The "Tripledemic" - COVID, Flu and RSV
From the Show: Henry Mayo Newhall Hospital - Its Your Health Radio
Summary:
Air Date: 12/15/22
Duration: 10 Minutes
How to best protect you and your loved ones from COVID-19, the flu and RSV.
Transcription:
Intro: It's Your Health, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.
Melanie Cole, MS: Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is fan favorite, Dr. Bud Lawrence. He's the Medical Director of Henry Mayo Newhall Hospital's Emergency Department and chairman of Henry Mayo's COVID-19 Response Task Force. He's here to tell us today about the triple-demic. What is that you say? He's going to tell us.
Dr. Lawrence, I'm so glad to have you with us. This triple-demic is an interesting term. Have you seen this uptick in RSV and other respiratory illnesses as we've seen physical distancing and masks and all that stuff go by the wayside? Now, we're starting to see this influx of COVID, RSV, colds, flu, and it's that time of year. So, what have you been seeing?
Bud Lawrence, MD: Well, first off, thank you so much for having me. It's always a pleasure to be part of these podcasts. You're absolutely correct that we are seeing, as some people say, the triple-demic. We are definitely seeing high cases of influenza; RSV, which is respiratory syncytial virus as well as COVID-19. So, usually, we expect to see this increase in viral infections during the winter months, but so far it has been a little bit worse. And part of the reason is that for the past two and a half years or so, people have been wearing masks and essentially not getting sick. So now that people are not wearing masks being outside more, being around other people, we're starting to see the contagiousness of the usual winter viruses rearing its ugly head with a significant amount of veracity.
Melanie Cole, MS: Yeah, boy, it's really starting to happen right now. Now, I'd like you to tell us the difference. Because I think one of the things that we're talking about, obviously this triple-demic, but is this co-infection aspect and how challenging it is to tell the difference between them, and especially like for parents whose kids might get RSV or COVID and they're at school or daycare. Tell us the difference, Dr. Lawrence, between flu, RSV and COVID, some similarities, some differences. How do we know?
Bud Lawrence, MD: That's a great question. So, the first one to start with is the one that people probably know the least about, which is RSV or respiratory syncytial virus. And that is a virus that is really for the majority of our population, almost everyone, it's just like a cold. It's just like any other viral infection that causes a cold. However, in our very, very young and our very old, it can make people much sicker. And particularly, kids that are, say, under the age of two, they can have issues with difficulty breathing, cough, even so much so to the point where they need to be admitted to the hospital for some supportive care. Now, that is not common. Most kids generally get better on their own, but that is something to watch out for. So, the respiratory syncytial tissue virus is going to be more of a respiratory or lung issue.
Influenza is the flu. And that infection is kind of something everyone's familiar with. Muscle aches, fever, headaches, nausea, vomiting, all the usual flu-like symptoms. But the flu is definitely ticking upwards. So, we're seeing more and more flu cases and the symptoms of the flu do overlap somewhat with the COVID symptoms. So, it can be challenging to tell these apart. Particularly at our hospital as well as many hospitals, the test for the flu also includes a test for respiratory syncytial virus and COVID, so we can usually detect all those at the same time.
Melanie Cole, MS: Wow. So then, Dr. Lawrence, what makes RSV a bit more dangerous for our littler kids? And are there certain kids who are going to be more at risk for complications from this?
Bud Lawrence, MD: So, it really is a virus that has its biggest activity on our very, very young children. Anyone from newborn up to two, three years old are really going to be the highest risk. And really what it does is it sets up shop in the lungs and it causes kids to have real significant challenges breathing. Sometimes that can be mild, sometimes that can be more than mild, and sometimes it can be severe. So, every child's going to have a different reaction. But certainly, children who have preexisting lung issues, perhaps somebody who is born prematurely may have a higher likelihood of having an issue with RSV, but it can affect all children and there's an entire spectrum of how sick kids can get. But as I said, for the most part, kids don't get that sick that they need to be in the hospital, that's very rare. But when it does happen, we have the ability to care for that.
