Common winter illnesses can be tricky to tell apart
Transcript
Host Amber Smith: Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, with the podcast that features experts from Central New York's only academic medical center.
I'm your host, Amber Smith.
When someone is sick this time of year with a cough, maybe a fever, maybe body aches or congestion, it's tricky even for doctors to tell whether it's COVID or the flu or something else. Here to explain is the chief of infectious disease at Upstate, Dr. Elizabeth Asiago Reddy.
Welcome back to "The Informed Patient," Dr. Asiago Reddy.
Elizabeth Asiago Reddy, MD: Thank you, Amber. It's great to be here.
Host Amber Smith: Let's first talk in the aggregate about how each of these respiratory diseases are distinguished. Do you want to start with COVID?
Elizabeth Asiago Reddy, MD: Sure. 所以我认为重要的信息是,实际上是测试让我们能够区分这些病毒, one from the other. The symptoms between them are so similar that for any given patient, we really can't guarantee what they might have just based on their symptoms. So it is testing that allows us to distinguish them.
Host Amber Smith: Does it matter then if it's COVID or flu or whatever? I mean, are they all treated the same?
Elizabeth Asiago Reddy, MD: Great question. When I talk to my patients, and they call into our practice, saying, "I feel sick. I have an upper respiratory infection,“我正试图弄清楚我是否应该带他们来做测试,或者他们应该做什么样的测试. And the few things that I think are especially important are, do they have something that I could treat?
OK, so that's No. 1. And we do have some treatments for COVID and flu, 所以这是我想知道的一件事,以确定他们是否适合治疗. And then also, are they around people who might be at high risk if they were to have specific infection? So let's say that I know my patient is a caregiver to their elderly parent, and now they're telling me, oh, they have these respiratory symptoms. So not only am I thinking about what might be going on with them, but whether or not they might be placing their parent at risk. And specifically in that scenario, I'm thinking about COVID, which has an outsized risk for elderly patients compared to other viruses, even.
Host Amber Smith: So respiratory viruses, COVID, flu, RSV, and maybe there's others. Which one is the worst to get?
Elizabeth Asiago Reddy, MD: It really depends on what age group you're in and what underlying conditions you have. So we've been hearing a lot about COVID, flu and RSV, and generally speaking, those are the worst, and that's why we're hearing the most about them.
There's a lot of dedication towards trying to prevent them, trying to treat them, et cetera, 但是任何已知的呼吸道病毒都可能是非常糟糕的,特别是对免疫功能低下的人来说. But those three are generally the worst. And specifically, sometimes, as I kind of alluded to before, there are age groups that might be most especially impacted.
So for young infants, RSV is really a big danger situation. 我们对呼吸道合胞病毒疫苗或预防措施的很多研究和努力都是针对这个年轻群体的. That's the individuals who are most likely to end up in the hospital, have very severe outcomes as infants, especially less than 1 year old, but including up to less than 2 years old.
And then, for COVID, it's been the opposite in elderly individuals, and it just goes up exponentially every 10-year blocks of age, so 60-year-olds, 70-year-olds, 80-year-olds, et cetera. They are at heavily increased risk of bad outcomes from COVID.
Now, that has changed a little bit with COVID as we've had increased access to vaccines and treatment. But if you look at the broad spectrum of the pandemic from the beginning, older individuals have been very severely impacted.
Host Amber Smith: Is that true with influenza as well?
Elizabeth Asiago Reddy, MD: Influenza is a little bit more of a biphasic age impacter, in that the youngest and the oldest are going to be the most severely impacted.
But people across the age spectrum can get very sick from the flu, and also similar to COVID, people with immune-compromising conditions can also get very sick with the flu.
Host Amber Smith: Can you explain what a "triple-demic" is and why infectious disease experts are concerned about it?
Elizabeth Asiago Reddy, MD: Yes. So last year was the year where we really saw all three of these pathogens take the big stage together.
Prior to that, at the beginning of COVID, of course, we implemented a lot of measures, including masking and social distancing that reduced our risk of acquiring other respiratory infections. 因此,在我们对COVID实施这些预防措施的这段时间里,我们看到流感和RSV显著减少.
So entering the fall of 2022, so about a year and a half ago, people were dropping those preventative measures as we found the risk of death from COVID to be dropping. We had ways to treat COVID. We had ways to prevent COVID. More people had been exposed to COVID, so it was not as dangerous as it had been, and we said, OK, it's time to open things up.
