them up,” he said. “These people are coming in with baggy eyes, not sleeping and pulled muscles. By the time they get to me, they're not doing well.”
It's possible people are just more tuned into coughing since the pandemic. Before COVID, people routinely went to work and social gatherings with coughs. Today, that's frowned on.
Russell Buhr, a pulmonary and critical care medicine physician at UCLA Health, said anywhere from 20 to 40 per cent of adults who get a viral infection can develop a post-infection cough that persists for two to eight weeks.
“I've seen it more frequently in my practice than I did a few years ago,” Buhr said. But he thinks it's because people have been “paying more attention” to their coughs, and other respiratory symptoms, since the start of the pandemic.
Ashwin Vasan, the commissioner of the New York City Department of Health and Mental Hygiene and a primary care physician, said “post-viral coughs are actually very common.”
Charles A. Powell, system division chief of pulmonary, critical care and sleep medicine at the Icahn School of Medicine at Mount Sinai, said it's very likely “the incidence of these diseases is higher than it was PRE-COVID” and that's why more patients have these lingering coughs.
“With the influenza, the COVID and the rhinovirus, the common cold virus — all those things are coming around the same time for us.”
A cough is a “protective reflex” intended to clear the lungs and keep the airway clear, said Peter Dicpinigaitis, director of the Montefiore Cough Center. When someone has a lingering cough because of a viral infection, the reflex “isn't serving any protective or beneficial purpose ... It just simply is a bothersome symptom for the patient.”
A persistent cough after a respiratory virus is often a “sign of a lingering inflammatory response to that initial illness,” Buhr said. People who get RSV can “cough for weeks.”
If you have a high fever, shortness of breath or trouble breathing, dizziness or confusion, or other signs that any symptoms are getting worse, contact your doctor right away.
“The key one is if their symptoms are actually getting worse,” Bhuyan said. “At that point, they might be developing a pneumonia or a bacterial infection, or another kind of infection.”
If you've been coughing for more than eight weeks, “it becomes much more likely” the “treatable underlying cause” needs to be diagnosed, said Dicpinigaitis. Some of his patients have been persistently coughing for years. Those chronic coughs that last more than eight weeks, are often due to one of three conditions: asthma, acid reflux (known as gastroesophageal reflux disease or GERD) and postnasal drip syndrome, he said.
With the influenza, the COVID and the rhinovirus, the common cold virus — all those things are coming around the same time for us.
Has COVID made us more susceptible to coughs? Doctors say it's possible a bad case of COVID could affect how quickly a person bounces back from subsequent colds or other respiratory viruses. It takes longer for some patients to heal from a COVID infection and, when someone's recovering, it's possible that other viruses will have an easier time infecting the airway, Stephen said.
“COVID has really changed things,” Stephen said. “The fact that it causes a pretty significant bronchitis, I think, in a lot of people, it's changing the immunology of their lungs.”
COVID -19 has also been “a bit of an eye-opener,” said Ziyad Al-aly, chief of research and development at the VA St. Louis health care System and a clinical epidemiologist at Washington University in St. Louis.
“We have a new-found appreciation that viruses that we trivialized actually can have serious effects,” Al-aly said, adding that the flu and RSV can both lead to a lingering cough. “I don't think any of this is new. I think our awareness and our documentation of it is new.”
There's “no magic bullet” to treating a lingering cough, said Powell. Hydration and hot beverages help and will probably provide the same relief as over-thecounter medications and cough syrups.
“If drinking tea with honey makes you feel better, and it's soothing, that's great,” Powell said.