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Healthy Outlook

Is it the Flu or the Cold?

By Dr. Nishant Shah

Wednesday, February 20, 2013

The other day a patient came in wondering if he had the flu or just a cold, a pretty common question people have this time of year. He'd been dealing with a sore throat and nasal congestion for about two weeks. The persistence of his symptoms made him wonder if he was dealing with something more serious than a garden-variety cold.

After looking over his chart and asking him a few questions, it was clear he didn't have the flu.

The first clue was that he didn't have a fever. People with the flu typically have persistent fevers over 100 degrees. Essentially, the patient—a man in his mid-40s—was feeling alright except he was congested and had a sore throat. If he had the flu, he would probably have felt like he'd been hit with a ton of bricks and would have just wanted to crawl into bed.

Telling a cold apart from the flu can be tricky since many of the symptoms overlap. I tell my patients that, broadly speaking, a cold is annoying and slows you down, but the flu knocks you down for the count. Here are a few guidelines for determining whether you have the flu or a cold:

  • Fever: I said this before, but it's worth repeating. If you have a persistent fever of 100 degrees or higher, you could possibly have the flu and not a cold.
  • The flu comes on fast, escalating quickly within 24 hours from the onset of symptoms. Colds tend to build more slowly.
  • Muscle aches and soreness: Whole-body muscle aches and soreness are hallmarks of the flu.
  • Fatigue: If you have a cold you might feel a little lethargic, but the flu causes fatigue that can persist for days.
  • People with colds are more likely to have a runny or stuffy nose, although these symptoms are also sometimes associated with the flu.

If you think you may have the flu, you should consult your health provider about what to do. If you're an otherwise healthy adult, your doctor may just tell you to rest, drink lots of fluids and take over-the-counter pain medications. However, infants, the elderly and those who are already sick are vulnerable to suffering from flu-related complications such as pneumonia and a doctor may want to more aggressively treat those people and, in some cases, prescribe antiviral medication.

The most effective "treatment" for the flu is by not getting it in the first place. Getting a flu vaccine every year is your best defense against influenza. You can also avoid catching the flu by doing some of the same things you'd do to avoid catching a cold: Regularly washing your hands and covering your mouth when you cough, preferably by coughing into your elbow or a tissue.

This has been a particularly nasty flu season with influenza cases reaching epidemic proportions in the U.S. last month. Hopefully, we've seen the worst this season has to offer. The flu season typically peaks around February, although it can vary and we still need to remain vigilant. If you haven't gotten your flu shot yet, it's not too late to get vaccinated.

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Healthy Outlook is written by the professional staff of Contra Costa Health Services, the county health department. Send questions to series coordinator Dr. David Pepper at For more health information, go to
About the Author

Dr. Shah practices family medicine at Contra Costa Regional Medical Center & Health Centers.