Not Every Cough Is Contagious

In times of outbreak alerts and heightened public vigilance, most recently surrounding the Nipah virus, a simple cough can carry disproportionate weight. No longer just a bodily reflex, it has become a trigger for worry, suspicion, and self-diagnosis. Now, clinicians are urging patients and caregivers alike to pause before panicking.

Across specialties, doctors are turning the spotlight on an often-overlooked condition with growing relevance: Cough Hypersensitivity Syndrome (CHS), where the cough persists, not because of infection, but because the nervous system hasn’t yet stood down. Beyond Infection: A Neurological Aftermath

According to Dr Jagadeesh, senior physician, diabetologist and internal medicine specialist, CHS is frequently misunderstood because it mimics infectious cough, without being one.

“Cough Hypersensitivity Syndrome (CHS)—often called neuropathic cough—is changing how clinicians approach prolonged, treatment-resistant cough. Unlike infectious coughs, CHS typically does not require routine medication,” says Dr Jagadeesh. What it does require is a physician who understands the cause, the timeline of illness, and the pattern of symptoms before choosing a plan of care. In the wake of widespread viral pneumonias and bronchitis, doctors are seeing patients daily with coughs that outstay the infection and defy standard syrups.

“Many patients come weeks after viral bronchitis or pneumonia,” he explains. “The infection has resolved. Scans are clear. Blood tests are normal. Yet the cough persists.”

The reason, he says, lies not in the lungs but in the nerves. CHS is often a sensory neuropathy of the vagus nerve, where the throat remains hypersensitive long after the viral trigger disappears.

Fear, Misinformation, and the Outbreak Effect

For Dr Gogineni Ratnakara Rao, consultant pulmonologist at Apollo Hospitals, the challenge today is as much social as it is clinical.

“In outbreak-prone regions, people begin to associate every cough with danger,” he says. “That fear leads to panic, repeated testing, and sometimes stigma, despite no evidence of active infection.”

Dr Rao explains that viral illnesses can prime the nervous system, leaving behind what he calls a neurological imprint. “The lungs may be clear, but the sensory nerves are misfiring. This is post-viral neurological fallout, not contagion.”

Why Routine Treatment Often Fails

Both doctors agree: CHS does not behave like infectious cough—and treating it as one only prolongs suffering.

“Not all coughs need medication,” says Dr Jagadeesh. “What they need is understanding—of timing, triggers, and pathophysiology.”

Dr Rao adds, “The real clinical skill lies in separating a contagious threat from a nerve-driven reflex. The response to each must be entirely different.”

Breaking the ‘Cough–Irritation–Cough’ Cycle

Before reaching for drugs, clinicians recommend interrupting the reflex loop:

· Recognise the throat “tickle”

· Suppress the urge to cough

· Practice pursed-lip breathing

· Swallow repeatedly with the chin tucked down

· Sip water slowly

Equally important is laryngeal hygiene:

· Strict hydration

· Keeping throat mucosa moist

· Avoiding menthol and harsh irritants

When to Seek Help

Dr Rao advises that any cough persisting beyond three weeks deserves evaluation—not alarm.

“A proper clinical assessment, basic blood work, and imaging if needed can rule out serious infections. Once that’s done, we can focus on managing hypersensitivity with breathing techniques, trigger avoidance, and targeted therapy.”

The Larger Distinction

As outbreaks demand rapid response and strict protocols, both doctors stress balance.

“We must act decisively against real infections like Nipah,” Dr Rao says, “but not at the cost of mislabelling non-infectious conditions.”

Dr Jagadeesh concurs, “Not every cough is a crisis. Medicine today must be as much about restraint as it is about intervention.”

The Takeaway

In an era of viral vigilance, the most powerful tool may be discernment. Understanding when a cough signals danger and when it reflects a nervous system still recovering—can quiet more than symptoms. It can calm a public conditioned to fear every sound of breath.

What CHS Typically Looks Like

Dr Jagadeesh outlines a familiar pattern:

· A dry, non-productive cough

· Allotussia—cough triggered by talking, laughing, or breathing in air

· Symptoms lasting weeks or months

· Poor response to routine cough syrups or antibiotics