And when we did that, 我们发现,我们的免疫系统并没有接触到这些病原体,而我们可能在某种程度上接触到了这些病原体, typically, on a regular basis. And so we did end up in a situation of a triple-demic last year, and particularly our RSV, I would say was really heavily impactful last year. There was a very early peak in RSV infections in children and hospitals. Many of the pediatric hospitals were really struggling even to find beds, including in our area. We had to expand the network of hospitals that were taking children during the fall last year. And then influenza last year also experienced a very early peak.
And so by this time last year, we were almost done with our flu peak already. We had a really high peak, around November, December, that was more shifted towards the earlier fall than what we would normally see. And of course we still had a lot of people sick with COVID, so that was really the triple-demic that we experienced last year.
We are experiencing it again this year. 就我们在COVID之前几年可能看到的情况而言,它似乎遵循了RSV和流感的更正常模式, but of course now we have COVID added into the mix.
Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.
I'm talking with Dr. Elizabeth Asiago Reddy, the chief of infectious disease at Upstate Medical University.
所以我很好奇这些呼吸系统疾病,以及它们在世界各地是否遵循相同的季节性模式, or if they vary depending on the different cultures in the different countries. Because I've always wondered, is it the temperature or the climate that influences the spread of the disease, or is it the human behavior that may be tied to the weather that influences the spread?
Elizabeth Asiago Reddy, MD: It looks like it's both, 流感是最典型的例子,因为我们看到南半球的流感高峰发生在北半球的夏天, and then it flip-flops during our Northern Hemisphere winter, then they're done with their flu and enjoying the nice weather in the Southern Hemisphere.
That one we can say is definitely highly weather related. 它也与候鸟的模式有关,因为我们看到影响人类的流感毒株可能来自鸟类, and birds are following patterns of migrating from the south to the north. Again, some of this is going to be impacted by climate change in the future, but those are the typical patterns that we see.
So, I would say influenza is a very classic weather-related example, but behavior does play a role, 因此,我们在美国COVID感染期间最具影响力的时期看到的一件事是,在一年中最热的几个月里,南方各州经常经历COVID的大幅飙升,因为人们聚集在室内,打开空调.
And so Florida, Texas, 亚利桑那州在7月和8月出现了严重的高峰,这在其他呼吸道感染中并不常见. And I think that was definitely behavior related in terms of congregating indoors. Of course, that is an impact of the weather, but then also was impacted by the immunological naivete (lack of exposure) of our systems at the time, that we just didn't have the background immunity to fight it off.
Host Amber Smith: 似乎大多数出现呼吸系统疾病症状的人永远不会知道那是什么, so how do they go about, at home, taking care of themselves if they've got a fever or body aches or a cough, and they know they're sick? What do you recommend? Are there any over-the-counter medicines or any practices that they should follow?
Elizabeth Asiago Reddy, MD: I know you said people are never going to know what they have. Hopefully, we can talk a little bit about COVID home testing during this conversation.
But I'll go back to the question about how to treat your symptoms. These are really like the time-tested types of interventions, such as taking acetaminophen for fevers, taking lots of fluids, especially non-sweetened beverages, water, tea, giving yourself the time to get some extra rest.
If you have a cough, dextromethorphan, which is the ingredient, and I guess the most commonly known brand name would be Robitussin (cough syrup). That definitely can be helpful for people who have bad coughs.
Pseudoephedrine can be helpful to clear out the sinuses in people who have a lot of sinus congestion, although it can raise blood pressure for people who have blood pressure issues, 所以当你在柜台买药的时候你可以看一些替代药物上面会说, a lot of times, "suitable for people with high blood pressure."
And that's usually Mucinex. It's suitable for people with high blood pressure, though its efficacy, I would say, is a little bit more questionable. Pseudoephedrine is definitely very effective.
For anyone who uses the nasal sprays, it is important to keep in mind that nasal sprays can be highly effective. So over-the-counter nasal sprays, such as Afrin, which is a pseudoephedrine-based nasal spray, can be highly effective in reducing congestion, but it's extremely important to follow the instructions of only using them for a few days. 三天真的应该是最多的,因为如果你长时间习惯了,它们实际上会使你的症状恶化.
Host Amber Smith: You brought up the home testing kit for COVID. Do we still need to do that? Is that still something that needs to be on our minds?
Elizabeth Asiago Reddy, MD: Yes. I think these still do play a role, and they can be helpful. The most important thing to remember is that they are excellent at detecting a true positive, meaning that if you have symptoms that you suspect are related to COVID, and you take a COVID test, and you get those two lines, it looks positive, then in all great likelihood you have COVID. That is considered to be a dead ringer for a positive test, that we really think would be a true positive. It's very, very, very rare that you would have a false positive, almost negligibly rare.