Melanie Cole, MS: So, let's talk about transmission then, because we learned a lot about transmission of viruses during COVID, right? We were all hearing about this little virus and how it had really didn't hang around in the air too long. But surfaces, we didn't know, then we knew. Tell us about transmission for these. Are they airborne? Do they live on surfaces a long time? When we're thinking about all three of these things, because we got kids in daycare, in school, a lot of us are back to work, you know, in office spaces. So, tell us about transmission.
Bud Lawrence, MD: The most common mode with this is going to be airborne. I have to say the easiest way to think of this is that the things that you did over COVID to not catch COVID, if you continue to do those things, you will be safer than if you just go about your daily life. Meaning, you know, if you are someone who's very high risk from a lung perspective or from any other perspective, perhaps you want to consider wearing a mask when you're out amongst other people. I think hand washing is and has always been critical in decreasing transmission of viruses, and other things like not touching your face.
And really, one thing we learned during COVID was this idea of, if you are sick, stay home. Stay home from work, stay home from school in an attempt to not get other people sick. And I think that's something that's very important when we consider influenza and RSV, as well as COVID, is that if you are feeling sick, it's probably not the best idea to go to work because that is a way that you can transmit this to others or maybe stay home from school, just, I think, have more attention to that. Those are the important things.
Melanie Cole, MS: I'm so glad you said that because that's really important. Now, for me, I'm somebody who really doesn't want to go out these days. I don't want to go anywhere. So, I'm not going to put myself at risk, but it's just really because I think I've gotten quite lazy about that. But for the people that are going out and maybe they get this stuff, what's about home care? I'm glad you mentioned staying at home because that's really important. But what about home care? What helps? What self care do you recommend, Dr. Lawrence? Do any of these things help nasal congestion, the sneezing, fever, you know, all of those things? I like Vapor Rub too when I was having respiratory things with my kids.
Bud Lawrence, MD: Yeah. There are a lot of over-the-counter remedies. Certainly with influenza, if you can get in within the first couple days, there is Tamiflu, which is a prescription medication that you could receive from your primary care physician. With COVID, there is something called Paxlovid, which has been shown to be helpful. That is a prescription medication you can take at home.
But generally, to answer your question, the usual things like Tylenol and Motrin for fever and muscle aches and headache and staying hydrated, these things are critical. Now, many of the people, if you're listening to this podcast in real time, are going to know that there are significant shortages in over-the-counter remedies that, when you go to a drug store or a supermarket, it may be very challenging to find things that you would otherwise normally use, things like DayQuil, NyQuil, certain throat lozenges. Many of these products are sold out because the amount of people who are dealing with these viral illnesses at this time of year is more so than the supply chains can handle. So, we are seeing an issue with that. I've even gone to the store to get something for a family member to find that the entire aisles are wiped clean, very similar to when COVID first started. So, something to think about. Prepare ahead if you are in the store and you do see some of those items, you may want to pick something up just so you have it at home.
Melanie Cole, MS: That's such great advice. I think one of the big questions people want to know, Dr. Lawrence, is how long are you contagious? We stay at home, we try the supportive care, you know, symptom management, try to make ourselves feel a little bit better. But when do we get the go-ahead? When is it okay to send our kids back to school or daycare? When is it okay to go out? What are we doing?
Bud Lawrence, MD: So, there are three different viruses here and they all act differently. And even within these three different viruses, the contagiousness of every individual is going to be in some large part a factor of how many viruses they have floating around their body in the sense of we call that viral load. And so, somebody with a very high viral load is going to be more contagious than somebody who's not. But generally speaking, you're probably contagious with any of these viruses, even the common cold viruses, for a few days prior to when you get sick to up to four to seven, maybe even eight days after you get sick. Of course, that's variable. And we do have recommendations on COVID that are changing over time. But if you follow those guidelines, one thing that would be important is to ensure that your fever is gone. If you're still having a fever, it's very likely you're still contagious. So once your fever has dissipated without the use of any anti-fever medications, and as your symptoms are improving, those would be very good indicators that you are likely heading towards being not contagious any longer.
