Clarification of misinformation about common colds and flus: a new insight from traditional Chinese medicine
Now it is the season that respiratory infectious diseases, such as common colds and flus, become prevalent. Although many people get flu shots every fall, some of them are still infected with the flu and even die of it. While common colds are usually mild, they still pose threats to seniors and immunocompromised individuals. And there are no vaccines for common colds. Given the ongoing covid-19 pandemic, the coming winter will become increasingly challenging for the people who are susceptible to respiratory diseases. Here, I would like to share my opinions about common colds and flus and hopefully clarify some of the most common misinformations.
Part 1: Official Information of common colds and flus from medical authorities
Here I summarize the information about common colds and flus from the website of the U.S. Centers for Disease Control and Prevention (CDC) (www.cdc.gov).
Common colds:
It is a respiratory infection caused by viruses. The main symptoms include sore throat, runny nose, cough, sneezing, tears, headache, physical pain and fever. It usually lasts 7-10 days.
Many viruses, mostly rhinoviruses, can cause common colds. Viruses are transmitted through air and close contacts. To reduce the risk of catching a cold, people should pay attention to personal hygiene, wash hands frequently and avoid touching faces with unwashed hands.
On average, adults catch 2-3 common colds per year, while children usually catch more common colds.
Because there are many kinds of viruses that cause common colds, there are no specific antivirals or vaccines for common colds. In the absence of complications, doctors generally recommend patients to rest more and drink more water without treatment.
Flus:
Flus have similar symptoms to common colds, mainly fever, fear of cold, cough, sore throat, runny nose, headache, body pain, and fatigue. Without virological tests, it is difficult to distinguish between flus or common colds, other respiratory diseases.
Flus are generally more infectious than common colds, with more serious symptoms, more complications, and even death.
Flus are caused by influenza viruses. There are at least three influenza viruses, Types A, B and C.
Prevention and treatment of flus: vaccine, personal hygiene and antivirals.
Part II: The vaccines and antivirals for flus
CDC considers vaccination as the most effective measure to prevent flus. There are three types of flu viruses (types A, B and C), and each type has several subtypes. Because it is difficult to accurately predict which types will become the prevalent virus next winter, which vaccines to use depends much on speculation. Given the rapid mutation of flu viruses, vaccines often fail to protect people. The data show that in the winter of 2017-2018, the protection rate of the vaccines was only 10-30%, so many vaccinated people still got flus. Due to the low protection rate of flu vaccines, it becomes critical to stress personal hygiene to stop the spread of the viruses. CDC recommends avoiding close contacts with flu patients; washing hands frequently, disinfecting object surfaces; avoiding touching eyes, noses and mouths; covering up when sneezing and coughing.
Note that CDC believes that flu has nothing to do with cold temperature or weather, so it does not take “keep warm in cold weathers or temperature” as a preventive measure. If you unfortunately catch a flu, CDC recommends using antiviral drugs as early as possible for patients with severe flu symptoms. The most widely used anti-flu medicine is oseltamivir (brand name Tamiflu) that is the first oral neuraminidase inhibitor developed by Roche and was approved in the US in 1999 for treating influenza A and B. It is mainly used within 36 hours of symptom onset. It was first listed by WHO as a priority drug for flus, but then was downgraded as a supplemental drug in 2017. The effectiveness of oseltamivir has been debated for years. A 2014 Cochrane review concluded that oseltamivir didn’t reduce the rates of hospitalization and complications caused by flus 1. Two other meta-analyses concluded that for a healthy person who gets flu, the benefits of using oseltamivir didn’t outweigh its risks. There's little evidence supporting that it changes the risk of hospitalization or death in high-risk populations 2,3. Another meta-analysis found that oseltamivir had some effects on preventing flus at the individual and family levels, however its common side effects included vomiting, diarrhea, headaches, sleep difficulties, psychiatric symptoms, seizures, and neurological hallucinatory responses. These side effects are related to its inhibition of neuraminidase 4. In summary, the effectiveness of oseltamivir may not meet the expectation of treating flus.
