How to prevent and treat colds, the flu, Covid-19, and more.
Does it feel like everyone you know is sick right now? It’s not your imagination: It’s been a particularly fierce season for all kinds of respiratory infections, from mild colds to more serious bugs.
According to the Centers for Disease Control and Prevention (CDC), health care visits for coughs and sore throats with fever were “above baseline” for the eighth consecutive week by the end of December. Hospital admissions for flu, RSV, and Covid-19 are ticking up ahead of schedule.
The increase isn’t itself atypical. “Pre-Covid, we always saw a surge of hospitalized patients in this winter time period, especially after New Years,” said Dhaval Desai, who oversees hospital medicine at Emory University’s St. Joseph’s Hospital in Atlanta. But compared to five years ago, “we are at a more intense spot from a respiratory illness standpoint,” he said.
It’s not entirely clear why this particular season is so gnarly. Although the CDC focuses its tracking on the viruses most likely to cause severe illness and death — Covid-19, flu, and RSV — lots of other germs with less name recognition are landing people in the hospital.
A broader age group is turning up very sick, too. In addition to the usual severe illness in people with chronic conditions, who are typically more vulnerable to bad outcomes, Desai said, “we’re also seeing those that may be younger or middle-aged who really don’t have any other major contributors to their medical history, but are coming in really sick, from whether it’s the flu, RSV, or some of the other common viruses.”
If you’re one of those fortunate people who’s not yet gotten sick, there are ways to reduce your risk, most of which will be especially familiar after living through the pandemic. If you are sick, there are ways to lower the chances you’ll spread your ick to people around you — and ways to feel better faster.
Why are so many people sick right now?
This isn’t the first weird cold and flu season in recent memory: Every respiratory virus season since Covid-19 came on the scene has been strange in one way or another. During the years when many people were taking precautions to avoid the coronavirus, rates of most other germs that cause respiratory illness hit historic lows. When those precautions stopped, lower population-wide levels of short-term immunity to those germs led to broader transmission than usual.
Many experts caution we haven’t yet reached a “steady state” as far as cold and flu season goes. “I don’t actually think we know what sort of the ‘normal’ is post-pandemic yet,” said Richard Webby, an influenza researcher at St. Jude Children’s Research Hospital.
It does seem that at least for a while, seasonal respiratory illness rates will stay higher compared with pre-pandemic years. That’s due to the simple fact that Covid-19 continues to cause a lot of additional illnesses, both during cold and flu season and during other times of the year. So far this season, Covid-19 has led about 60 out of every 100,000 Americans to be hospitalized — more than both flu and RSV combined. Older adults are at particular risk for hospitalization due to the virus, but so are infants under 6 months old — a risk many people seem unaware of, said Brendan Jackson, a respiratory virus expert at the CDC.
On top of that, the viruses that were considered the heaviest hitters before Covid-19 came on the scene — flu and RSV — made their debuts earlier than usual this season. According to the latest estimates, hospitalizations for both viruses are two to three times higher than at the same time point pre-pandemic, and doctor visits for cold and flu symptoms are also much higher than usual for this time of year.
Desai wonders if this season’s severity has to do with a particularly ugly flu virus this year: He’s noted unusually high levels of inflammation in flu patients he’s been caring for. Jackson said low vaccination rates for both flu and Covid-19, especially among older and chronically ill people who are at highest risk for complications from these infections, aren’t helping.
This doesn’t necessarily mean that once the season is over, more people will have gotten sick than in a typical pre-pandemic season. It depends on the quirks of each particular pathogen: Last year, flu season started with an early and astonishing bang, but also ended pretty quickly, without leading to lots of excess hospitalizations. Meanwhile, RSV’s early peak caused a record-breaking number of severe illnesses.
Jackson also noted that while Covid-19 is causing a substantial number of emergency room visits and hospitalizations this year, these numbers are still over 30 percent lower than last year — even as test positivity and wastewater data suggest that actual infections are about 25 percent higher. These trends suggest a phenomenon of “decoupling” infections from severe disease: “As we gain more immunity over time, from vaccines and from previous infections, each infection is less likely to result in severe disease,” he said.
