ABOUT THIS EPISODE
It started in my right ear. By Tuesday I was standing at the bathroom sink with a lamp, looking down my own throat at a swelling I had only ever seen in patients. As a maxillofacial surgeon I've examined countless throats, but tonsils belong to the ENT doctors, so I saw a colleague. By Thursday it was peritonsillitis. He offered the hospital and a tonsillectomy, or high-dose antibiotics. I picked the one without the hospital bed. I'm fine now.
My best guess is that it started in Munich, at Bits & Pretzels during Oktoberfest, where I host a table for health care founders every year. I came home with what felt like a cold and kept going. Then I went back to work with the swelling still there. I pushed through twice.
This episode of Under Load looks at why so many of us do that, and what's worth doing this winter instead. In a study of 12,935 Danish workers, more than 70% went to work sick at least once a year, and supervisors and people working more than 45 hours a week did it more often. Going in sick often was linked to more long sick leave later. When workers in the US got access to paid sick leave, flu-like illness dropped by roughly 5 to 6%.
In this episode:
- Why a beer tent is an extreme version of any crowded winter room: loud speech releases about ten times more particles than quiet speech.
- What one heavy drinking session did to immune cells in 15 healthy volunteers, and what that study can't tell us.
- The realistic plan for when you can't take the week off: stay home while you have a fever, work from home if you feel up to it, cancel the dinner, keep the call.
- The NHS throat red flags that mean emergency department now.
- Fresh air in meeting rooms, and what Germany's Federal Environment Agency tells schools.
- Sleep and colds: about four times the odds of getting sick under six hours, in a small virus-challenge study.
- The flu shot in absolute numbers, who STIKO and the CDC recommend it for, and why I get it.
- Hand washing: about one in seven respiratory infections avoided.
- Vitamin C, vitamin D, zinc lozenges and echinacea: what the evidence shows, and what I'd stop buying.
The episode closes with five things to do this week and a promise for next year's Wiesn.
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Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Activate pillar, with Recover: the daily inputs you control, and knowing when to stop.
This episode is general health education, not individual medical advice. For your own symptoms or decisions, talk to your doctor.
Key sources
- Cheng, 2026, MSD Manual Professional Version: peritonsillar abscess and cellulitis.
- Herold et al., 2025, Health Policy: Oktoberfest 2022 and COVID-19 infection rates.
- Asadi et al., 2019, Scientific Reports: voice loudness and aerosol emission.
- Afshar et al., 2015, Alcohol: immune effects of binge drinking.
- Ebrahim et al., 2013, Alcoholism: Clinical and Experimental Research: alcohol and sleep.
- Hansen & Andersen, 2008, Social Science & Medicine: going to work ill.
- Nordenmark et al., 2019, Safety and Health at Work: presenteeism among the self-employed.
- Bergström et al., 2009, Journal of Occupational and Environmental Medicine: presenteeism and later sickness absence.
- Heikkinen & Järvinen, 2003, The Lancet: the common cold.
- Pichler & Ziebarth, 2017, Journal of Public Economics: sick pay and contagious presenteeism.
- Schwellnus et al., 2022, British Journal of Sports Medicine: IOC consensus on acute respiratory infections in athletes.
- NHS, 2024: tonsillitis.
- Earwood et al., 2018, American Family Physician: ear pain.
- Galioto, 2017, American Family Physician: peritonsillar abscess.
- Milton et al., 2000, Indoor Air: ventilation and sick leave.
- Umweltbundesamt, 2021: ventilating classrooms.
- Prather et al., 2015, Sleep: sleep and susceptibility to the common cold.
- Demicheli et al., 2018, Cochrane: flu vaccines in healthy adults.
- KBV, 2026: STIKO influenza vaccination recommendations 2026/27.
- CDC, 2025: who needs a flu vaccine.
- Spiegel et al., 2002, JAMA: sleep deprivation and vaccine response.
- Jefferson et al., 2023, Cochrane: physical interventions against respiratory viruses.
- Chastin et al., 2021, Sports Medicine: physical activity and infectious disease.
- Grande et al., 2020, Cochrane: exercise and acute respiratory infections.
- Klug et al., 2013, European Archives of Oto-Rhino-Laryngology: smoking and peritonsillar abscess.
- Hemilä & Chalker, 2013, Cochrane: vitamin C and the common cold.
- Jolliffe et al., 2025, The Lancet Diabetes & Endocrinology: vitamin D and acute respiratory infections.
- Nault et al., 2024, Cochrane: zinc for the common cold.
- Hemilä, 2017, JRSM Open: zinc lozenges meta-analysis.
- Hemilä et al., 2020, BMJ Open: zinc acetate lozenges trial.
- Karsch-Völk et al., 2014, Cochrane: echinacea and the common cold.
Audio note
Andre reads the written newsletter, adapted for speech. Inline citations are omitted, and some numbers are rounded. The written edition contains the full references.
How I use AI
AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the fina...
