Seasonal viruses: when will it stop?
My Viral Season Playbook: How I Help Families and Busy Professionals Get Through Winter
Flu season is rough this year! The CDC reports 18 million illnesses, 230,000 hospitalizations and 9,300 deaths from flu so far this season.
Every winter, my inbox fills with the same themes:
“Is this just a cold or something serious?”
“Do we need Tamiflu?”
“What can we actually do to prevent this from sweeping through the whole house?”
We now have better tools than we did five years ago—antivirals, smarter nasal strategies, and reasonable evidence on a few supplements. We also have a lot of noise.
Here’s the playbook I use in my practice for families and high-performing adults:
Prevention and “front door” defenses
Early testing and when I pull the trigger on antivirals
What I tell people about supplements
My home kit
Education only, not personal medical advice. Decisions for you or your family should always be made with your own clinician.
Prevention: vaccines, noses, and the home “environment”
Vaccines: the boring but very high-yield base
I still start here, briefly:
Flu vaccine each season, especially for kids, adults over 50, pregnant people, and anyone with heart, lung, or metabolic disease.
A recent mRNA flu vaccine looked very effective and offers greater seasonable flexibility relative to the current egg-incubated vaccines that must be strain-selected months in advance.
Updated COVID vaccine for similar groups; data continue to show lower risk of severe disease and hospitalization in higher-risk adults though diminishing returns of boosters relative to seasonal influenza vaccine.
RSV: New in 2023, there is now an effective vaccine for adults ≥60 and others with select risk factors
Once that base is covered, we get into the more interesting, day-to-day tools.
Noses matter: saline and antihistamine sprays
Hypertonic saline in kids: small intervention, decent payoff
A large randomized trial (ELVIS Kids) in children <7 with early cold symptoms found that hypertonic saline nasal drops shortened cold duration by about two days and reduced onward transmission to family members compared with usual care.
Earlier adult pilot work with hypertonic saline nasal irrigation and gargling also suggested shorter symptom duration and lower viral shedding.
How I use this:
For young kids with colds: Simple saline or hypertonic saline nose drops as part of supportive care, especially if parents are motivated. The downside is low; the upside is a slightly shorter illness and less spread.
For adults: I describe the evidence as promising but not magical—worth trying for people who tolerate nasal irrigation and want to do “something” beyond medications.
I frame saline as a mechanical rinse, not a cure: it can help clear mucus, lower viral load locally, and make you more comfortable.
Intranasal antihistamine (azelastine) and COVID: promising but not standard
A mid-stage randomized trial of azelastine nasal spray (a common allergy medication) used 2–3 times daily for 8 weeks found:
PCR-confirmed COVID infections in 2.2% of the azelastine group vs 6.7% in the placebo group (OR ~0.31), and
Fewer rhinovirus infections and respiratory symptoms overall.
Mechanistically, azelastine appears to have antiviral effects beyond histamine blockade in cell and animal models.
How I talk about it:
I describe it as early, interesting data: for a patient already using azelastine for allergies, I’m happy that it might confer a bit of extra protection, but I don’t prescribe it solely for COVID prophylaxis yet.
It does not replace vaccines or common-sense measures (ventilation, vaccination, etc.).
Quick home “environment” wins
These sound simple, but they matter:
Ventilation: crack windows when possible, small HEPA purifier in bedrooms or shared spaces.
Hand hygiene around meals and when coming home.
Testing and antivirals: when it’s worth moving fast
This is where timing really matters.
When I actually test
At home or clinic, I’m more likely to test when:
The patient is high risk (age, comorbidities), and
They are within the antiviral window, and/or
The result will change behavior (return to work/school, protect a high-risk household member, etc.).
At home, I tell families:
Use rapid COVID/Flu tests when someone has compatible symptoms and exposure or when there’s a high-risk contact.
Don’t run 10 tests for every sniffle; use them strategically in the first 1-2 days of illness.
Antivirals for influenza: what they actually do
Treatment
Meta-analyses of randomized trials show that oseltamivir (Tamiflu) started within 48 hours of symptom onset:
Shortens symptom duration by roughly 17–25 hours in otherwise healthy outpatients,
Reduces lower respiratory complications requiring antibiotics, and
May reduce hospitalization in higher-risk adults.
