The humble cough drop could be used to map omicron’s spread

As governments around the world start to limit testing for COVID-19, the humble throat drop may become a gauge of how quickly omicron is spreading.

Sales of medicated lozenges and gargles, cough suppressants and over-the-counter pain relief medications have soared so high that the products are often in short supply around the world, according to manufacturers and sellers. The trend has emerged even in countries where official testing numbers appear to show that active cases are falling.

That could make supermarket and pharmacy sales of nonprescription remedies a useful indicator of COVID-19 infections as governments around the world decrease testing, citing the high cost and plans to “live with COVID.”

Many countries will need to ask, “are there alternative forms of surveillance that can be used to give us a better insight into undiagnosed infections?” said Alex Cook, vice-dean of research at the National University of Singapore’s Saw Swee Hock School of Public Health. “Over-the-counter sales is one way we could do that.”

Singapore and other countries have begun switching to less stringent reporting and isolation standards often based on antigen rapid test results, which are less sensitive than their PCR peers. The U.K. will also greatly reduce supplies of free test kits from April.

The surge in sales of cough drops is thanks to three factors: a loosening of restrictions and return to normal socialization, a global surge in the highly contagious omicron variant, and its symptoms that are more akin to a traditional cold or flu compared to earlier strains.

Where earlier coronavirus waves had unusual effects like a loss of smell and an extreme shortness of breath, health services say common omicron symptoms include sore throats, headaches and coughs, which can be relieved through store-bought remedies.

“The removal of masks and the removal of social distancing measures leads the products to go back to pre-pandemic levels in a relatively fast way,” said Sacha Ernst, Asia president of iNova Pharmaceuticals, which licenses, produces and distributes popular brands like Difflam and Duro-Tuss across the region. “But omicron is really on top of that.”

In February, pan-Asian sales of throat products — such as lozenges and gargles — were 2.5 times higher than a year earlier, Ernst said. Singapore sales jumped 3.7 times and were up 22% from February 2019, before the pandemic started.

Consumer-health giants are benefiting. Reckitt Benckiser Group PLC’s over-the-counter sales grew 40% in the fourth quarter amid a “positive start” to the northern cold and flu season, Chief Financial Officer Jeff Carr said last month.

Extra orders

Ernst said sales of many cold and flu medications actually fell during the pandemic because social distancing lowered people’s exposure to both COVID-19 and more common bugs. But as omicron surged in Africa, Europe and Australia in December, so too did demand in those markets.

That triggered additional orders from manufacturers in preparation for a global spread. But with deliveries often taking months, shortages have been reported from the U.S. to Singapore since late 2021.

To be sure, cough drop sales can’t replace scientific methods of monitoring for the virus’s presence, like sewage surveillance, and the emergence of another variant may force governments to bring back large-scale testing.

For now, omicron’s dominance is bringing a windfall for sellers. Many customers are buying up the higher-strength treatment products rather than confectionery ones, and sales even spiked in summer or in places without traditional cold seasons, such as Southeast Asia, Ernst said.

“It’s much too correlated to be linked to the normal cold and flu,” Ernst said.