Cold Case of the Year

Common Cold, Flu, Allergies, or COVID-19?

Farheen Khan (Get Well Clinic)


As the nights come earlier and the mornings become cooler, some of us have already started to experience sniffles, sneezing, and sore throats. Each year, as we start to feel the onset of these symptoms, we ask ourselves, “Do I have a cold, the flu or are my allergies just acting up again?” This year however, we have an additional candidate - a much more severe one too - to add to our list of potential diagnoses: the novel (or not so novel anymore) COVID-19.

This new coronavirus strain can cause severe illness in certain groups of people including the elderly population and individuals with underlying health conditions (i.e. heart disease, lung disease, diabetes, etc.) (CDC, 2020a). There is no cure or vaccine for COVID-19 at the moment, and thus social distancing and other preventative measures are extremely important to ensure its containment (WHO, 2020).


For the common cold, patients typically experience a gradual onset of symptoms (CDC, 2020b). 

The most common symptoms are: sneezing, runny or stuffy nose, and sore throat. Patients may have a mild cough, experience fatigue, or have aches and pains, but will rarely experience diarrhea, fever, headaches, or shortness of breath (CDC, 2020b).

Summary: COMMON COLD SYMPTOMS: Sneezing, Runny or Stuffy Nose, Sore Throat.


For the flu, patients experience an abrupt onset of symptoms (CDC, 2020b). Common symptoms include: fever (39-40°C, lasting 3-4 days), fatigue, cough (typically dry), aches and pains (often severe), headaches (can be severe), and diarrhea (in children). Sometimes, patients may also experience a runny or stuffy nose, a sore throat or sneezing (Goldman, 2020; Immunize Canada, n.d.).

Summary: COMMON FLU SYMPTOMS: Fever, Fatigue, Cough, Aches and Pain, Headache, Diarrhea


With COVID-19, symptoms can range from mild to severe depending on the individual and their pre-existing medical conditions (Government of Canada, 2020). Patients experiencing fever (> 37.8°C), cough, difficulty breathing, and/or loss of taste or smell must stay home, self-isolate, and get tested at their nearest assessment centre as soon as possible (City of Toronto, 2020). Other potential COVID-19 symptoms include: sore throat, stuffy/runny nose, headache, nausea/vomiting/diarrhea, fatigue, and muscle aches. If patients experience more than one of these symptoms, it is advised that they self-isolate and get tested as soon as possible (City of Toronto, 2020). Patients will rarely experience symptoms including confusion, runny nose, fainting, or skin manifestations (Government of Canada, 2020). In some cases however, individuals may not experience any of the above symptoms at all - they remain asymptomatic. It can take 5-14 days post-exposure for the symptoms to start appearing (Wolfson, 2020). 

Summary: MOST COMMON COVID-19 SYMPTOMS: Fever, Cough, Difficulty Breathing, Loss of Taste or Smell


As some symptoms tend to overlap between the 3 illnesses - especially those associated with the upper respiratory system - it is important for individuals experiencing any of the symptoms above to stay at home until they are fully recovered (CDC, 2020c).

If individuals think that they may have COVID-19, especially if they’ve been around someone who’s tested positive, it is important for the individual to get tested as soon as possible at their nearest assessment centre, after which they must self-isolate (Government of Canada, 2020). 

Feeling sick can be a stressful experience and the uncertainty associated with COVID-19 and its symptoms can definitely induce additional anxiety. However, if we all continue to wear our face masks, distance ourselves socially, wash our hands properly, get our flu-shots, and eat and rest well, we can surely prevent the onset and spread of such contagious illnesses.



Centers for Disease Control and Prevention (CDC). (2020, September 11). Older Adults.

World Health Organization (WHO). (2020, April 15). Coronavirus disease (COVID-19).

Centers for Disease Control and Prevention (CDC). (2020, August 31). Cold Versus Flu.

Goldman, R. (2020, September 9). Cold or Flu? How to Know Which One You Have. Healthline.

