INSIDE WVSMA
Editor ’ s Letter
The Common Cold in the Time of COVID-19
Linda S . Nield , MD
With summer arriving , we would typically look forward to the end of cold and flu season . Since the arrival of the coronavirus disease ( COVID-19 ) pandemic , we no longer have that fully confident reassurance that respiratory infections will decline in the warmer months .
Prior to March 2020 , when a child came into the pediatrics clinic with a few days of rhinorrhea , low grade fever , and cough with a benign physical examination , a diagnosis of acute upper respiratory infection , likely viral in origin — also known as the common cold — was made , and supportive care prescribed . Now , when a child comes into the clinic with common cold symptoms , we must pause and consider if any testing is needed . Frequently , day care centers require documentation from physicians stating that the patient is not infected with the SARS-CoV-2 virus before the child can return to day care , and of course , that documentation is not possible without a confirmatory laboratory test .
Viral and bacterial respiratory screening panels are not inexpensive . More thought must be put forth today when dealing with symptoms of the common cold , especially in terms of diagnostic testing . The use of viral and bacterial screening panels must be done on a case-by-case basis , and clinicians must consider the cost and the consequences that the test result will have on treatment . Cost benefit analysis will differ in the outpatient versus the inpatient setting . For example , a patient may be hospitalized for lower respiratory tract disease , and the cost of laboratory testing can be readily justified as the results may lead to treatment modifications that decrease antibiotic use . 1 Further considerations involving monoclonal antibody infusion treatments are also part of the deliberations . Although the common cold has not gone away , some of us yearn for the days when rhinorrhea and a cough were as easily diagnosed as the common cold and the thought of ordering a test was not on our radar , except for those patients with underlying disorders and the suspicion of influenzae . In the notso-distant past , we could solely prescribe nasal saline and nasal suctioning for babies , rest with a vaporizer nearby , and administering a teaspoonful of dark honey for children over one year of age to soothe the cough without much thought given to a further work-up . The tracking of COVID-19 by the Centers for Disease Control and Prevention is likely here to stay for the time being , so common cold symptoms will continue to require more cognitive consideration at patient visits .
A fairly frequent complication of the common cold is otitis media , which can uncommonly lead to mastoiditis . In this issue of the West Virginia Medical Journal , Wanstreet and Shaffer describe the unusual occurrence of acute otitis media and mastoiditis with post-auricular abscess formation in a five week old infant . 2 Haught and colleagues author a case report also involving the head and neck in their 11-yearold patient who presented with an enlarging cervical mass ultimately diagnosed with a ganglioneuroma . 3 The data provided in the article written by Mansoor and Sarwari about patients with a mean age of 33 years at the time of diagnosis with human immunodeficiency virus ( HIV ) informs the readers about the impact of a Ryan White clinic on HIV transmission rates in West Virginia , 4 while Cottrell and colleagues ’ article shares data and authors ’ insights about the cardiodynamic profiles of pregnant patients with obesity in early gestation . 5 Enjoy this issue , as you enjoy the summertime and potential decrease in respiratory infections .
REFERENCES
1 . Erich BJ , Kilic A , Palavecino E , Williamson J , Johnson J , Ohl C et al . Evaluation of the potential impact of a multiplex rapid diagnostic panel in critically ill patients with hospitalacquired pneumonia . Cureus . 2022 ; 141 ( 1 ): e21716 .
2 . Wanstreet T , Shaffer M . Acute otitis media and mastoiditis with post-auricular abscess in 5-week-old . WVMJ ; 2022 ; 118 ( 2 ): 30-32 .
3 . Haught E , Harper T , Phillips P , Shaffer M . Cervical ganglioneuroma presenting as a neck mass with Horner ’ s syndrome . WVMJ ; 2022 ; 118 ( 2 ): 20-23 .
4 . Mansoor A , Sarwari A . Impact of a Ryan White clinic on statewide HIV infections . WVMJ ; 2022 ; 118 ( 2 ): 24-28 .
5 . Cottrell J , Hayes W , Jude D , Chaffin . Cardiodynamic profiles of gravidas with obesity in early gestation . WVMJ ; 2022 ; 118 ( 2 ): 16-19 .
6 • www . wvsma . org