If you’re feeling well, here’s what can help keep it that way
Vaccination is the single best way to boost immunity to the worst of the circulating nasties.
Everyone over 6 months old is eligible for flu and Covid-19 vaccines, and getting vaccinated for these viruses during pregnancy is one of the best ways to protect newborns from severe illness. RSV vaccination is also recommended for pregnant people, newborns, and adults 65 and over. (The newborn formulation is technically an antibody infusion rather than a true vaccine, but the protective effects are the same.) Although September or October was prime time for getting these vaccines, there’s still a lot to gain from getting them now: Protection kicks in a couple of weeks after you get the vaccines, and transmission will likely still be going on.
Other measures will sound familiar to most people: “handwashing, masking, and distancing — those are the big three,” said Desai. Cleaning your hands before touching your face or preparing food, and after touching shared surfaces or using the bathroom, is a key way to reduce the likelihood that any germs on your hands make it into your nose or mouth. Masking is particularly effective for preventing transmission through the air, which is more likely to happen in crowded places, and in the case of the especially transmissible Covid-19 infection; a surgical mask offers a lot of protection, although if you’re really worried about Covid-19, an N95 or KN95 is best.
Ventilation is also a powerful tool for preventing viral transmission, said Jackson. He recommends opening windows and turning on fans if the space and climate you’re in allow. “That can really make a difference, especially in a crowded space,” he said. He also recommends considering a portable air purifier for use if you’re gathering with others at home.
People with chronic illnesses are more likely to have severe outcomes from even plain old colds, said Desai. To minimize their risk, he recommends ensuring symptoms are as controlled as possible throughout the season. He uses the analogy of a tightrope: It’s easier to get knocked off by a cold — and harder to get back on afterward — if you have a chronic illness. So if you have asthma, have enough inhalers on hand and use them as prescribed; if you have diabetes, make sure your blood sugar levels are controlled.
If you get sick, here’s what to do
Testing
When you do get sick, it’s important to rule certain infections out — but most people don’t need to undertake extensive laboratory testing.
“We are never wrong to take a Covid test to start with,” said Desai. If your first at-home test is negative, you’ll want to test again 48 hours later for the most accurate results; you can order free tests from the US government at the Covid.gov website.
If Covid-19 isn’t the culprit, it’s smart to visit a health care provider to get tested for the flu. That’s especially true if you plan to be around lots of other people, you live with people who have weaker immune systems (including babies and older adults), or you have persistent or severe symptoms (like shortness of breath, or more than three days of fever). A confirmed flu test may make you eligible to take the antiviral medication oseltamivir, which can reduce symptom severity and get you feeling better sooner; some of your more vulnerable close contacts might also benefit from taking the medication as prevention.
Treatment
Just as there is antiviral treatment for the flu, there is also prescription medication to help treat Covid-19. If you get diagnosed with Covid-19, check with a health care provider or a pharmacist about whether it makes sense to take Paxlovid. It’s a lifesaving drug that’s still broadly underused, especially in older people whose lives it’s most likely to save. Many pharmacies can prescribe the drug without a separate health care visit, so check with your local drugstore if that’s an option for you.
Regardless of which virus is causing your illness, rest and hydration are among the most important treatments. Sleep boosts immune function, and drinking plenty of fluids (including at least some that contain salt and sugar, like electrolyte-rich sports drinks, juices, and broth) helps reduce the risk of dehydration while you’re sweating it out.
Over-the-counter fever controllers like acetaminophen (brand name Tylenol or generic will do) and ibuprofen (brand names include Motrin and Advil) can also provide a lot of relief, and importantly, enable you to get the rest you need. If you’re very congested, pseudoephedrine (often sold under the brand name Sudafed) is the only decongestant worth reaching for. A lot of people also get relief from nasal irrigation — but make sure you follow the package directions to avoid other infection risks.
There’s a dizzying array of cough medicines on pharmacy shelves that claim to make the hacking stop, or at least to make coughing more effective at clearing out respiratory gunk. While most of these medications won’t hurt adults, review studies have found little evidence to suggest they help — and they can be dangerous to young children. However, there is evidence that a couple teaspoons of honey reduces nighttime coughing, making it a safer and more cost-effective choice for most people (note that honey is not safe for babies less than a year old).