The key message I give patients:
“If you’re high-risk or very sick and we can start within the first 1–2 days, antivirals are worth serious consideration. For a healthy 25-year-old on day 4 of symptoms, the benefit is much smaller.”
Baloxavir (Xofluza), a single-dose antiviral, is an alternative for uncomplicated outpatient flu; one trial showed greater efficacy than oseltamivir in influenza B but other trials showed comparable results for other strains.
So in practice:
For higher-risk adults and teens within 48 hours: oseltamivir or baloxavir depending on flu type, drug interactions, and pregnancy status.
For late presenters or very low-risk patients: I explain the limited benefit and often lean toward good supportive care unless there are risk-amplifying factors in the household.
Post-exposure prophylaxis (PEP) for flu
We actually have good data here:
A classic family-cluster RCT showed that oseltamivir 75 mg daily for 7 days in household contacts started within 48 hours of exposure reduced symptomatic lab-confirmed influenza by roughly 80–90% vs placebo.
In my practice, I consider PEP when:
There is a confirmed flu case in the home, and
A household contact is high risk for complications (older adult, immunocompromised, significant heart/lung disease, very young infant, etc).
I’m more cautious about blanket prophylaxis for every healthy family member: the benefit is real, but so are costs, pill burdens, and potential side effects.
What about COVID antivirals?
Nirmatrelvir/ritonavir (Paxlovid) still has the strongest data for reducing hospitalization and death in high-risk adults when started early, though effect sizes are smaller in highly vaccinated, lower-risk populations.
I use it for older and higher-risk patients; I’m more selective in younger, vaccinated, otherwise healthy adults. It appears rebound is more common in patients treated with Paxlovid.
The general principle is the same as flu: short window, biggest payoff in higher-risk patients.
Supplements: what I actually say when people ask
I get some version of “What about vitamin ___ ?” nearly every winter visit. Here’s my honest synthesis right now.
Vitamin C
Large Cochrane-type reviews show that routine vitamin C does not prevent colds in the general population, but regular supplementation modestly shortens cold duration (on the order of ~10%) and may reduce severity.
“Treatment-only” trials (starting vitamin C after symptoms begin) are less convincing.
My take: “If you want to take vitamin C during winter at reasonable doses, it’s safe and may shave a bit off duration or severity, but it’s not a force field. I don’t see a strong case for megadoses.”
Zinc lozenges
Meta-analyses of high-dose zinc lozenges (>75 mg/day elemental zinc) show a ~30–40% reduction in cold duration in some trials, especially when started early, but results are heterogeneous and sensitive to formulation.
One study showed intranasal zinc caused anosmia (loss of smell) in some!
What I say: “Zinc lozenges can be reasonable if you start them at the very first signs of a cold, stick to high-dose regimens briefly, and accept that they may not help and don’t use intranasal!”
Vitamin D
Large meta-analyses including new trials show little to no overall effect on infection incidence in largely vitamin-D-replete populations, though vitamin D remains important for bone health.
Elderberry
A small meta-analysis of randomized trials suggests standardized elderberry extract can reduce duration and severity of upper respiratory symptoms, particularly in influenza, but not clearly prevent infections. Total participant numbers are modest and study quality varies.
My message: “If you like elderberry and use a reputable product at labeled doses, it may slightly shorten symptoms once you’re sick.”
My overall take on supplements:
Worth considering (with realistic expectations): vitamin C, zinc lozenges (short-term), elderberry.
Not a substitute for vaccines, antivirals in the right person, or staying home when you’re truly sick.
My Viral Season Home Kit (What I like families to have ready)
Viral Season Kit
Thermometer (oral, not forehead/ear)
Acetaminophen and ibuprofen
A few COVID/Flu rapid tests
Simple saline or hypertonic saline nasal drops/spray
Oral rehydration solution or electrolyte packets
A small supply of high-filtration masks for higher-risk visits or if someone in the house is vulnerable
(For select situations, we also talk about having pre-arranged access to antivirals so we don’t waste the early window.)
For my own patients, the goal of this playbook isn’t to chase every sniffle. It’s to:
Use powerful tools where they clearly help (vaccines, antivirals, selected prophylaxis).
Layer in low-risk adjuncts like hypertonic saline and, for some, evidence-informed supplements.
Have a clear plan at home for when someone gets sick at 10 p.m. on a Sunday.
Avoid the two extremes: “do nothing and hope for the best” vs “throw ten unproven interventions at every cold.”