Melanie Cole, MS: As my last question, I'd like you to summarize for us this triple-demic and how we best can protect ourselves, our loved ones from RSV, COVID, the flu. So, hit us up with vaccines, doc. Tell us about the ones that work for at least a couple of these, you know, we don't have one for RSV yet. But I'd like you to give us your best advice to protect ourselves from really what could overload our immune systems.
Bud Lawrence, MD: You know, that is such a great question. I think in terms of vaccination, listen, getting the flu vaccine is something that we recommend every year. I think it becomes more critical when you have overlapping symptoms with viruses. We've talked about this before, influenza and COVID seem very similar at times, so it's very good to protect yourself against at least influenza. Certainly, there is the newer COVID boosters that can theoretically provide more protection against the current variants that are out there today. So, that is something that has been recommended globally.
So, I think that if you're somebody who is at high risk, I think your decision to vaccinate needs to be your decision to vaccinate. So if you're somebody who's high risk and you feel like that's a good decision for you and your family, then I would say these vaccines are available. They seem to be fairly effective and fairly low. It is something you should consider. If you're somebody who feels that you don't wanna be vaccinated, I would certainly consider, you know, staying away from people who are sick. If you yourself are sick, try and stay away from your family members. Wash your hands. Wear a mask if you're sick to try to keep others from getting sick from you. And of course, stay home from worker school.
The idea is to slow down the transmission of these viruses between people in our population. And so, anything we can do to accomplish that will really help us be successful in sort of not having an overwhelming viral season this winter as it is already looking to be.
Melanie Cole, MS: And bless your heart, Dr. Lawrence. You doctors and the healthcare industry has stepped up like none of us could imagine. And so, I hope that this season is not as bad for you as maybe they're predicting, because maybe hopefully people will listen to this podcast and get this great advice from you. You are so, so knowledgeable and such a great educator. Thank you so much for joining us.
To learn more about COVID-19 the flu or RSV, you can visit the Henry Mayo Newhall Hospital Digital Health Library at library.henrymayo.com. That concludes another episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Please share these shows with your friends and family because we are all learning from the experts at Henry Mayo Newhall Hospital together, and it's all about keeping us safe and healthy. Thanks for listening.
Intro: It's Your Health, a special podcast series presented by Henry Mayo Newhall Hospital. Here's Melanie Cole.
Melanie Cole, MS: Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me today is fan favorite, Dr. Bud Lawrence. He's the Medical Director of Henry Mayo Newhall Hospital's Emergency Department and chairman of Henry Mayo's COVID-19 Response Task Force. He's here to tell us today about the triple-demic. What is that you say? He's going to tell us.
Dr. Lawrence, I'm so glad to have you with us. This triple-demic is an interesting term. Have you seen this uptick in RSV and other respiratory illnesses as we've seen physical distancing and masks and all that stuff go by the wayside? Now, we're starting to see this influx of COVID, RSV, colds, flu, and it's that time of year. So, what have you been seeing?
Bud Lawrence, MD: Well, first off, thank you so much for having me. It's always a pleasure to be part of these podcasts. You're absolutely correct that we are seeing, as some people say, the triple-demic. We are definitely seeing high cases of influenza; RSV, which is respiratory syncytial virus as well as COVID-19. So, usually, we expect to see this increase in viral infections during the winter months, but so far it has been a little bit worse. And part of the reason is that for the past two and a half years or so, people have been wearing masks and essentially not getting sick. So now that people are not wearing masks being outside more, being around other people, we're starting to see the contagiousness of the usual winter viruses rearing its ugly head with a significant amount of veracity.
Melanie Cole, MS: Yeah, boy, it's really starting to happen right now. Now, I'd like you to tell us the difference. Because I think one of the things that we're talking about, obviously this triple-demic, but is this co-infection aspect and how challenging it is to tell the difference between them, and especially like for parents whose kids might get RSV or COVID and they're at school or daycare. Tell us the difference, Dr. Lawrence, between flu, RSV and COVID, some similarities, some differences. How do we know?