It may also help reduce nighttime cough and congestion to sleep propped up on lots of pillows, or even to elevate the head of your bed by putting a brick or cinder block under the top legs.
Reducing spread
A lot of the measures we can take to keep from spreading our germs are the same as those we take to keep from catching others’.
If you’re sick, the best way to keep from spreading your infection is to stay home. If you do have to be around others, mask up (a surgical mask is fine, although an N95 or KN95 is better if you have Covid-19). Make a habit of coughing into your sleeve, and wash your hands frequently, but especially after blowing your nose or coughing into your hands.
When to see a health care professional
Most respiratory infections start to get better after a few days. Signs that things are going in the right direction include receding fevers (typically after two or three days), decreased snot production (usually within five to seven days), and improving cough (although a dry, irritative cough can hang around for weeks after a nasty cold, the worst of it should be over within a week).
If things don’t get better in that time frame, it might be time to get professional help. See a health care provider — whether it be your primary care physician, or someone at your neighborhood urgent care clinic — if you have a fever that lasts for more than three days, or if you have severe symptoms like shortness of breath, a throat so sore you can’t stay hydrated, persistent dizziness, or trouble getting out of bed. If you have anything else going on that feels atypical or concerning to you, check in with a provider to determine whether it’s something that needs more than the usual home care.
Iraq’s prime minister called for an end to US presence after a drone strike killed a senior militia leader.
Iraqi Prime Minister Mohammed Shia al-Sudani announced Friday he will remove about 900 US-led coalition forces from his country, saying that “the justifications for its existence” — the threat of the Islamic State, or ISIS — “have ended.”
Al-Sudani announced that he would put together a “bilateral committee,” which includes members of the coalition forces, charged with ending their presence in the country, Reuters reported Friday. But it’s not clear that al-Sudani and the Iran-linked political blocs crucial to his appointment as prime minister will actually be able to push coalition forces out, though it may succeed in limiting their ability to operate in the country and the wider region.
The announcement came just a day after the US killed Mushtaq Jawad Kazim al-Jawari, also called Abu Taqwa, who the Department of Defense said was a leader of Harakat al-Nujaba (HaN), a Shia militant group associated with Iran and responsible for attacking US installations in Iraq and Syria. Other reporting has identified Abu Taqwa as Mushtaq Taleb al-Saeedi. The Pentagon confirmed the identity of Abu Taqwa as al-Jawari, but did not confirm the identity of a second person killed in the attack, beyond his affiliation with Abu Taqwa and HaN.
Such attacks have occurred in varying tempo and intensity for years now, ramping up again following Israel’s war with Hamas in Gaza after the October 7 attacks. Pentagon leadership has maintained that Abu Taqwa was “actively involved in planning and carrying out attacks against American personnel.” But given that Harakat al-Nujaba and groups like it are technically part of the Iraqi military, al-Sudani’s office called Thursday’s strike an “unwarranted attack on an Iraqi security entity that is operating within the powers authorized by the Commander-in-Chief of the Armed Forces.”
In Iraq, as in the Red Sea, US coalition forces are hamstrung regarding how to respond to attacks like those of Harakat al-Nujaba and the Houthis. Failure to respond has not deterred the attacks, but neither have limited strikes — for example, targeting munitions depots in Syria. But more aggressive attacks, like the one Thursday that killed Abu Taqwa, could have undesirable consequences, such as increased attacks on US installations or on commercial containers in the Red Sea — and risk further escalation in the region overall.
What’s the anti-ISIS coalition still doing in Iraq?
The US-led Global Coalition to Defeat ISIS was formed in 2014 to dislodge ISIS from the territory it controlled in parts of Iraq and Syria. The group imposed an extremist interpretation of Sunni Islam over its so-called caliphate, forcing conversions, executing those who opposed them, committing genocide, kidnapping and killing journalists, and executing terror attacks on Western targets.
In March of 2019, a grueling five years later, the coalition managed to largely dismantle the ISIS infrastructure and eject the group from the territory it once held. In October of that year, ISIS leader Abu Bakr al-Baghdadi died during a raid by US special operations commandos in Idlib, Syria.
