Family Medicine and COVID-19: Mucous Is the State Bird

"Mucous is the State Bird in Ohio"  I say that to a lot of people in my practice and in some of my holistic health presentations.  A normal adult head makes 2 liters of mucous daily, for many purposes.  Everyone in Ohio seems to have mucous generating allergies at one time of the year or another (or year round for many).  Why are we concerned?

COVID-19

We have to differentiate usual allergic mucous from infectious mucous and further sort out which of the infectious mucous might be a COVID-19 mucous.  One might think that people can tell if they're infected instead of "just" allergic, or COVID-19 instead of "just" a cold.  Unfortunately, it's not that easy.  A lot depends on how individuals sense and know themselves.  That's a challenge that is important as individuals have respiratory symptome, but go to Dot's Market or Kroger or Elsa's Restaurant or schedule an appointment with their Family Physician for their blood pressure or diabetic check-up.  Which mucous might be problematic in those venues?

If the patient is sensitive to what their mucous is saying, it helps a lot.  Many people are too stressed to notice anything about their mucous unless asked about it.  Sometimes it takes several questions from their physician to clarify that they even have extra mucous.  That's why so many medical visits have been shifted to video or phone visits.  They decrease the risk of spreading contagious infections, including, and especially, the COVID-19 infection

Many people sneeze, snort and blow their nose a lot is certain seasons and/or settings due to their allergies.  Many people also have those same symptoms as part of a respiratory infection.

Fever, aching all over, discolored mucous (e.g., green with living microbes or yellow caused by dead microbes) shakes, or chills are indications of infection- but not early in many respiratory infections.  So how do we sort out the people who may have the newest Corona virus, now known as COVID-19?

Usually, we don't sort well since evidence is mounting that millions of people have had the virus already.  The fact that we have over 100,000 deaths related to the virus so far makes us continue to be nervous about this particular microbe.  The statistics people will have to sort out the levels of certainty about the cause of death and the impact of the COVID-19 on life, death and the economy as we move ahead.  They have developed a good idea about who is most vulnerable to succumb to the infection, therefore also have some insights about strategies to protect the most vulnerable populations.  Each state/governor gets to make decisions and policies that apply this knowledge to their citizens.

What about your mucous or your children or your great grandmother in the nursing home?  Initially, notice that you have the mucous by increasing awareness to your "increased mucous"behavior.  Are you using more tissues, antihistamines, vitamins or supplements as you sneeze and cough more?  If you  notice it, look at it in the tissue that you coughed or blew your nose in.  Is it thin or thick?  What color is it (clear, green, brown, tan, yellow)?  If it's green, orange, tan or yellow- that usually means infection (some people with asthma, chronic obstructive pulmonary disease, chronic bronchitis may not have an acute or contagious infection in spite of varying color of sputum- but that's another story).

If your mucous implies infection, you may wish to take your temperature.  If it's 100.4 or above, that's an official fever.  If it seems to be one or more degrees higher than your "usual" (98.6 is just a line on a thermometer- not "normal"- your temperature varies by 1 degree Fahrenheit each 24 hour day).  Many businesses are taking daily temperatures on employees as a screen for undetected infection.  Medical professionals take their temperature daily.  People are often insensitive to a temperature elevation, so it pays to get an understanding about your temperature.  We now have the "scan the forehead" device (not as accurate as a thermometer type device, but there's no mucous involved).

If your mucous changes and/or you have a temperature elevation, reflect on your contacts.  Is anyone you know coughing or sneezing or blowing their nose?  If so, is it more than their usual levels of these behaviors?  Is anyone you know ill, missing work for illness, quarantined, taking antibiotics, going to urgent care or emergency rooms, just discharged from the hospital with pneumonia, just discharged from the hospital for any reason, working in a medical office, nursing home, assisted living, hospital or other high risk job/environment?  Are you exposed to young children such as your kids or grandchildren who may have respiratory signs or symptoms?

Are you infected?  Contagious?  Endangered?  A threat to others?  Just allergic to Ohio or the state where you live?

In a place such as Ohio where I live, where "mucous is the state bird", it's difficult to sort out the usual mucous from the potentially contagious mucous.  Together, we can become mucous sleuths and stay a bit safer.