I’m nestled into our couch cushions decompressing from the day, with YouTube videos streaming to the TV. Feet up, under a snuggly blanket. My husband and I have our regular evening watches: Daily Dose of Internet, Ozzy Man, any new Seth Meyers or Stephen Colbert clips. I select a Seth clip to watch, and an advert starts. I half tune out, checking my phone. Waiting for Seth.

I’m aware the advert is set at a kid’s birthday party. Snippets of excitement, kids running around, party decorations. A man isn’t feeling well though. He’s rubbing his throat and looking concerned.

My attention snaps fully to the TV. Being a pain nerd, representations of pain tend to grab me. The man is outside now away from the party. Good. Protecting the other party goers from his sore throat.

Within the next 20-seconds my mood shifts to enraged. My phone forgotten. Taking a Strepsil to relieve the pain…the man turns to head back inside to the party…pausing to pick up a kid on the way, resting them on his hip.

The message is that illness gets in the way of fun. Take medicine to relieve your symptoms and return to your daily life. Buy Strepsils and that pesky impediment to your participation is removed. But what about the other people at the birthday party?

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I can’t find a clip of the advert online. Here’s another one with the same message to consumers:

The theme is evident: take the symptom relief and continue with your life, with fun, with socialising.

The lesson we might have kept from Covid-19 is lost. Responses to the Covid-19 pandemic proved that we can make individual decisions to protect others from our infectious illnesses if we are supported to do so through our employers and government. We can change what we decide are acceptable social norms in illness.

Responses to Covid-19 have made my day-to-day life easier. Changing approaches to infection management have meant I’ve experienced fewer illnesses in the last four and a half years than pre-Covid. That’s down to us collectively deciding to stay home when we’re sick. That collective norm was supported by governmental policy and employers changing approach to sick leave.

For me, fewer illnesses mean I experience less severe flare-ups of my pain and other symptoms, and, crucially, when I do get sick it’s more socially acceptable for me to stay home. Staying home both reduces my recovery time from any infection and prevents or shortens flare-ups of my chronic illnesses.

Of course, I can’t claim causation here but since 2020 my chronic pain has become easier to manage. There are confounding factors here: I’ve also had surgery and am in a permanent job. It’s only an association between fewer illnesses and my pain levels.

However, moving beyond my specific circumstances, stress is associated with flare-ups in chronic pain conditions like fibromyalgia (1) and lower back pain (2); inflammation after infection may be one causal mechanism in the development of chronic pain (3); and individuals with autoimmune conditions (e.g., Lupus) are adversely impacted by catching preventable infections (4).

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Growing up and into my early adulthood, Codral was my go-to for colds and the like. Even now, just thinking of Codral risks the jingle “soldier on” becoming an earworm. Play this version from 1985 at your own risk:

I’ve played the game of taking Codral, Strepsils, Panadol and Ibuprofen (not all at once!) and taking my germs out in public, to school, university, workplaces, gigs, the movies, theatre shows, meals out, and parties.

Going to work sick with a cold was something we did without question pre-2020. As long as you felt well enough to work, you did. We’re not in 2019 now. Evidence – like the reporting of illnesses through the period we had Covid-19 prevention measures in place – shows how our behaviour drives circulation of illness-causing viruses and microorganisms.

The below figure shows the difference between the incidence of new reports of fever + cough symptoms across 2019 to 2022 in a regular community survey of Aotearoa New Zealanders. Time by week is on the horizontal axis. The percentage of respondents reporting fever + cough symptoms is on the vertical axis.

The green and red lines show a typical winter illness pattern, a peak of illness over July and August in 2021 and 2022. The blue and yellow lines are flat. These flat lines for 2020 and 2021 reflect that self-report of fever + cough were uniformly low across the year. 2020 and 2021 were the years we had social isolation measures in place and stayed home when we had any symptoms of illness; however mild.

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The Strepsils advertising campaign isn’t an anomaly. See the 2023 Difflam version.   

“Sore throat”. “Scratchy throat”. “Razor blade throat”.

“Definitely Difflam”

I’m hugely supportive of taking medication that will help you to feel less awful while you’re sick!

The Defintiely Difflam campaign demonstrates something more than effective medication. Something more insidious: a driver for the return to being out and about when you’re sick. A medication for pain relief and relief of other cold-type symptoms is not the answer to the other half of Difflam’s advertising strategy, these problem statements:

“No time to stop”. “Exam starting”. “Concrete pour in 2 minutes”.

These statements show the worth we assign productivity in our modern societies. Chronic pain interrupts my life, but a large part of that interruption comes from chronic pain preventing me from succeeding in the capitalist treadmill of productivity.

We can choose not to “soldier on” though. A shared social responsibility supported by collective decisions and structures in place to allow people to rest, get better, and keep their germs home is the answer to the pressures of time and responsibility.

Not as catchy as “Definitely Difflam”.

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1. Vincent, A., Whipple, M. O., & Rhudy, L. M. (2016). Fibromyalgia flares: A qualitative analysis. Pain Medicine, 17, 463–468. https://doi.org/10.1111/pme.12676

2. Costa, N., Hodges, P. W., Ferreira, M. L., Makovey, J., & Setchell, J. (2020). What triggers an LBP flare? A content analysis of individuals’ perspectives. Pain Medicine, 21, 13–20. https://doi.org/10.1093/pm/pnz021

3. Cohen, S. P., Wang, E. J., Doshi, T. L., Vase, L., Cawcutt, K. A., & Tontisirin, N. (2022). Chronic pain and infection: mechanisms, causes, conditions, treatments, and controversies. BJM Medicine, 1, e000108. https://doi.org/10.1136/bmjmed-2021-000108

4. Jung, J.-Y. & Suh, C.-H. (2017). Infection in systemic lupus erythematosus, similarities, and differences with lupus flare. Korean Journal of Internal Medicine, 32, 429–438. https://doi.org/10.3904/kjim.2016.234