Though the coalition had ostensibly met its goals by that time — dismantling the caliphate, and killing the group’s leader and many commanders — ISIS itself didn’t die. That’s partly because affiliate groups still operate all over the world, including the Philippines, parts of Iran, Afghanistan, and Pakistan, in the Arabian Gulf nations, and in parts of Africa. And it’s also due to the fact that thousands of people associated with ISIS — former fighters as well as their wives and children — have been held at prisons and camps for the displaced and haven’t been repatriated yet.
Furthermore, as US Central Command (CENTCOM) claimed in a 2022 report, ISIS still operated in the region, although at a much lower capability than at the height of its power. The CENTCOM mission, Combined Joint Task Force — Operation Inherent Resolve, now “advises, assists, and enables Partner Forces” — such as the Iraqi military and the Syrian Democratic Forces — “to secure lasting defeat of ISIS and to enable the establishment of a security cooperation framework.”
Complicating that mission are the Popular Mobilization Forces, or PMFs — mostly Shia militias that are, to varying degrees, affiliated with Iran but technically part of the Iraqi military. Those groups grew significantly and gained power in Iraq in 2014 and were critical to the fight against ISIS, particularly early on in the conflict, as a recent report from the RAND Corporation notes.
“There is a core network of Iranian-controlled groups in Iraq that run these front groups” which are carrying out rocket attacks on US bases in Iraq and Syria, according to Phillip Smyth, an independent analyst who focuses on Hezbollah and jihadist groups in the region.
These groups have been launching rocket attacks since about 2020, after the assassination by the US of Qasem Soleimani, a revered leader in the Iranian military, though some occurred as early as 2019. Some of the groups have been around much longer and are trusted allies of the Iranian regime. They’re unlikely to deviate from Iran’s strategy and interests in the region. But other smaller front groups aren’t necessarily quite so closely aligned, Smyth said, and can sometimes mistakenly go off-course or outright flout Iran’s orders.
What’s the potential fallout?
Until late last year, al-Sudani had “publicly defended U.S. troops by stating they were in Iraq at the invitation of the Iraqi government,” Sarhang Hamasaeed, director of Middle East Programs at the US Institute for Peace, wrote in early November. The US and Iraq were even on a trajectory to deepen their military cooperation as recently as August.
Al-Sudani has, over the past year, tried to balance competing interests — those of a coalition called the Coordination Framework, which former Iraqi Ambassador to the US Rend al-Rahim described in a piece for the Arab Center as “a motley group of Shia political parties dominated by former Prime Minister Nouri al-Maliki” and the PMFs, and aligned with Iran, as well as Kurdish and Sunni interests and those of the US.
Prior to the October 7 attacks, that might have been an easier prospect; attacks on US installations by PMFs and Iran-aligned groups in Syria had ceased for months prior to Israel’s war on Hamas, as part of a de-escalatory trend between Iran and the United States and its partners in the region.
While Iraq has always aligned with Palestinians and declined to recognize Israel, the war — and particularly Thursday’s US strike on Abu Taqwa — has changed the domestic balance for al-Sudani, Jennifer Kavanagh, senior fellow in the American Statecraft Program at the Carnegie Endowment for International Peace, told Vox. “For Sudani, the move creates additional domestic pressure for action against US forces,” she said. “I do think the strike on [Abu Taqwa] will at least create a wider and more vigorous and public debate about whether US forces should stay or go. It may not result in US forces being kicked out, but it will likely restrict their freedom of movement and force the US to take a lower profile.”
Indeed, in late October, the powerful Shia Iraqi cleric Muqtada al-Sadr called for the closure of the US embassy in Baghdad due to the US’s “unfettered support” for Israel; that has not yet come to pass, even as tensions between the US and Iraq increase due to the war.
For the US, the harsh Iraqi response — and al-Sudani’s pivot, seemingly due to internal political pressure — is a consequence of crossing a line, Kavanagh said. “In this already tense context, the US strike was a risky and escalatory move. Rather than reducing the threat to US forces in Iraq, I think it increases that threat.” And though it’s not yet clear whether al-Sudani’s threat will materialize, “if there are any additional US strikes, I think the effort to expel US forces could have enough momentum to be successful.”