A false negative, on the other hand, is pretty common. And this is why I feel like a lot of people get confused, so that, if I have symptoms that I'm concerned might be COVID, and I take a COVID test at home, and it's negative, there's still a 20% to 30% chance that I actually do have COVID.
So, I think people are catching up on the idea of retesting. That can help. If you test every day for three days, that can help to try and determine whether or not you truly have COVID, but it still doesn't reach the accuracy of a PCR test.
So why is this important? It's important for those people who are age 60 and up, or who have severe immune-compromising conditions who may benefit from one of the therapies for COVID, so an oral outpatient therapy, such as nirmatrelvir (with) ritonavir, which is known as Paxlovid. 我认为,对于某些确实有发展为严重COVID风险的高风险人群来说,这仍然发挥着作用. 因此,这些人应该试着弄清楚他们是否真的患有COVID,因为他们可能会从治疗中受益.
And unfortunately COVID is the only test that we have regularly available for outpatient use. There have been flu tests designed and strep throat tests that have been designed, but they have not really reached heavy circulation, the way COVID tests have.
Host Amber Smith: For people who are home sick, how long should it take before they start feeling better?
And are there any red flags that would tell them they really should see their doctor?
Elizabeth Asiago Reddy, MD: Yes. Most of these illnesses, your first five days are going to be the worst. And it's still not unusual, especially for COVID and flu, for people to feel quite poorly for five days, be spending a lot of time in bed, be having fevers, but after that five-day mark, and a lot of times, even after the three-day mark, symptoms should start to improve, especially now that, like I said, we do have a little bit better background immunity to these infections.
But every person is different, so there are people, unfortunately, who are still having a couple of weeks of symptoms from either COVID or flu. Whether or not you got recent vaccinations might impact that, 所以最近接种过流感或COVID疫苗的人很可能患有较轻的疾病, compared to someone who's not been recently vaccinated.
And then, 人们可能在后台拥有的其他类型的条件可能会影响他们疾病的严重程度.
What should you be worried about?
Certainly shortness of breath is a big red flag. We worry about any of these respiratory illnesses progressing to pneumonia. So what they usually cause is sinusitis, bronchitis, laryngitis. Those are all upper-respiratory infections. They haven't gone down into your lungs. But when you start to feel short of breath, we worry that the infection has gone down into the lungs, and that is a signal of pneumonia. That's dangerous, potentially dangerous, and should be evaluated by your provider. And certainly if somebody's severely short of breath, by an emergency physician.
And then, other things, really inability to keep down anything. So sometimes, COVID or flu could be associated with gastrointestinal symptoms. If you really can't eat, you can't drink, you're becoming dehydrated, especially in the setting of fevers going on as well, then that would be another reason to seek medical attention.
Chest pain would be concerning. So, 如果你在呼吸时感到胸痛,或者在任何时候感到胸痛,那就不会消失, that's disturbing to you, that would also be concerning.
I think those are really the major red flags that you would definitely want to give your provider a call. Or if it's very severe, go to the ED (emergency department).
Host Amber Smith: So what is done for someone who comes to the emergency department with a respiratory illness?
Maybe they do have shortness of breath or some chest pain along with it, and they've been sick for more than five days. What is done for them there? Do you test right away to see what virus it is?
Elizabeth Asiago Reddy, MD: We do the respiratory virus panel (tests) as part of routine care at Upstate. A lot of other places may not have the full panel, but they may have a rapid test for COVID, flu and RSV that will help to distinguish what's going on, at least, as we've talked about, for ones that are the most severe.
And then, you would also want to determine whether the person could possibly have a bacterial pneumonia, 这将是一系列的体征和症状,包括胸部x光检查和检查他们的情况, the severity of their illness. And if someone is considered to be at risk for having a bacterial infection, that would be something that would need to be treated with antibiotics.
Host Amber Smith: Well, let's talk about prevention. Are there vaccines available for adults and children for flu and COVID and RSV?
Elizabeth Asiago Reddy, MD: Yes, there are. So, RSV, there's a little subtlety to that answer, but I'll just go through them individually.
COVID is available for all age groups, starting at 6 months, and it has this year been formulated into a new formulation that is covering Omicron strains only. So it doesn't have any of the old strains of COVID in it, which is the first time that's been the case for the COVID vaccines. And we have the three major COVID vaccines available are Moderna, Pfizer and Novavax.
And Novavax is the only one that is a protein-based vaccine, so there's no mRNA, and that's what some people still find concerning. So those are the main COVID vaccines. And it's very simple because the vast majority of people would just need to be updated with one shot. 所以对于那些可能已经接种过疫苗或处于严重免疫损害状况的幼儿来说,也有一些例外.
