It started in my right ear.
Over the weekend, my ear canal swelled so much it was nearly closed. It was painful, but I ignored it, as usual.
By Tuesday, swallowing hurt. I stood at the bathroom sink, held a lamp into my mouth, and checked my own throat. The right side looked swollen and shiny, and behind my right tonsil was a large swelling I’d only seen in patients before.
As a maxillofacial surgeon, I’ve examined countless throats. But tonsils are the ENT doctors’ territory, and I always warn against doctors diagnosing themselves in the mirror. So I saw an ENT colleague.
On the first day, he found a large swelling but no obvious sign of infection. I had no fever and could open my mouth as usual. He treated the swelling, it got better for a day, and I went back to work.
By Thursday, the swelling was back and even worse. He took one look and said, “Yeah, now it’s fully there.” Peritonsillitis. The infection had spread into the tissue around the tonsil, which can be the step before an abscess [1].
He gave me two choices: go to the hospital and have my tonsils removed right away, or take high-dose antibiotics and check again in a day or two. I’m just like any other patient, and chose to avoid the hospital bed. Without an abscess, that’s also the usual first step [1].
Two days later, the pain was gone. I knew I’d be fine.
Last November, I wrote here that I rarely get sick. This time, I wasn’t so lucky. And winter hasn’t even started yet. Flu season is coming, the kids will soon be swapping viruses at school, and my calendar is packed with dinners and meetings. Here’s what I’d tell a friend: why pushing through, what many of us tend to do, deserves a second thought, what’s worth doing this winter, and what isn’t.
Two rounds at the Wiesn
I think it probably started in Munich.
Every year I host a table at Bits & Pretzels, the startup conference that runs during Oktoberfest. Founders pick which table they join, and there are two rounds. Mine always fills up with people building health care and medical science companies. They ask about business models and the market, and I get to hear what they’re working on. I love it.
Part of the day is spent in a beer tent. I grew up in Bavaria and go to the “Wiesn” every year. Maybe it’s just in my nature, like birds migrating.
In Munich, there’s even a name for what people catch at the tents: the Wiesn flu. It’s whatever bug is spreading in the loudest, most crowded room of the year.
Most years, I avoid it. This year, I came home with what felt like a cold. It wasn’t bad enough to stop me, so I kept going. I think the throat infection started from that cold, though I can’t be sure.
I’ve had tonsil infections on and off since I was a teenager, so my throat has always been my weak spot.
The loudest room of the year
The tent is like an extreme version of any crowded winter room. After the 2022 Oktoberfest, the first after the pandemic break, COVID-19 cases in Munich rose during and after the festival, mostly among people aged 15 to 59 [2].
Shouting is part of the problem. Speaking loudly releases about ten times more particles than speaking quietly [3]. These are just particles, not actual viruses being counted. Now imagine a brass band, thousands of people, and an afternoon spent on the benches.
Beer is the other factor. In one study, 15 healthy volunteers drank about 60 grams of alcohol in 20 minutes. That’s about three to four and a half regular beers, depending on the size. Two hours later, their monocytes, which are key immune cells, had dropped by almost a third, and were still low five hours later [4]. The study only measured blood cells, not infections, so we don’t know how much this matters. Alcohol also disrupts the second half of your night’s sleep [5], and sleep is important here. I’ll get to that below.
Even without the beer and dancing on tables, the same risks apply in a packed restaurant, a bar, a classroom, or a meeting room where a dozen people talk over each other for two hours with the windows closed.
The doctor’s take: Last Sunday, I wrote that no amount of alcohol has been shown to help you live longer, and I still believe that. I still go to the Wiesn, and I still enjoy a glass of wine with friends at dinner. I drink to enjoy time with people I care about, not to end up asleep behind the tents. For me, the evening is worth the cost, and I accept that.
The mat across the hallway
This week, I didn’t work out. That hardly ever happens.
My gym in Berlin is just a spare room across the hall. I got up at my usual time, rolled out a mat, and moved a little, like slow shoulder exercises and some gentle mobility. No weights, no cardio. It was the right decision.
We have three kids, and with winter coming, we know what’s ahead. School and kindergarten kids catch everything, and the more kids you have, the more often those bugs come home. This time, I was the one who brought it in.
Why we keep going anyway
I pushed through twice. First with the cold after Munich, then by going back to work while the swelling was still there. I’ll never know if resting sooner would have made a difference.
In a study of 12,935 Danish workers, more than 70% went to work sick at least once a year. People with a supervisory role or more than 45 hours a week were more likely to do it [6]. In northwestern Europe, 52% of self-employed people said they worked while sick, compared with 44% of employees [7].
And it’s linked to more sick leave later. In a Swedish study of more than 6,000 workers, those who went in sick more than five times a year were 40 to 51% more likely to need over 30 days of sick leave later [8].
It also costs the people around you. In experimental colds, the virus in the nose peaked on the second day after infection [9]. When US workers got access to paid sick leave, flu-like illness dropped by roughly 5 to 6% [10].
It’s the same with training. The old “neck check” says symptoms above the neck are okay. The International Olympic Committee says that’s just expert opinion with little research behind it, and if you have a fever, aching muscles, or exhaustion, it recommends rest [11]. And a throat infection on antibiotics is not just a head cold.
