Every winter the same handful of viruses cause the same waves of illness, and every winter the same triage questions get asked at 11 pm: is this just the flu, should we be worried, should we go in tonight? Here is a clean framework.
The 80/20 of winter respiratory illness
About 80% of all winter respiratory presentations are mild to moderate viral illnesses that will resolve at home in 5–10 days regardless of medical intervention. About 15% benefit from same-night clinical assessment for symptom management, exclusion of bacterial complications, or reassurance. About 5% genuinely need hospital-level care.
The problem is that when you're the one sick at 11 pm, it's hard to know which bucket you're in. The framework below is what we use in clinic.
Green — safely manage at home
You can probably manage at home if all of the following are true:
- Temperature manageable with paracetamol or ibuprofen (drops below 38.5°C with one dose)
- Drinking fluids and passing urine normally
- Alert, engaging, recognisable as your usual self
- Breathing normally — not fast, not laboured
- No persistent vomiting
- Not at high risk (over 65, pregnant, severe immunosuppression, chronic lung or heart disease) — or if you are, you have a clear plan from your usual GP
Home care: rest, fluids, paracetamol/ibuprofen for fever and aches, throat lozenges if you have a sore throat, a saline nasal spray for congestion. Stay away from work and school until 24 hours past your last fever (most workplaces and schools accept this convention).
Amber — walk in to urgent care tonight
Walk in to MAEC if any of the following apply:
- Mild asthma exacerbation — using your reliever more often than usual, needing it every 3 hours, but still moving air well
- Otitis media in a child that isn't settling with simple analgesia after 48 hours
- Sinus pressure with severe facial pain, particularly with thick discoloured discharge, that has been progressively worse for more than 7 days
- Productive cough with high temperatures persisting past day 5 — could be developing bacterial pneumonia
- Throat infection with high fever, white patches, and difficulty swallowing — could be bacterial tonsillitis
- Mild dehydration — slightly reduced urine output, drinking but not eating much
- Need a script for asthma inhaler, antibiotic, antiviral, or symptom-relief medication
We can examine, listen to your chest, look in your ears, swab your throat if needed, prescribe appropriately, and arrange follow-up. Most amber visits resolve in 30–60 minutes door to door.
Red — go to ED or call 000
Go to ED immediately (or call 000) for any of these:
- Difficulty breathing — fast, shallow, gasping, can't complete sentences
- Chest pain or pressure, especially with shortness of breath
- Severe asthma exacerbation — reliever not working, can't speak in full sentences, blue lips
- Confusion, drowsiness or unrousable — particularly in older adults
- Any baby under 3 months with a temperature of 38°C or higher
- Severe dehydration — no urine for 8 hours, dry mouth, dizziness on standing
- Persistent vomiting unable to keep any fluids down for 8+ hours
- Petechial rash (non-blanching purple spots) with fever
- Coughing up significant blood
Tripledemic-specific notes
If it's flu
Antiviral medication (oseltamivir) is most effective if started within 48 hours of symptom onset. For at-risk groups (over 65, immunocompromised, pregnant, chronic disease), early antiviral is genuinely worth a visit. For otherwise healthy adults, the marginal benefit is smaller and most people don't need it.
If it's RSV
RSV is particularly relevant for infants, toddlers and older adults. The clinical features of concern are breathing fast, retracting (chest sucking in between ribs), nasal flaring, and difficulty feeding in babies. RSV bronchiolitis in infants under 6 months is a common reason for ED admission and is not something we can manage in clinic.
If it's COVID
Most healthy adults will have a mild to moderate illness and recover at home. Antivirals (Paxlovid, molnupiravir) are funded under PBS for high-risk groups within 5 days of symptom onset. If you're high-risk and symptomatic, the priority is contacting your usual GP for an antiviral prescription — phone triage often works fine for this.
Practical home toolkit for winter
Worth having in the cupboard before the season hits:
- Digital thermometer (we covered the parent's first-aid kit in an earlier post)
- Paracetamol and ibuprofen, weight-dosed for any children in the house
- Saline nasal spray for congestion
- Oral rehydration sachets for any gastro overlap
- A box of RATs (Rapid Antigen Tests) for COVID
- Your usual asthma reliever, in date, with a spacer if relevant
When to phone us first
Phone triage is free. If you're unsure whether you're in the amber zone, ring 0403 025 359 — we'll listen to symptoms for two minutes and tell you honestly whether to come in, go to ED, or stay home tonight.