It turns out shoplifting isn’t spiraling out of control, but lawmakers are pushing for tougher penalties for low-level and nonviolent crimes anyway.
Over the last couple of years, it seemed that America was experiencing a shoplifting epidemic. Videos of people brazenly stealing merchandise from retailers often went viral; chains closed some of their stores and cited a rise in theft as the primary reason; and drugstores such as CVS and Walgreens started locking up more of their inventory, including everyday items like toothpaste, soaps, and snacks. Lawmakers from both major parties called for, and in some cases even implemented, more punitive law enforcement policies aimed at bucking the apparent trend.
But evidence of a spike in shoplifting, it turns out, was mostly anecdotal. In fact, there’s little data to suggest that there’s a nationwide problem in need of an immediate response from city councils or state legislatures. Instead, what America seems to be experiencing is less of a shoplifting wave and more of a moral panic.
For some time, retailers had indeed been complaining about a rise in theft. In April, the National Retail Federation, a lobbying group for retailers, published a report to back up that claim. It said that nearly half of all inventory loss in 2021, which amounted to roughly $94 billion, was driven by “organized retail crime” — that is, coordinated shoplifting for the purpose of reselling goods on the black market. As it turned out, organized shoplifting didn’t come close to costing businesses that much: With a few exceptions, major US cities actually saw lower shoplifting rates in 2022 than in 2019, and in December, the National Retail Federation retracted its alarming claim.
That’s not to say that shoplifting ought to be ignored. Particularly concerning are reports of organized rings stealing merchandise to turn a profit, rather than people who steal products they need but can’t afford, like baby formula. One expert told the New York Times that organized retail theft accounts for roughly 5 percent of total inventory loss — a far more modest estimate than the National Retail Federation’s original erroneous claim, but one that still amounts to billions of dollars a year. While that’s a minuscule problem for big retailers, small businesses that are targeted can feel the pinch. Added security measures also mean a more unpleasant experience for consumers, as well as a potentially more expensive one because, as some analysts say, the added costs for retailers are reflected in higher prices.
In the years leading up to the Covid-19 pandemic, progressive prosecutors, who pushed for a more lenient and less punitive criminal justice system, had been gaining ground. But their critics have pounced on faulty statistics like the one put out by the National Retail Federation as evidence that America needs to expand policing and once again impose harsher penalties for petty crimes, reversing reforms that have sought to reduce incarceration rates, including looser enforcement of laws around things like drug possession, loitering, or, in some cases, shoplifting low-cost goods.
Now, those more forgiving criminal justice policies are at risk, in part because of a perceived trend that appears to have been overblown.
What we actually know about shoplifting
In the early months of Covid, shoplifting declined because businesses closed and people stayed home. But as life started going back to normal, so did shoplifting, and rates of retail theft started to creep up again.
The change since 2020 wasn’t at all drastic. A report by the nonpartisan Council on Criminal Justice, which looked at 24 big cities, found that amid generally lower shoplifting rates in most cities, seven saw increases. Some were modest — shoplifting incidents in Pittsburgh grew by 8 percent between 2019 and 2023 — but others were more serious. New York City, for example, saw a 64 percent increase in that period, though even there, the trend seems to be coming to an end: The city saw lower shoplifting rates in the first half of 2023 than in 2022.
There had been evidence that fears of a major shoplifting wave were overblown. In 2021, Walgreens closed five stores in San Francisco, citing a rise in organized shoplifting. When the San Francisco Chronicle analyzed police data, the newspaper found that there was little evidence to back up Walgreens’s claim. The Chronicle reported that “the five stores slated to close had fewer than two recorded shoplifting incidents a month on average since 2018.”
In an earnings call with investors last year, a Walgreens executive suggested that the company had indeed overstated concerns about shoplifting. “Maybe we cried too much,” he said, adding that it may have resulted in the retailer spending more than it should have to bolster security.
