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With the winter season comes a cacophony of coughs, sniffles and sneezes. In an effort to reduce the bottleneck caused by the sheer volume of people that flock to A&E with a simple common cold, using up valuable time and resources, we speak to Dr Krishna Rawal.

How do I know whether I have the flu, or a common cold? 

​The common cold is of course the most ‘common’ and is a viral illness that can vary from just feeling a little ‘out of sorts’ to feeling tired and feverish with muscle aches, nasal congestion, sore throat, coughs and sneezes. Sometimes you may cough up some green sputum, but this in itself is not a sign of a secondary bacterial infection. Influenza or the flu is also viral but can last longer or be more severe with more extreme symptoms of fever, exhaustion, muscle aches and cough. However, for both the common cold and the flu, the symptoms can vary from so mild you do not even know you have it, to being quite unwell, depending on your own state of health and immunity.

How can each of these be treated? 

Both the common cold and the flu are viral illnesses, so there is no definitive treatment that will get rid of the virus. The key is to support the immune system to do the job it is designed to do, by keeping warm and hydrated, avoiding strenuous exercise (which can aggravate the muscle aches), and using supportive medications such as paracetamol for general muscle aches, sugar free cough linctus or honey and lemon in hot water for a cough or sore throat.

Often people worry about the fever and think this is a sign of a secondary infection or that the fever needs to be treated with paracetamol, however, fever itself is a sign of the immune system working to fight the infection. The cold virus lives at body temperature, so the response in the body is to raise the body temperature to kill the virus. In many cases a bit of fever, especially early on, is not a bad thing and ‘sweating out’ the cold is a way to fight the virus naturally. It is also worth considering staying at home so as not to pass the cold on to friends and colleagues at work, and also preventing spread using a tissue for coughs and sneezes – Catch it. Bin it. Kill it.

Fever is a sign of the immune system working to fight the infection.

Influenza that is bad enough to need medical treatment or admission may need specific anti-viral medications, but these are only considered in cases of rapidly spreading flu infections such as the ‘bird flu’ epidemic that occurred in 2008, or under specialist guidance.

At what point should I seek medical attention? 

It is difficult to be exact with this, as it varies with every person, but prolonged symptoms lasting more than a week, very high or persisting fevers, a cough with brown or dark sputum, or feeling so unwell that you are bed-bound are good reasons to seek medical advice. The medical advice may be to just continue supportive treatment with bed rest and fluids, or it may mean further treatments such as antibiotics if there is a secondary infection.

When is high temperature dangerous?

The advice here is that anything above 37°C is considered a fever but does not always require medical attention, especially if patient is physically stable. In children under 6 months, medical advice should be sought if the temperature is above 39°C, and in children under 3 months if the temperature is above 38°C. In these cases, the child should be assessed by a doctor.

People in Gibraltar visit A&E on average 3 times more often than in the UK

In older children and adults, if physically stable with no difficulty breathing, most episodes of fever can be treated with over the counter medication such as paracetamol and ibuprofen, as long as someone is able to take these medications. Bed rest and fluids are very beneficial and a reminder that sick certificates can be obtained without the need to see a doctor via the Primary Care Centre sick certificate telephone service on 2000 7888.

How can I best prevent catching the flu/a cold? 

The best way is to keep healthy and support your immune system with a healthy diet, drinking plenty of fluids daily, regular exercise and sleep, and not smoking as this reduces defences in the lungs. This is really the same recommendation for preventing any ill health. If someone has another medical condition, such as lung disease or diabetes, then having the annual flu vaccine is also a very good idea. This year in Gibraltar we have extended the flu vaccine to include children, so that more sections of the community are protected.

Do you have a rough figure for how many A&E patients could have booked a regular GP appointment or self-treated at home? ​

This is impossible to quantify as every person has a different interpretation of how well or unwell they feel. We do know that people in Gibraltar visit the A&E department on average 3 times more often than in the UK, but Gibraltarians are not unhealthier than their UK counterparts. Patients do attend A&E for conditions that would be better treated by a GP, and the A&E Consultant argues that perhaps half of all those who attend A&E would have been better seeing their GP, seeking advice from a Pharmacist, or using simple medications at home. However, there are many factors for this including convenience and worry that it might be something more severe. However, we must always bear in mind that the best way to treat a cold is rest and supportive treatment, and not sitting in an A&E department or GP surgery where you may feel more unwell, and you may also pass the virus on to others who may have chronic health conditions and may be severely affected by your cold.

A&E is there for accidents and emergencies such as heart attacks and strokes.

What is the most common ailment people visit A&E/their GP for? 

Again, this is impossible to say. Patients attend their GP for anything from chronic ill health such as diabetes and high blood pressure, to backaches and arthritis, to common colds or throat or chest infections. Every day patients come with different problems. A&E also sees the same medical conditions, but is there for accidents (anything from a road traffic accident to a fall or laceration) and emergencies such as heart attacks and strokes.

Do you have any parting advice for our readers?

The key is that we must all as a community use medical services appropriately, so for routine medical conditions, reviews and minor illnesses go to the GP. For accidents and emergencies go to A&E. If we use A&E for minor illnesses for example, we are stretching resources that should be focused on caring for those most unwell, and certainly I would want the A&E department to be ready and free to deal with me or my loved ones in an emergency where time is of the essence. The same applies to the GP. If we stretch GP time and resources with minor ailments such as the common cold which can just be treated at home, then those who are chronically unwell may struggle to get the appointments they need. It really is about all of us being wise with how we seek medical advice, and how we need to ensure that medical services are kept free to care for the most unwell or vulnerable.

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