Part III: The mysteries of seasonal common colds and flus
The public common sense:
Modern medicine believes that common colds and flu are caused by viral infections and have nothing to do with cold temperature or weather, which is inconsistent with the common sense of the public who intuitively believe that common colds and flus are related to being exposed to cold temperature. For example, Chinese parents always remind their children “Put on more clothes, keep warm, and beware of catching a cold...” It’s not just common sense in Chinese culture, but also in the world. I remember that there was a classic dialogue in the Hollywood blockbuster “Independence Day”: David’s father came to comfort David, who was desperate because he couldn’t find a way to win against aliens, “go, put coat on and have a cup of coffee, I don’t want you to catch a cold”.
It is odd that CDC doesn’t remind the public to prevent common colds and flus by avoiding cold temperature, and the mainstream media also constantly interview medical experts to publicize that “common colds and flus have nothing to do with cold temperature”. These medical experts explain the reason why common colds and flus often occur in winter is because people prefer to stay indoors in winter, which increases the spread of viruses among people in close contact.
Is that really the case? The explanation can’t withstand logical scrutiny. This so-called “indoor transmission theory” claims that people tend to stay indoors more often in winter, so it increases the chances of spreading viruses from person to person. In other words, no matter in which season, as long as people stay indoors more often, it will increase the chances of getting sick. If this hypothesis is true, there are many places or occasions where more people stay indoors in close contact, such as classrooms, cinemas, indoor stadiums, conference rooms, trains, and planes. For example, students in the same class sit together throughout the year. If the theory is right, we should see students have common colds and flus all year round without seasonal differences. Therefore, this “indoor transmission theory” obviously does not explain why common colds and flus are mainly prevalent in winter.
Is human immunity suppressed when exposed to cold weather?
There is a hypothesis that when the human body is exposed to cold, its immunity is suppressed, then viruses take the chance. The immune system of the human body is one of the most important forces against pathogens. Immunity is affected by environmental factors inside and outside the human body. In biological sciences, it is very common to see that changes in temperature affects gene expression or protein activity. In 2015 and 2016, the Iwasaki research team of Yale University published two consecutive papers in the Proceedings of the American Academy of Sciences (PNAS). They found that when the temperature of the respiratory tract of mice drops to 33-35 degrees, the replication activity of the rhinovirus in the respiratory tract is greatly increased than at 37 degrees. Further research has found that the expression of type I and III gamma interferon in epithelial cells in the respiratory tract in low temperatures has been greatly reduced. These two interferons can effectively inhibit the replication of the rhinovirus at 37 degrees 5,6. This is the first time to show that low temperature can inhibit animal immunity and lead to increased virus replication. Therefore, the folk’s common sense is finally approved by modern science that exposure to low temperature does increase the chances for people to get sick through down-regulating immunity.
Which is more important, cold temperature or virus?
Although both viruses and cold temperature contribute to infectious diseases, which one is more important? I guess most people intuitively vote on viruses, because no matter how cold it is, people don’t get sick without viruses. However, this question is far from as simple as we thought. Before figuring out which is more important, we need to figure out another interesting question: Where are the common cold and flu viruses living?
We know that viruses can only replicate inside cells and have a very short lifespan (e.g., hours) in the environment. Then the question is, where do they stay throughout the year? The answer is that viruses stay in the human body all year round, in other words, human beings have always been the carriers of these viruses. The human body is an ecological system composed of human cells and a large number of viruses and microorganisms. For example, the number of microorganisms in the intestinal tract is more than ten times the total number of human cells. These microorganisms are vital and indispensable to humans. They help us digest food, absorb nutrients, and even resist other pathogens. When the symbiotic balance is destroyed, some viruses and bacteria that used to be friends of us will become “enemies”. Viruses take human beings as the carrier and usually achieve a harmonic relationship with the human body under the supervision of the immune system. However, when the human body is exposed to low temperatures, which suppress the immunity, viruses will replicate, leading to diseases. Since humans are more often exposed to cold weather in winter, they tend to get more common colds and flus in winter. So now do you still think cold temperature is not as important as viruses?
Of course, we know that common colds and flus also occur in other seasons with less frequency. There are many reasons for it. For example, the use of air conditioners makes people exposed to cold temperatures even in summer. In fact, not only cold temperature, other external environmental factors, such as humidity, dryness and heat can also make people sick through disrupting the homeostasis of the human body and suppressing immunity. This is one of the reasons why traditional Chinese medicine (TCM) emphasizes the unity of nature and humans, meaning that humans need to adapt themselves to the external changes in nature and maintain homeostasis.
