Pesky cough may be reaction to pandemic
You tested negative for COVID, or perhaps didn’t test at all. Any mild fever or body aches you had weeks ago have long since faded, but a lingering cough — be it from COVID-19, the flu or a bug of unknown provenance — just won’t go away.
The remnants of a pesky virus seem to be plaguing many people right now as March brings the tail end of the winter respiratory virus season.
A prolonged cough “is something I’ve been hearing a lot, anecdotally, from a lot of friends and patients,” said Dr. Lauren Eggert, a clinical assistant professor in Stanford University’s division of pulmonary, allergy and critical care medicine. “I’m not sure it’s a new phenomenon, but I think there are several reasons why it’s an issue currently.”
One potential explanation is people are reacting to the pandemic, both physically and psychologically, according to local doctors who treat patients with respiratory problems.
Many people this winter virus season are more relaxed than they’ve been in years at wearing masks, washing their hands and keeping their distance from others. As a result, they’re exposing themselves to respiratory viruses that they had largely been shielded from during the peak COVID years, and their immune systems are now readjusting.
Sutter Health pulmonologist Vanessa Walker likened it to when young children go back to school, bring viruses home and get the whole family sick after they had just enjoyed an illness-free summer.
“We haven’t really been very sick over the past few years except for ones that got COVID,” said Walker, chief medical executive at Sutter Health in Roseville (Placer County). “You weren’t seeing a lot of flu or RSV until last year. So we’re emerging out of that cocoon we wrapped ourselves into during COVID and are exposing our immune system to all these viruses.”
There’s no hard data suggesting that people are experiencing more severe cold or cough symptoms this winter season, or that those symptoms are dragging on longer than usual. While hospitals regularly test for influenza, RSV and COVID and report cases to public health departments, they do not track the so-called common cold or other viruses that trigger respiratory symptoms.
“The vast majority of people with cold symptoms aren’t getting tested, and if they do, it’ll be for RSV, influenza or COVID,” Walker said. “So there isn’t truly a way to quantify in the community the level of colds or the magnitude of a chronic cough because we simply don’t collect data on that.”
Absent hard data, it could be that people are simply more aware and sensitive to coughing or any kind of respiratory symptoms — in themselves and in those around them — even if they barely gave the same symptom a second thought before the pandemic.
“People are a lot more attuned to it,” Eggert said. “I’ve seen such an upsurge in patients in my practice for a chronic cough they’ve had for years. But now it’s an issue because people around them are nervous, people move away from them, it’s bothering their partner. … It’s kind of on the forefront of everyone’s minds.”
It’s fairly common to have a cough for up to six weeks after a respiratory infection, often because of continuing inflammation, Eggert said.
If a cough stretches beyond eight weeks and isn’t accompanied by other concerning symptoms like coughing up blood or weight loss, it’s considered a chronic cough. Some of the most common causes of chronic cough include allergies, post-nasal drip, asthma and acid reflux.
The annual winter respiratory season has been thrown off its usual trajectory the last few years, in part because COVID is not seasonal the way flu and RSV tend to be. In the 2020-21 season, there were barely any flu cases in California, which was still under COVID restrictions. In 2021-22, the flu peaked unusually late — in June instead of the usual December to March period. And the 2022-23 season saw an unusually early wave of flu and an unusually steep spike in RSV.
The current state of affairs could just be another example of an atypical respiratory season in the aftermath of the pandemic.
“It’s hard for us to really know where we’re at,” said UCSF’s Dr. Jahan Fahimi, an emergency physician who often orders viral testing for patients with respiratory symptoms. “We’ll have a better sense of the new state of upper respiratory infection in hindsight when the season is over.”