Some throat symptoms are an emergency. The NHS tells people with tonsillitis to call an ambulance or go to the emergency department if [12]:
you have a severe sore throat that quickly gets worse
you have swelling inside the mouth and throat
you have difficulty speaking, breathing or opening your mouth
you cannot swallow
Pay attention to your ears as well. The nerve that goes to the tonsils also supplies the middle ear [13], so throat problems often show up as earache on the same side [14]. I’m not sure if that explains my swollen ear canal, but I do know I ignored it.
The doctor’s take: Let’s be honest. Most of you won’t take a week off for a cold, and sometimes you really can’t. So make the illness as small as possible. Stay home while you have a fever and until you’re clearly getting better. If you need to work and feel up to it, work from home. Cancel dinner plans, but keep the call. Skip the gym until your fever is gone and you feel better, then ease back in. If you’re a leader, remember your team pays more attention to what you do when you’re sick than what you say about it. If you have a one-sided sore throat or an earache on the same side, see a doctor that day.
What’s worth doing this winter
Let fresh air in. In a study of office workers, those in areas with lower fresh-air supply took about 50% more short-term sick leave [15]. That’s an association, not proof. Germany’s Federal Environment Agency tells schools to open windows wide every 20 minutes for three to five minutes in winter and to keep carbon dioxide at or below 1,000 ppm [16]. A cheap CO2 monitor tells you when a meeting room needs it.
Protect your sleep. In a study where researchers intentionally exposed 164 adults to a cold virus, those who slept less than six hours had about four times the odds of getting sick than those who slept more than seven [17]. The study was small: only 22 people slept more than seven hours.
Consider the flu shot. In a Cochrane review of healthy adults, 2.3% of unvaccinated people caught confirmed flu, compared with 0.9% of vaccinated people. In those trials, you had to vaccinate 71 people to prevent one case. The same review found no clear drop in hospital stays or work days lost [18].
Germany’s vaccine committee STIKO recommends it from age 60, and at any age for chronic conditions such as diabetes or asthma, pregnancy, medical staff, and anyone who lives with someone at higher risk [19]. The US CDC recommends it for everyone from 6 months [20].
If you get it, sleep well around it. In a small study, young men who slept four hours a night around their shot had less than half the antibodies of normal sleepers ten days later. After three to four weeks the difference had faded [21].
The doctor’s take: I usually get the flu shot. When I worked in the hospital, I got it every year because I didn’t want to bring the flu to patients who were more vulnerable than me. For a healthy adult like me, the personal benefit is sometimes small. Now, the people I want to protect are at my own breakfast table.
Wash your hands. In trials with more than 52,000 people, better hand hygiene reduced respiratory infections from 380 to 327 per 1,000 people [22]. That’s about one in seven infections avoided. Modest, but it costs you nothing.
Keep moving. In studies with over 557,000 people, those who got at least 150 minutes of activity a week had about a third lower risk of everyday infections [23]. That’s just a link, not proof. In trials, exercise didn’t change how often people caught a respiratory infection, but the illness was milder and people had fewer sick days overall, though the evidence is weak [24]. Exercise probably won’t stop you from catching a cold, but I still think it’s one of the best things you can do for your health. That’s a hill I’m willing to die on.
If you smoke, stop. In a Danish study, smokers had about two to five times the odds of a peritonsillar abscess, depending on age [25]. This can’t be said enough: if you smoke, quitting beats everything else on this list.
In my Upward ARC framework, most of this falls under Activate: sleep, movement, and the daily habits you can control. Recover is the other half, knowing when to stop.
What isn’t worth buying
Vitamin C. Taken every day, it didn’t prevent colds in the general population. It shortened adult colds by about 8% [26], about half a day on a seven-day cold. Starting it after the cold began showed no consistent effect.
Vitamin D. In the main analysis of a 2025 review, 40 trials with 61,589 people, it showed no clear drop in respiratory infections [27]. If your doctor finds a real deficiency, treat it. As winter insurance, it doesn’t hold up.
Zinc made little or no difference to catching colds [28]. For treatment, the theory is that zinc ions released in the mouth and throat act right where the virus sits. That’s why lozenges you let dissolve, not tablets. Three early trials of zinc acetate lozenges found colds about 40% shorter [29]. A later trial of a commercial zinc acetate lozenge found no difference, and more side effects [30]. If you still want to try it, lozenges are what the positive trials used. Don’t expect miracles.
Echinacea. The products vary too much to compare, and the results are small and inconsistent [31]. Many of the “immune” sachets at the pharmacy mix these same ingredients.
Try this today
Open the window in your next long meeting, wide, for a few minutes every 20 minutes or so.
Protect your sleep through conference season and year-end dinners. Aim for seven hours.
If you’re getting a flu shot, book it for a week without overnight flights, and sleep normally the nights around it.
Stay home while you have a fever and until you’re clearly getting better. If you have to work and feel up to it, work from home.
Know the throat red flags. If you cannot swallow, struggle to breathe, speak or open your mouth, or see swelling inside your mouth and throat: emergency department now. A one-sided sore throat or an earache on the same side: see a doctor today.
Next year’s migration
Next September, I’ll be back at my table in the tent. Pretty sure about that. I’ll keep an eye on the beer and make sure I get enough sleep. And if I come home feeling a bit off, I’ll try to stay home.
When was the last time you pushed through something you should have stayed home for? Reply and let me know. I read every message.
Stay healthy.
Andre
PS: Forward this to the colleague who always comes to the office with a cold. That’s how this newsletter grows, and it’s the only way I want it to.
PPS: If a friend sent you this, you can get Under Load, my Sunday edition, here:
https://www.andreheeg.com
References
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