Part IV: The wisdom of traditional Chinese medicine
TCM believes that nature has Six Qi, namely “wind, cold, heat, dampness, dryness and fire” and the human body is a small universe, so it also has Six Qi. The Six Qi should be balanced, and when imbalance between Six Qi occurs, it will disrupt the homeostasis and compromise immunity. Therefore, not only can low temperature cause disease, but the imbalance of any of the Six Qi can affect the body’s immunity, resulting in pathogen invasion or replication. A large number of TCM cases have proved that TCM can treat infectious diseases through restoring homeostasis or Yin-Yang balance of the human body7.
As we all know, balance is the most important idea in TCM. Now we know that the human body is an ecosystem composed of human cells, bacteria, viruses, and other microorganisms. As long as the components of the ecosystem are in a balance, humans should be healthy. It is not a smart idea to use chemical drugs to directly kill viruses and bacteria. First, there are countless pathogens in the world. It is time-consuming, costly, and laborious to develop vaccines and drugs for each specific pathogen. Second, using chemical drugs to directly kill pathogens forces pathogens to develop resistance to the drugs, and pathogens can also escape the vaccine protection through mutation; Third, since chemical drugs usually have toxicity and side effects, which can damage human tissues and organs as well as compromise self-healing power and immunity. On the contrary, TCM uses acupuncture and natural drugs to regulate the flow and distribution of energy in the body, so as to improve the internal environment and restore the ecological balance inside and outside the human body to treat diseases, which is much more effective and safer than chemical drugs. Mr. Peng Ziyi, a TCM master, concluded that the imbalance of the human body’s Six Qi is the root cause of all diseases, and treatment to restore the balance is most effective.
Summary:
1. We have clarified the misinformation that common colds and flus have nothing to do with cold temperature. In fact, cold temperature plays an important role in common colds and flus, and probably other infectious diseases.
2. The vaccines and antivirals for flus are not as effective as we expect. Pathogens can develop resistance to the chemical drugs and escape from the vaccine protection.
3. TCM treats common colds and flus with natural herbs and acupunctures through regulating and restoring Yin-Yang balance of the human body and promoting immunity, which is more effective and safer.
We are devoted to sharing TCM knowledge with the public, and more details about how TCM treats infectious diseases will be discussed in the coming articles.
Reference:
1. Butler D. Tamiflu report comes under fire. Nature 2014;508(7497):439–40. Doi: 10.1038/508439a.
2. Ebell MH., Call M., Shinholser J. Effectiveness of oseltamivir in adults: a meta-analysis of published and unpublished clinical trials. Fam Pract 2013;30(2):125–33. Doi: 10.1093/fampra/cms059.
3. Michiels B., Puyenbroeck KV., Verhoeven V., Vermeire E., Coenen S. The Value of Neuraminidase Inhibitors for the Prevention and Treatment of Seasonal Influenza: A Systematic Review of Systematic Reviews. Plos One 2013;8(4):e60348. Doi: 10.1371/journal.pone.0060348.
4. Butler CC., Velden AW van der., Bongard E., Saville BR., Holmes J., Coenen S., et al. Oseltamivir plus usual care versus usual care for influenza-like illness in primary care: an open-label, pragmatic, randomised controlled trial. Lancet 2020;395(10217):42–52. Doi: 10.1016/s0140-6736(19)32982-4.
5. Foxman EF., Storer JA., Fitzgerald ME., Wasik BR., Hou L., Zhao H., et al. Temperature-dependent innate defense against the common cold virus limits viral replication at warm temperature in mouse airway cells. Proceedings of the National Academy of Sciences of the United States of America 2015;112(3):827–32. Doi: 10.1073/pnas.1411030112.
6. Foxman EF., Storer JA., Vanaja K., Levchenko A., Iwasaki A. Two interferon-independent double-stranded RNA-induced host defense strategies suppress the common cold virus at warm temperature. Proceedings of the National Academy of Sciences of the United States of America 2016;113(30):8496–501. Doi: 10.1073/pnas.1601942113.
7. Luo X., Zhang Y., Li H., Ren M., Liu Y., Liu Y., et al. Clinical Evidence on the Use of Chinese Herbal Medicine for Acute Infectious Diseases: An Overview of Systematic Reviews. Front Pharmacol 2022;13:752978. Doi: 10.3389/fphar.2022.752978.
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