Perhaps because she was vaccinated and boosted, her initial symptoms were relatively mild — a slight cough and scratchy throat. “Then, almost overnight, I developed a dry, painful cough that got progressively worse,” says Searight. It got so bad that her internist gave her a prescription for a cough suppressant with codeine so she could sleep. For four days, she was knocked out by a sore throat that became severe, headache, and that hacking cough. Weeks later, “I’m still coughing intermittently at night,” she says. A cough can be a hallmark of many conditions such as a cold, the flu, pneumonia, undiagnosed asthma, lung disease like COPD, even postnasal drip and acid reflux, says Donna Klitzman, MD, a pulmonary and critical care physician at Pulmonary Intensive Care Specialists of New Jersey in East Brunswick. “Not only does coughing disrupt sleep, but it makes it difficult to go out in public, because everyone thinks you have COVID-19,” Dr Klitzman adds. What if everyone’s right? The cough tends to come on quickly, says Dr. Checkley, beginning about a day or so after the onset of illness, but it doesn’t typically subside quickly, especially for people who aren’t vaccinated. An April 2021 study in The Lancet Respiratory Medicine found that cough lasts an average of 19 days for most people with COVID-19 and up to four weeks in about 5 percent of patients. Some people with long COVID might find themselves coughing for months, “but we need to get more and better data to really understand the numbers,” says Checkley.
The COVID-19 Cough and Omicron
With the arrival of omicron even more of us are coughing: An investigation out of Norway published in December 2021 in the journal Eurosurveillance, looking at a group of mostly vaccinated people who became infected by omicron at a company Christmas party, found that 83 percent reported having a cough. Omicron appears to replicate rapidly in the bronchi, the two large tubes that bring air from the windpipe to the lungs. A December 2021 study from the LKS Faculty of Medicine at The University of Hong Kong (which has not yet been peer-reviewed) reported that omicron multiplies in the airways 70 times faster than delta and the original virus. Yet the researchers found that omicron does not infect the lungs as much as earlier variants do, suggesting that it is less likely to cause severe disease. RELATED: Is It a Cold, the Flu, or COVID-19?
Is a COVID-19 Cough Different From Other Kinds of Coughs?
Ubiquitous as it may be, a COVID-19 cough is not unique. “A COVID-19 cough is similar to the cough produced from other viral or bacterial pneumonias,” says Checkley. Klitzman agrees that you can’t diagnose a patient just by listening to them cough. She says, “I’ve had patients who come in with severe symptoms and coughing, and when you test them, they have a rhinovirus,” the main cause of the common cold. But for people who land in the hospital with COVID-19 — and these days, that usually means patients who have not been vaccinated — a painful, dry cough accompanied by lower-than-normal oxygen levels (hypoxia) is a sign of trouble. “Hospitalized COVID-19 patients just can’t take a deep breath without coughing,” Klitzman observes.
What Causes Coughing
As unsettling as it is to deal with any kind of cough, this protective reflex is necessary for bouncing back from an infection. “You don’t want to suppress coughing too much because if there are secretions, like mucus, you have to be able to clear them out,” says Klitzman. “The major reason older people with pneumonia die is that they decline and become too weak to even cough and clear their lungs.” All of us have sensory nerves in the epithelium, the thin layer of tissue that forms the outer lining of body parts ranging from the eardrums, heart, and stomach to the larynx (voice box), trachea (windpipe), and bronchi, explains Checkley. Normally, when sensory nerves detect a virus or other foreign invader, they activate cough sensors in the medulla region of the brain, which in turn trigger the muscles around the respiratory tract to eject the unwanted visitor. “But it’s also possible that the COVID-19 virus may directly or indirectly target the sensory nerves themselves, as a part of the infection,” says Checkley, adding that this theory needs further study.
How to Prevent Coughs From Spreading the Coronavirus
As most of us know by now, it’s crucial to cover a COVID-19 cough with a face mask, a tissue, or a bent elbow to reduce the spread of infectious respiratory droplets and aerosols. A January 2022 report in the physics journal AIP Advances that studied how droplets are dispersed via coughing also recommends lowering your head to reduce the risk of transmitting COVID-19 to others. If your cough hangs on even after you’re past the worse of the acute infection, could you still be spreading COVID-19? “The risk of transmissibility drops significantly after 10 days,” says Checkley. “But while you don’t have to stay isolated at home if you’re coughing, it’s prudent — and polite — to continue wearing a mask and to social distance.”
How to Calm That Cough Down
Fortunately, there are things you can do to treat a cough while you recover from COVID-19 at home. “It can help to elevate yourself when sleeping by slipping a wedge under your pillow,” says Klitzman. She adds, “Over-the-counter cough suppressants — antitussives — taken before bed can be very helpful. So can cough suppressants with codeine. They make you sleepy, so are good to use at night, but you don’t want to become reliant on that.” For Searight, who is off prescription cough medicine, drinking lots of herbal tea and taking lozenges help, she says. Be sure to let your physician know if you have a cough that won’t quit or another stubborn COVID-19 issue. “This can affect your quality of life,” says Klitzman. Klitzman also points out that the best way to ease a symptom of any illness is to treat the underlying disease. If you have mild or moderate COVID-19 and are at high risk for becoming severely ill, antiviral pills and certain monoclonal antibody infusions may help you heal — and that means less coughing.