Bud Lawrence, MD: That's a great question. So, the first one to start with is the one that people probably know the least about, which is RSV or respiratory syncytial virus. And that is a virus that is really for the majority of our population, almost everyone, it's just like a cold. It's just like any other viral infection that causes a cold. However, in our very, very young and our very old, it can make people much sicker. And particularly, kids that are, say, under the age of two, they can have issues with difficulty breathing, cough, even so much so to the point where they need to be admitted to the hospital for some supportive care. Now, that is not common. Most kids generally get better on their own, but that is something to watch out for. So, the respiratory syncytial tissue virus is going to be more of a respiratory or lung issue.
Influenza is the flu. And that infection is kind of something everyone's familiar with. Muscle aches, fever, headaches, nausea, vomiting, all the usual flu-like symptoms. But the flu is definitely ticking upwards. So, we're seeing more and more flu cases and the symptoms of the flu do overlap somewhat with the COVID symptoms. So, it can be challenging to tell these apart. Particularly at our hospital as well as many hospitals, the test for the flu also includes a test for respiratory syncytial virus and COVID, so we can usually detect all those at the same time.
Melanie Cole, MS: Wow. So then, Dr. Lawrence, what makes RSV a bit more dangerous for our littler kids? And are there certain kids who are going to be more at risk for complications from this?
Bud Lawrence, MD: So, it really is a virus that has its biggest activity on our very, very young children. Anyone from newborn up to two, three years old are really going to be the highest risk. And really what it does is it sets up shop in the lungs and it causes kids to have real significant challenges breathing. Sometimes that can be mild, sometimes that can be more than mild, and sometimes it can be severe. So, every child's going to have a different reaction. But certainly, children who have preexisting lung issues, perhaps somebody who is born prematurely may have a higher likelihood of having an issue with RSV, but it can affect all children and there's an entire spectrum of how sick kids can get. But as I said, for the most part, kids don't get that sick that they need to be in the hospital, that's very rare. But when it does happen, we have the ability to care for that.
Melanie Cole, MS: So, let's talk about transmission then, because we learned a lot about transmission of viruses during COVID, right? We were all hearing about this little virus and how it had really didn't hang around in the air too long. But surfaces, we didn't know, then we knew. Tell us about transmission for these. Are they airborne? Do they live on surfaces a long time? When we're thinking about all three of these things, because we got kids in daycare, in school, a lot of us are back to work, you know, in office spaces. So, tell us about transmission.
Bud Lawrence, MD: The most common mode with this is going to be airborne. I have to say the easiest way to think of this is that the things that you did over COVID to not catch COVID, if you continue to do those things, you will be safer than if you just go about your daily life. Meaning, you know, if you are someone who's very high risk from a lung perspective or from any other perspective, perhaps you want to consider wearing a mask when you're out amongst other people. I think hand washing is and has always been critical in decreasing transmission of viruses, and other things like not touching your face.
And really, one thing we learned during COVID was this idea of, if you are sick, stay home. Stay home from work, stay home from school in an attempt to not get other people sick. And I think that's something that's very important when we consider influenza and RSV, as well as COVID, is that if you are feeling sick, it's probably not the best idea to go to work because that is a way that you can transmit this to others or maybe stay home from school, just, I think, have more attention to that. Those are the important things.
Melanie Cole, MS: I'm so glad you said that because that's really important. Now, for me, I'm somebody who really doesn't want to go out these days. I don't want to go anywhere. So, I'm not going to put myself at risk, but it's just really because I think I've gotten quite lazy about that. But for the people that are going out and maybe they get this stuff, what's about home care? I'm glad you mentioned staying at home because that's really important. But what about home care? What helps? What self care do you recommend, Dr. Lawrence? Do any of these things help nasal congestion, the sneezing, fever, you know, all of those things? I like Vapor Rub too when I was having respiratory things with my kids.
Bud Lawrence, MD: Yeah. There are a lot of over-the-counter remedies. Certainly with influenza, if you can get in within the first couple days, there is Tamiflu, which is a prescription medication that you could receive from your primary care physician. With COVID, there is something called Paxlovid, which has been shown to be helpful. That is a prescription medication you can take at home.