Immunize Canada. (n.d.).  Is It A Cold or Influenza? [Chart]. Retrieved November 10, 2020, from

Government of Canada. (2020, September 18). COVID-19 Signs, Symptoms, and Severity of Disease: A Clinician’s Guide.

City of Toronto. (2020, November 2). COVID-19 School Information for Parents & Caregivers.

Wolfson, A. R. (2020, May 15). Allergies? Common cold? Flu? Or COVID-19? Harvard Health Publishing.

Centers for Disease Control and Prevention (CDC). (2020, August 31). Stay Home When You Are Sick.


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Advil or Tylenol?

What should I take if I have a cold or flu?

Ava Kavianpour (Get Well Clinic)

Which should I take? Which is better? What’s the difference? These are questions you’ve probably asked yourself that led you to this article. In short, both relieve pain. The way they relieve pain and the type of pain they relieve is where these drugs differ.


Advil, also known as ibuprofen, is under a category of drugs called nonsteroidal anti-inflammatory drugs (NSAID), and they decrease inflammation. Advil reduces pain by reducing inflammation through blocking the chemical prostaglandin. Prostaglandins are chemicals produced by the body that cause inflammation. Through stopping inflammation, Advil also reduces fever.


Tylenol is a drug that is also known as an acetaminophen. There is little anti-inflammatory response, which is what makes it different from advil. Doctors are not sure how acetaminophen works though they think it increases your pain threshold so you feel less pain.

Which should you use?

For headache, common cold or fever it’s your preference. If you have a muscle ache or pulled/strained muscle it is recommended to use Advil because it an anti-inflammatory.


There has been recent news about Advil vs Tylenol when it comes to COVID-19. Currently, there is no scientific evidence that Advil (NSAID) will worsen symptoms of COVID-19. If you would like to read more about the this topic, read this article from Public Health Toronto.

Even before COVID-19, there were certain precautions regarding the use of NSAIDs like Advil that should still apply if you suffer from COVID-19. If you are at risk for stomach problems (like stomach ulcers, reflux, gastritis), or have kidney problems (such as those with diabetes, or chronic kidney disease), or have hypertension, you should consult with your doctor before using Advil because prolonged use could aggravate some of these conditions. If you become dehydrated (ie. not drinking enough water while you are sick), Advil could worsen the harm to your kidneys brought on by dehydration.

I still don't know what to do!

If you are feeling sick or have pain, book a virtual appointment on our website, send a message to the front desk to start or call us at 16-508-5691.

To message online click the bottom right “Click here to open or start the Chat now” box.



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How Does the COVID-19 Test Work?

Tenzen Gyaltsen (Get Well Clinic)


We’ve all seen the videos online. A gowned individual sticks a long cotton swab into the back of someone’s nose and twists it around for a few seconds. Their unfortunate victim winces with discomfort but is evidently fine once the swab is removed (although maybe a bit teary-eyed). But what happens to the swab and its mucosal contents and how do specialists distinguish a COVID-19-positive from a COVID-19-negative case? How accurate actually are these results?

Upon arrival to a testing lab, the contents of the swab will be extracted and subjected to a reverse transcription-polymerase chain reaction (RT-PCR) test. Firstly, the sample is subjected to a series of steps that removes unneeded molecules such as proteins and lipids so that only genetic material remains. In a COVID-19-positive patient, the remaining genetic material (called RNA) is likely made up mostly of the patient’s own RNA and, to a lesser extent, RNA from the COVID-19 virus.

The viral RNA must first be replicated, a process known as “amplification”, in order to be plentiful enough for detection. For amplification to occur, the RNA is converted to DNA using an enzyme (a handy biological molecule) called reverse transcriptase. The amplification process requires a number of biochemical reagents (ingredients), each aiding in amplification in different ways. Within this “master mix” of ingredients is found heat-resistant DNA polymerase, another enzyme, that is required to produce new copies of viral DNA from existing copies. In addition, dNTPs (nucleotides) are the building blocks of RNA and DNA, and must be added to the sample in order for DNA polymerase to build new DNA. Finally, specific DNA primers, genetic fragments that bind only to viral DNA, are added and serve as initiation sites at which DNA polymerase may operate. Of course, if no viral RNA/DNA are present (i.e. a COVID-19-negative patient), specific DNA primers will not bind and no amplification will occur.