So where did the National Retail Federation get the number that nearly half of retailers’ “shrink” — the industry term for inventory loss due to a range of factors, including theft but also damage and tracking mistakes — was a result of shoplifting? A spokesperson for the group told Reuters that it came from 2021 congressional testimony from the former president of the advocacy group the Coalition of Law Enforcement and Retail, who claimed that retailers lose $45 billion a year because of organized retail theft. But it’s unclear where that number came from.
Previous reports from the National Retail Federation showed that shoplifting was nowhere near as dire. In a 2020 report, the lobbying group found that retailers lost, on average, roughly $720,000 for every $1 billion in sales due to organized retail theft. Shoplifting, in other words, amounts to less than 0.1 percent of total revenue — a cost that retailers often accept as part of operating a business.
Like any crime, shoplifting is often underreported, and it’s hard to figure out the extent to which it is. That’s in part because there is no national data set to parse, and many law enforcement agencies have not reported their recent crime data to the FBI, according to the Marshall Project. But Adam Gelb, the president and CEO of the Council on Criminal Justice, said there are factors other than the total number of reported incidents to consider when trying to understand the overall picture, including how shoplifting incidents have changed.
The Council on Criminal Justice report found that the number of shoplifting incidents that involved another crime, including assault, increased by 9 percent between 2019 and 2021. That could mean shoplifters have a higher tolerance for risk than they used to: an argument that security might be too lax. It could also indicate more organized crime. Still, those incidents accounted for less than 2 percent of overall shoplifting events, and they also started to decline in the first half of 2023.
Regardless, part of the reason so many retailers and lawmakers have sounded the alarm on a rise in thefts might be because reports of shoplifting had plummeted when Covid first hit, and then shot back up after stores reopened. That created the impression that the problem was spiraling out of control when in reality, shoplifting rates remained below pre-pandemic levels.
“People don’t know if something is high or low or medium on some scale, historical or otherwise. But they have a sense of whether it’s getting better or getting worse,” Gelb said. “And when things are moving in the wrong direction, people want to see action.”
The great American shoplifting scare has already had consequences
Since the number of reported shoplifting incidents rose after the initial collapse in 2020, there have been plenty of media reports and viral videos about the potential crime wave. Republicans used the alleged lawlessness, particularly in big Democratic cities, to paint a grim picture of Joe Biden’s America. It didn’t matter what the reality was; it seemed that the public’s perception of rising crime was enough for politicians from both major parties to feel the need to look tougher — be they Eric Adams, the Democratic mayor of New York City, or Ron DeSantis, the Republican governor of Florida and candidate for president.
As a result, many policies that were championed by progressive criminal justice reform advocates, including the progressive prosecutor movement, have come under scrutiny, criticized as not only insufficient at combating crime but as policies that promote breaking the law.
Evidence points to the contrary. In Boston, a former district attorney implemented a policy of declining to prosecute certain low-level offenses that are associated with poverty, such as shoplifting. In one study, researchers found that the new policy had positive impacts — not only in reducing the number of people who get sucked into the criminal justice system but also in reducing the likelihood of reoffending. Low-level and nonviolent crimes, researchers found, also did not increase as a result of looser enforcement.
As shoddy data about shoplifting helps stir up fear of a potential crime wave, voters are becoming less tolerant of those kinds of policies, and progressive prosecutors have faced tough election cycles in recent years as a result. That includes Boston, and other places, too: Chesa Boudin, the former San Francisco district attorney who became nationally prominent for his more lenient approach to addressing low-level crime, was recalled in 2022, for example, after a fearmongering campaign about rising crime, including shoplifting, was launched against him.
Legislatures have also started passing stricter laws. Since 2022, at least nine states have imposed harsher penalties for organized retail crime offenses, according to CNBC.
But given how unclear the data on shoplifting actually is and how much is still unknown, this could ultimately be a misdirection of resources — as Walgreens seems to have figured out after beefing up security measures. And given that preliminary data from 2023 shows that the apparent shoplifting trend might actually be moderating, it’s worth waiting for more data before drafting up laws that could have lasting consequences.
In a presidential election year, that might be too much to ask for. Everything, after all, is politics, and shoplifting — real or imagined — is no exception.