But generally, to answer your question, the usual things like Tylenol and Motrin for fever and muscle aches and headache and staying hydrated, these things are critical. Now, many of the people, if you're listening to this podcast in real time, are going to know that there are significant shortages in over-the-counter remedies that, when you go to a drug store or a supermarket, it may be very challenging to find things that you would otherwise normally use, things like DayQuil, NyQuil, certain throat lozenges. Many of these products are sold out because the amount of people who are dealing with these viral illnesses at this time of year is more so than the supply chains can handle. So, we are seeing an issue with that. I've even gone to the store to get something for a family member to find that the entire aisles are wiped clean, very similar to when COVID first started. So, something to think about. Prepare ahead if you are in the store and you do see some of those items, you may want to pick something up just so you have it at home.
Melanie Cole, MS: That's such great advice. I think one of the big questions people want to know, Dr. Lawrence, is how long are you contagious? We stay at home, we try the supportive care, you know, symptom management, try to make ourselves feel a little bit better. But when do we get the go-ahead? When is it okay to send our kids back to school or daycare? When is it okay to go out? What are we doing?
Bud Lawrence, MD: So, there are three different viruses here and they all act differently. And even within these three different viruses, the contagiousness of every individual is going to be in some large part a factor of how many viruses they have floating around their body in the sense of we call that viral load. And so, somebody with a very high viral load is going to be more contagious than somebody who's not. But generally speaking, you're probably contagious with any of these viruses, even the common cold viruses, for a few days prior to when you get sick to up to four to seven, maybe even eight days after you get sick. Of course, that's variable. And we do have recommendations on COVID that are changing over time. But if you follow those guidelines, one thing that would be important is to ensure that your fever is gone. If you're still having a fever, it's very likely you're still contagious. So once your fever has dissipated without the use of any anti-fever medications, and as your symptoms are improving, those would be very good indicators that you are likely heading towards being not contagious any longer.
Melanie Cole, MS: As my last question, I'd like you to summarize for us this triple-demic and how we best can protect ourselves, our loved ones from RSV, COVID, the flu. So, hit us up with vaccines, doc. Tell us about the ones that work for at least a couple of these, you know, we don't have one for RSV yet. But I'd like you to give us your best advice to protect ourselves from really what could overload our immune systems.
Bud Lawrence, MD: You know, that is such a great question. I think in terms of vaccination, listen, getting the flu vaccine is something that we recommend every year. I think it becomes more critical when you have overlapping symptoms with viruses. We've talked about this before, influenza and COVID seem very similar at times, so it's very good to protect yourself against at least influenza. Certainly, there is the newer COVID boosters that can theoretically provide more protection against the current variants that are out there today. So, that is something that has been recommended globally.
So, I think that if you're somebody who is at high risk, I think your decision to vaccinate needs to be your decision to vaccinate. So if you're somebody who's high risk and you feel like that's a good decision for you and your family, then I would say these vaccines are available. They seem to be fairly effective and fairly low. It is something you should consider. If you're somebody who feels that you don't wanna be vaccinated, I would certainly consider, you know, staying away from people who are sick. If you yourself are sick, try and stay away from your family members. Wash your hands. Wear a mask if you're sick to try to keep others from getting sick from you. And of course, stay home from worker school.
The idea is to slow down the transmission of these viruses between people in our population. And so, anything we can do to accomplish that will really help us be successful in sort of not having an overwhelming viral season this winter as it is already looking to be.
Melanie Cole, MS: And bless your heart, Dr. Lawrence. You doctors and the healthcare industry has stepped up like none of us could imagine. And so, I hope that this season is not as bad for you as maybe they're predicting, because maybe hopefully people will listen to this podcast and get this great advice from you. You are so, so knowledgeable and such a great educator. Thank you so much for joining us.
To learn more about COVID-19 the flu or RSV, you can visit the Henry Mayo Newhall Hospital Digital Health Library at library.henrymayo.com. That concludes another episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Please share these shows with your friends and family because we are all learning from the experts at Henry Mayo Newhall Hospital together, and it's all about keeping us safe and healthy. Thanks for listening.
