We are seeing an uptick in RSV and the flu in the Northern Hemisphere and particularly in the United States. Given an anticipated uptick in COVID-19, the media is coining this the “triple threat.” Here is the current state of affairs and what it means for you.
I'm curious to hear more about what you make of the COVID 'calming down' we're seeing in Europe and the unexpected smaller wave in Singapore. I know Germany had implemented some enhanced NPIs, but it seems those were too recent to have a material effect on the infection curve? What can we make of these seemingly better than expected trends and is it possible to extrapolate anything to what might happen in the US in the coming months?
Thanks so much Katelyn, I am a school district medical director and have shamelessly re-worded and quoted from your post for a school website announcement. I gave you the credit today and I give you SO much credit every day for the great work you are doing.
Thank you for this update. Passing this along in case it's helpful to others.
I got my flu shot Monday, two weeks after my covid booster. The pharmacist entered the room with a long thin syringe. I said, "Just double checking that you're giving me the *flu* shot today." The pharmacist blinked, disappeared, and returned with a short fat syringe. Pharmacists are busy people - never hurts to confirm with them which shot they're giving you.
I am going to my physical in about an hour, and will get my flu vaccine then. My insurance does not cover the vaccine in a pharmacy, only a doctors office, which I find baffling. Wouldn't it be cheaper for them to have it done at a pharmacy? And that extra hurdle - go t the doctor or pay ca. $50 out of pocket - might be just the thing that keeps people from getting it. Which in turn would mean more expenses for the insurance company?
There is no mask wearing in schools right now at least in Texas, especially with the little ones as they need to see our mouths to develop their language. It appears (no data) that more kids are struggling developmentally with their language and social/emotional growth. In the classroom it feels like we are addressing it at every turn. What can we do? I am going to try the "Clearmask" as it claims to be FDA approved and fingers crossed it does not fog! How do we balance building our immune systems with safe practices? I am guessing vaccines AND IF TRUE WHY IS THERE SO MUCH PUSH BACK?
A simple word of thanks seems inadequate for your insightful and invaluable posts, which have truly added so much to public knowledge during this pandemic! I just wanted to comment that there is a "vaccine" (as the public generally understands the term) for RSV, by the brand name of Synagis. It is a monoclonal antibody, so confers passive immunity, and therefore it is not technically a vaccine, as it does not stimulate our own antibody production. However, it is so expensive that it is only available to premature infants born at or before 35 weeks of gestation who will be 6 months or younger during the RSV "season", which isn't even a thing anymore! Nevertheless, this technology exists and maybe we will someday figure out how to lower the cost.
Re: RSV - a respiratory virus.....not thought to be transmitted primarily as an aerosol/airborne. I have difficulty understanding that "older" assessment and current advice for prevention. It seems intuitive that masking should be the norm as well as hand washing and PPEs. If the infection is seasonal, then I would personally advocate masking if/when RSV is reported in the community. Not really addressing JMoore's concerns for learning in the school setting, I would not downplay masking in general. Masking really is not a big inconvenience. Annoying a bit, sure. My reviews of the "clear masks" as a stop-gap for language instructions hasn't been very positive. Fogging because there is no porosity appears to be the issue, but I would defer to more knowledgeable folks. What about HEPA air filtering, ductwork UV-C devices?
Quite a surprise… Of course, unknown if these hybrids will pose any threat or will be unable to function well, and there will have been years in the past when such co-existence in people’s lungs occurred without emergence of chimeras… Still, potentially very important to know can happen in case a future one in the population is successful:
Coinfection by influenza A virus and respiratory syncytial virus produces hybrid virus particles
24 October 2022
Abstract
Interactions between respiratory viruses during infection affect transmission dynamics and clinical outcomes. To identify and characterize virus–virus interactions at the cellular level, we coinfected human lung cells with influenza A virus (IAV) and respiratory syncytial virus (RSV)...
Locally in San Diego influenza is surging exponentially but the sickest kids have RSV or rhino/enterovirus. ED wait times exceed 8 hours. Wish media would encourage parents to seek care if their kids are having trouble breathing or other severe symptoms and not go to the ER for mild URI, athlete’s foot, etc
Should we be asking our pediatricians to test for RSV? Was at doctor's with my 3yo w/2-day 103+ fever and cough. They tested for covid (negative) but nothing else (RSV, flu).
Regardless, we just keep following the school/CDC guidelines (stay home 24-hours after fever and until cough starts to improve, stay home if cough worsens).
Wise choices those boosters and the masking...no brainer as far as I'm concerned. Those that decry the common sense approach, are, well, you know........
I live near Birmingham, Alabama and the Children’s Hospital there is slammed with RSV patients. They’re converting some areas of the hospital to add patient rooms and using announcements on the news and online asking people to use the urgent care clinics if their child has fever but is not having difficulty breathing.
Heard you say you were the only one at a conference wearing a mask. I'm usually the only one wearing one - your example helped me to buck peer pressure. Yeah, even old ladies feel that pressure. Thanks.
Molnupiravir is known to work for flu and covid. If it turns out to work for RSV, what are the implications for testing? Could it be prescribed based solely on local prevalence and symptom severity?
For us, this just means we continue doing what we've been doing for three years now. I think this is the New Normal and we can either accept it or pretend it's not true and roll loaded dice. Getting our latest boosters this afternoon at the local Walgreen's.
