Marek Kohn

Nasal Gazing


This article first appeared in the 'Big Tissue' special issue of the London Big Issue, 12 January 2004.


It's just a cold. A common cold, the commonest malady of all. Here we go again, twice to half a dozen times a year for most adults, more like ten for children. Medicines come and therapies go, but the cold is always with us. Just a cold, yet not just an illness, but a tradition; a part of our heritage, like tea-breaks and queuing. An unmistakably old-fashioned aura surrounds the cold, which has resolutely defied all pressure to succumb to medical progress.

The NHS caught the note with the poster you may see in your GP's surgery, insisting, in the face of a belief deeply held by many patients, that 'Antibiotics Don't Work On Colds'. Featuring a capsule with face and limbs, refusing to approach a large, red and dripping nose, it is executed in a pastiche of 1940s public information posters. In the same moral tone with which wartime propaganda exhorted the public not to waste resources and feed the 'squanderbugs', it stoutly maintains that "plenty of liquid and plenty of rest" is the best treatment. In a concession to a generation that wears trainers, not hobnail boots, it adds that "you can usually take something to ease the symptoms". But that is up to you. The NHS is concerned with what you need, not what you want. Through the chilly corridors the ghostly matron glides, intoning the old injunction, 'What cannot be cured must be endured'.

There may not be much to endure. A cold may get no further than a few sneezes as a new knot of viruses arrive, before all goes quiet as the immune system recognises familiar viral faces and deals with them, using antibodies it raised when it encountered the same strains previously. The longer we plough through life, the more varieties of cold virus we encounter, and so - here we go again, sighs the immune system - the more frequently we can produce the right antibodies to see off a new infection. That's why adults get fewer colds than children.

If a cold does get a grip, the disturbance is usually confined to the nose and throat. Sneezes, drips, coughs and local aches are the usual attendant discomforts. But sometimes discomfort escalates into minor misery, including fever and aches in muscles. When those symptoms appear, the distinction between colds and flu breaks down. As far as the patient is concerned, a bad cold is no better than a moderate dose of flu, and no different from it either. Even for the virologist, the distinction is blurred. According to the website of Cardiff University's Common Cold Centre, up to 15 per cent of colds are caused by influenza viruses. The largest proportion, up to half, are caused by rhinoviruses ('rhino' meaning nose); the balance is made up by assorted coronaviruses, adenoviruses and others. A cold is the body's general reaction to a range of viruses that infect the nose. You may as well define it yourself.

And that is what people are generally required to do. Since colds generally don't last as long as it takes to get a doctor's appointment, sufferers have only their own word to convince their employers that they should be at home. But the cold, like the tea-break, doesn't fit into the modern way of work. Sick-days are subject to quotas; employees are supposed to have a damn good reason for taking time off; swallow a capsule with your espresso on the train and get to your desk. The result is diagnosis inflation. If you take to bed with a cold, you upgrade it to flu. Say you've got a cold, and see how much sympathy you get. The common cold has become one of those diseases it's embarrassing to have.

Once upon a time, a sense of duty actually encouraged people to catch colds. Round about the dawn of the NHS, after the Second World War, the Common Cold Unit was set up in a collection of huts near Salisbury. For many of the volunteers who came to stay and be inoculated with cold germs, it was something of a selfless act, in the National Health spirit, like giving blood. But as a former CCU head of research, David Tyrrell, recounts in his book Cold Wars (with Michael Fielder, Oxford University Press) the spartan conditions were rather comfortable by the standards of the time. It compared rather well with the other holiday opportunities that were available to most people.

The CCU closed in 1990, having found out plenty about what causes colds, but no nearer a cure. Treating viral infections remains difficult; treating an illness caused by a couple of hundred viral varieties is a very tall order. Antibiotics, it's worth repeating, have no effect on viruses. New antiviral drugs are entering the market, but applying them to the host of viruses that cause colds might well be the quickest possible way of rendering them ineffective. As is happening with antibiotics, they would confound themselves by clearing the field for varieties resistant to them. Colds only rarely lead to really serious illness, among the old and the very young, and they generally clear up within a week. So there's a strong case for leaving them to our natural defences.

The collective medical mind isn't even made up about remedies that might take the edge off the wretchedness as our immune systems go through their motions. Decades after the eminent chemist Linus Pauling proclaimed that the common cold could be defeated by industrial quantities of vitamin C, the possible effectiveness of the vitamin is still unclear. According to a review conducted by a body called the Cochrane Collaboration, medical studies suggest that largish doses of vitamin C will not prevent colds, but may shorten a cold by half a day or so. Other Cochrane Reviews give a fairly positive 'maybe' to the herbal remedy Echinacea, report an inconclusively mixed bag of results from inhaling steam, and deliver a guarded verdict on zinc lozenges. Until all the further research they call for is done, the cold will remain essentially individual property. We are free to urge upon friends and family whatever remedy we have taken to our hearts.

Avoiding infection is not an option. The Common Cold Unit required that its volunteers keep 30 feet (10m) away from other people. You get a cold by inhaling a droplet of virus-loaded mucus that somebody else has expelled in a cough or sneeze (or perhaps by rubbing your eyes with dirty hands - the germs slip down into the nose). If the viruses were to arrange the world for their benefit, they could hardly do better than modern cities, and the metal tubes into which people are packed for transit between them. Wash your hands, cover your mouth when you sneeze: colds demand good old-fashioned hygiene, and good old-fashioned manners.

There is, however, a less obvious old-fashioned moral to be drawn from the common cold. We are used to thinking of infection as a mechanical process, governed by the density of crowds and the force of sneezes, but it is also a social process. Being thrust together with other people, in a bus or a crowded street, is a good way to catch a cold, but being involved with other people, in a family or a workplace or a club or a group of friends, is an excellent way to keep colds at bay.

In studies that may have major implications for our understanding of health and well-being, Sheldon Cohen, an American researcher, has investigated how feelings influence colds. Cohen has found that people are more likely to catch colds if they are undergoing stress that has lasted for a month or more, probably because stress generates a flow of steroid hormones that stifle the immune system. Stress related to work, especially lack of it, made colds five times more likely, while stress in marriages or other relationships brought about a threefold increase in colds. Money troubles in themselves seemed to have no effect on nasal infections.

Cohen also found that introverts were two and a half times more prone to colds than extraverts, that a similarly elevated risk was run by people who don't get enough sleep, and that smokers were three times as likely to catch colds as non-smokers. On the other side of the coin, the more 'social roles' his volunteers had, the less likely they were to catch a cold. Somebody who has half a dozen ongoing involvements, with family, friends or associates, is four times more likely to stave off cold viruses than somebody who is only involved in two or three such roles.

It seems as though the more that people feel themselves connected, warmly and voluntarily, to others, the less stressed they feel, and the more healthy they are. They feel instinctively that there are enough threads in their net to support them. Prevention, so much better than cure, lies in old-fashioned qualities; affinity, community, solidarity. A cold is a lonely disease of crowds.