And then, for influenza, the very similar situation, age 6 months and up is recommended to have an annual flu shot, and the vaccine formulation changes a little bit depending on age groups, and some younger age groups may be eligible for a nasal flu vaccine.
And then, for RSV, this is where there are some subtle differences. So for infants, 有一种单克隆抗体输注是专门为年龄最小的婴儿提供的,这些婴儿在年幼的时候可能会经历RSV季节. So the problem with that has been availability. It's highly effective, but it was impacted by lower availability than what was predicted in terms of the demand for it. So I think that one is now being reserved for infants who have immune-compromising conditions.
And then, for older adults, 60-plus, there are two new RSV vaccines. So I mentioned when I spoke about RSV that infants are at the highest risk, and that is the case, but also older individuals can experience very severe RSV infection, including RSV pneumonia. If you do end up in the hospital with RSV as an older adult, your risk of death is actually very high. So most of the people still aren't going to end up in the hospital, but if you do get to the point where RSV has driven you into the hospital, that is actually a very bad and dangerous situation.
The RSV vaccines are a single dose at this point for those individuals who are eligible, age 60 and up. And it is across the board. There's no specific conditions that you would need to have in order to be eligible. It's just based on age. And at this point, there is not a clear recommendation for any future vaccines. We need to give it some time to pan out and see. The studies have shown that at least through two years, it's offering good protection.
Host Amber Smith: Now what about pneumonia? Is there a vaccine for that?
Elizabeth Asiago Reddy, MD: A lot of people will hear their providers mention the pneumonia shot. 肺炎疫苗实际上指的是用来预防肺炎球菌性肺炎的疫苗.
So pneumococcal pneumonia is caused by a bacteria called Streptococcus pneumoniae. And for many, many years it was by far and away the most common cause of bacterial pneumonia. That actually changed with the advent of the vaccine. So it remains an important cause of bacterial pneumonia, and it can also cause other types of severe infections, including things like meningitis and bloodstream infections.
But the universal use of the vaccine, because it's also offered in children, 疫苗的普遍使用实际上已经改变了现状,因此它不像以前那么常见了, but it's still there as a risk, and it can make people very, very, very sick. So what has happened is that over the last several years, 肺炎疫苗已经有了不同的迭代,涵盖了被认为会导致严重疾病的其他血清型(菌株). So most recently, we have a vaccine that actually covers 20 different serotypes, and individuals who have immunocompromising conditions, and this is pretty broad, to include things like diabetes and heart disease, or anybody age 65 and up, should be getting a dose of that vaccine.
Host Amber Smith: In addition to vaccination, during the COVID pandemic, we heard so much about hand sanitizers and masking. 在呼吸道病毒流行的季节,你还会建议人们做这些事情来保持健康吗?
Elizabeth Asiago Reddy, MD: Absolutely. Those are definitely still very important components of keeping yourself healthy, obviously. Washing your hands, across the board, 尽管我们发现COVID不像其他病毒那样倾向于通过表面接触传播. There are plenty of viruses, including the common cold virus, rhinovirus, that is its most efficient mode of spread, is by touching things.
So, washing your hands, 100%. It'll prevent a lot of what might make you sick.
Masking, we have re-implemented masking in hospitals. Why have we done that? We really only had a very brief time where we weren't wearing masks most of the time, and they came back online. 我们这么做是因为很多住院的病人都有严重的免疫问题. 很明显,医院的条件是人们彼此非常接近. So, if you're a nurse working with a patient, you have to move them in bed, you have to help clean them, you have to give them medications where you're very close by. Many of our patients are still sharing rooms in the hospital.
So, for all of those reasons, it becomes a lot more important in those environments, where we have so many high-risk people, to be extra cautious.
But definitely, for anybody who has conditions that put them at increased risk of getting sick from respiratory infections, we've been able to show that masking is effective. I definitely counter the kind of notorious, I'm going to say it's notorious now in my medical field, Cochrane study that said that masking was not effective.
It's effective. There's so much other evidence to show that masking is effective. It really is. And there's different levels to which it can be effective depending on the type of mask that you're using, but it is a very viable option to reduce the risk of catching a respiratory infection, 这也是一个非常可行的选择,以减少传播呼吸道感染的风险,如果你有一个,你碰巧出去的地方.
Host Amber Smith: Well, Dr. Asiago Reddy, I appreciate you making time for this interview. Thank you.
Elizabeth Asiago Reddy, MD: Thank you. It's great to talk with you, and stay safe.
Host Amber Smith: My guest has been Dr. Elizabeth Asiago Reddy. She's the chief of infectious disease at Upstate.
"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.
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