I'm curious to hear more about what you make of the COVID 'calming down' we're seeing in Europe and the unexpected smaller wave in Singapore. I know Germany had implemented some enhanced NPIs, but it seems those were too recent to have a material effect on the infection curve? What can we make of these seemingly better than expected trends and is it possible to extrapolate anything to what might happen in the US in the coming months?
Thanks so much Katelyn, I am a school district medical director and have shamelessly re-worded and quoted from your post for a school website announcement. I gave you the credit today and I give you SO much credit every day for the great work you are doing.
Ann Engelland, MD. aengelland@gmail.com
Thank you for this update. Passing this along in case it's helpful to others.
I got my flu shot Monday, two weeks after my covid booster. The pharmacist entered the room with a long thin syringe. I said, "Just double checking that you're giving me the *flu* shot today." The pharmacist blinked, disappeared, and returned with a short fat syringe. Pharmacists are busy people - never hurts to confirm with them which shot they're giving you.
I am going to my physical in about an hour, and will get my flu vaccine then. My insurance does not cover the vaccine in a pharmacy, only a doctors office, which I find baffling. Wouldn't it be cheaper for them to have it done at a pharmacy? And that extra hurdle - go t the doctor or pay ca. $50 out of pocket - might be just the thing that keeps people from getting it. Which in turn would mean more expenses for the insurance company?
There is no mask wearing in schools right now at least in Texas, especially with the little ones as they need to see our mouths to develop their language. It appears (no data) that more kids are struggling developmentally with their language and social/emotional growth. In the classroom it feels like we are addressing it at every turn. What can we do? I am going to try the "Clearmask" as it claims to be FDA approved and fingers crossed it does not fog! How do we balance building our immune systems with safe practices? I am guessing vaccines AND IF TRUE WHY IS THERE SO MUCH PUSH BACK?
A simple word of thanks seems inadequate for your insightful and invaluable posts, which have truly added so much to public knowledge during this pandemic! I just wanted to comment that there is a "vaccine" (as the public generally understands the term) for RSV, by the brand name of Synagis. It is a monoclonal antibody, so confers passive immunity, and therefore it is not technically a vaccine, as it does not stimulate our own antibody production. However, it is so expensive that it is only available to premature infants born at or before 35 weeks of gestation who will be 6 months or younger during the RSV "season", which isn't even a thing anymore! Nevertheless, this technology exists and maybe we will someday figure out how to lower the cost.
Re: RSV - a respiratory virus.....not thought to be transmitted primarily as an aerosol/airborne. I have difficulty understanding that "older" assessment and current advice for prevention. It seems intuitive that masking should be the norm as well as hand washing and PPEs. If the infection is seasonal, then I would personally advocate masking if/when RSV is reported in the community. Not really addressing JMoore's concerns for learning in the school setting, I would not downplay masking in general. Masking really is not a big inconvenience. Annoying a bit, sure. My reviews of the "clear masks" as a stop-gap for language instructions hasn't been very positive. Fogging because there is no porosity appears to be the issue, but I would defer to more knowledgeable folks. What about HEPA air filtering, ductwork UV-C devices?
Quite a surprise… Of course, unknown if these hybrids will pose any threat or will be unable to function well, and there will have been years in the past when such co-existence in people’s lungs occurred without emergence of chimeras… Still, potentially very important to know can happen in case a future one in the population is successful:
https://www.nature.com/articles/s41564-022-01242-5
Coinfection by influenza A virus and respiratory syncytial virus produces hybrid virus particles
24 October 2022
Abstract
Interactions between respiratory viruses during infection affect transmission dynamics and clinical outcomes. To identify and characterize virus–virus interactions at the cellular level, we coinfected human lung cells with influenza A virus (IAV) and respiratory syncytial virus (RSV)...
Locally in San Diego influenza is surging exponentially but the sickest kids have RSV or rhino/enterovirus. ED wait times exceed 8 hours. Wish media would encourage parents to seek care if their kids are having trouble breathing or other severe symptoms and not go to the ER for mild URI, athlete’s foot, etc
Should we be asking our pediatricians to test for RSV? Was at doctor's with my 3yo w/2-day 103+ fever and cough. They tested for covid (negative) but nothing else (RSV, flu).
Regardless, we just keep following the school/CDC guidelines (stay home 24-hours after fever and until cough starts to improve, stay home if cough worsens).
Wise choices those boosters and the masking...no brainer as far as I'm concerned. Those that decry the common sense approach, are, well, you know........
I live near Birmingham, Alabama and the Children’s Hospital there is slammed with RSV patients. They’re converting some areas of the hospital to add patient rooms and using announcements on the news and online asking people to use the urgent care clinics if their child has fever but is not having difficulty breathing.
Heard you say you were the only one at a conference wearing a mask. I'm usually the only one wearing one - your example helped me to buck peer pressure. Yeah, even old ladies feel that pressure. Thanks.
Molnupiravir is known to work for flu and covid. If it turns out to work for RSV, what are the implications for testing? Could it be prescribed based solely on local prevalence and symptom severity?
What hypotheses are offered for the surge in viral outbreaks in 2022? Are we just better at detecting cases?
For us, this just means we continue doing what we've been doing for three years now. I think this is the New Normal and we can either accept it or pretend it's not true and roll loaded dice. Getting our latest boosters this afternoon at the local Walgreen's.