Once the different reagents are added, the sample is placed within a PCR machine that facilitates amplification through a 3 step cycle: denaturation (strand separation), annealing (DNA primer binding) and extension (new DNA construction). Each of these steps occur optimally at a specific temperature which is maintained by the machine in order to properly replicate the viral DNA (if present). By adding a fluorescent (light-emitting) dye or probe that binds to the sample’s DNA, scientists can determine if viral DNA has been replicated based on levels of detected fluorescence. If a sample has greater fluorescence compared to a control (a sample with no viral DNA), it can then be said that the sample contains viral genetic material and that the patient is COVID-19-positive.

After visiting a designated Ontario testing centre, RT-PCR results should be posted online within approximately 2–4 days (this also includes emergency department visits). But how accurate are these results?

It goes without saying that while the world combats COVID-19, other diseases and medical conditions aren’t simply going to wait their own turn. If you would like to seek medical help from a doctor but are hesitant to visit a clinic in-person, please contact us (either through the online chat system or call us 416.508.5691) to book a virtual appointment!



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Is the COVID-19 Test Accurate?

Tenzin Gyaltsen (Get Well Clinic)


As Ontario transitions into Stage 3, the province’s COVID-19 testing capacity remains a crucial factor for the speed at which we reopen. Recent numbers may seem promising, coming in at the lowest we’ve seen in months, but how accurate actually are these results? In a recent study by researchers at Johns Hopkins University, COVID-19 test results were shown to be alarmingly inaccurate, particularly in the case of false negatives.

A false negative is defined as a test that comes out negative, but should have been positive. In the case of COVID-19, a false negative refers to a patient that tests negative for their RT-PCR test (Link), but actually does have the virus. It’s easy to imagine why false negative cases are especially dangerous, as sick individuals may feel free to operate and go about their business as they usually do, increasing the risk of community spread.

In the study by Kucirka et al., the probability of a false negative result varied widely, but depended largely on the amount of time after initial exposure that the test was taken. The false negative rate was reported as 100% at the moment of exposure (or Day 0), which may seem drastic but makes sense given the limitations of the test (Link). At this point, the virus would have virtually no time to replicate and so the chances of any viral genetic material being picked up by a cotton swab are little to none. As the days progressed and symptoms developed (around Day 5), the false negative rate decreased to a minimum of 20% (Day 8). Interestingly, after Day 8, the false negative rate began to increase steadily, from 21% on Day 9 to 66% on Day 21. Like the early days of the disease, these high numbers may also be due to the decreased presence of viral genetic material during the patient’s recovery phase.

It goes without saying that every study has its own limitations, but the numbers presented in this particular study warrant concern. If we’re to safely continue reopening the province, we should be confident in our testing capability and accuracy, but these findings suggest that the ubiquitous RT-PCR (cotton swab) test may not be enough. It’s not all bad news though. Using the data collected from this study (and similar studies), we may gain a better understanding of when the best time to test patients actually is (i.e. when the false-negative rate is the lowest). From the data presented, it seems like that optimal window is about 2–4 days after symptoms first appear.

There are a number of things we can we take away from this study. The foremost is that the false-negative rate of COVID-19 tests is much higher than one might think, which may lead to an underestimation of the actual number of total cases. If you are feeling sick and receive a negative test result, do not treat it as a definitive answer. Continue to self-isolate to keep the people closest to you safe, and seek medical guidance before taking further steps. If you’re hesitant or unable to to visit a clinic in-person, please contact us (either through the online chat system or call 416.508.5691) to book a virtual appointment!


Kucirka LM, et al. (2020) Variation in false-negative rate of reverse transcriptase polymerase chain reaction-based SARS-CoV-2 tests by time since exposure. Ann Intern Med.



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Online COVID-19 Assessment


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649 Sheppard Ave West
Toronto, ON, M3H 2S4
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