Fall and Winter Respiratory Ailments Await

Whether it’s cold or flu, COVID or RSV, get ready for what seems like a growing number of respiratory illnesses this fall and winter. How do we recognize them, how do we react to symptoms, how do we treat them, and how can we reduce their likelihood in the first place? We ask UConn Health infectious diseases experts Nancy Dupont and Dr. David Banach that and more.

(September 2024, Nancy Dupont, Dr. David Banach, Carolyn Pennington, Chris DeFrancesco)

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Transcript

Chris: You’re congested and coughing. Remember when the question was, “Cold or flu? “ Not anymore. Today on the Pulse, we try to get a handle on the different respiratory ailments that lurk in the fall and winter.

This is the UConn Health Pulse, a podcast to help you get to know UConn health and its people a little better, and ideally leave you with some health information you’ll find useful. With Carolyn Pennington, I’m Chris DeFrancesco. COVID, RSV, flu —

Carolyn: — and not just regular flu, we’ve got bird flu too. Plus, whooping cough seems to be making a comeback, you’ve got pneumonia, bronchitis, sinus infections, how do we recognize and manage them, and what do we do to prevent the spread?

To provide some insight, we’ve invited two infectious disease experts from UConn Health to join us: Nancy DuPont, nursing director of epidemiology and infection control, and Dr. David Banach, hospital epidemiologist. Thank you both for being here today.

So, we can dig into the different respiratory illnesses, but first, with so much potentially going around, let’s start with the best practices to reduce the spread of these ailments in general, and I think, Nancy, that’s a perfect question for you.

Nancy Dupont: Thank you, Carolyn. Yes, there’s a lot of things that we could do that are really basic just to prevent the transmission of infection. Obviously, when one isn’t feeling well or you know that people you may be seeing have an illness or are sick, you want to restrain from going to those functions with the people. And you yourself, if you’re sick, you want to stay home and be mindful of who you may be exposing.

Of course, I have to say that hand-washing is one of the best ways to prevent transmission of infection. And I think hand-washing is important because it helps to eliminate the potential pathogens on your hands. And hand sanitizer is recommended as well. Also, the fact that we don’t realize how often we touch our eyes or face, nose, and mouth, even when we’re eating something. You want to be very mindful of that. And that’s when the accidental exposures, self exposures, occur.

Carolyn: What about masks? It seems to be kind of all over the place with people wearing masks.

Nancy Dupont: Well, one thing I can say is that we really saw very positive effect for when we had our mandatory masking protocol. However, it does become burdensome sometimes. And I think that the quality of the mask really plays into it, meaning that if you’re wearing a cloth mask or a bandana, obviously, it’s not going to be as protective as a medical grade procedure mask would be. And also, as we see, oftentimes people are wearing them incorrectly, below their nose, around their neck, and I understand sometimes people just need a break, but really, you’re defeating the purpose when you don’t have it on appropriately.

Carolyn: But heading into the winter, if you do feel like you’re kind of coming down with something, you don’t know what exactly, is it best to wear a mask just in case? Or what would you recommend?

Nancy Dupont: I think it’s prudent to wear a mask. And frankly, if there are, if we’re moving into a very high-risk season, or we see the prevalence increasing, it may be that people would like to wear a mask just to prevent their exposures as well.

Chris: One of the interesting things I found about when we were in the height of the pandemic was, especially early on, we were encouraging people to cover your cough and wash your hands. And we as a culture, I think, for the most part, did a better job collectively of doing that. But that’s really good advice no matter what you’re dealing with, right?

Nancy Dupont: That’s excellent advice and actually there’s a campaign, it’s called cough etiquette, and all of those components are put together, reminders in the outpatient waiting rooms to provide tissues, a trash barrel close by, cover your cough and use hand sanitizer afterwards.

Carolyn: Cough into your

Nancy Dupont: Sleeve.

Carolyn: Sleeve, that’s right. Yes

Nancy Dupont: I actually see a lot of children doing that now. So they must be getting an education.

Carolyn: Oh, that’s very positive.

Chris: Alright, preventing the spread, we just covered that. What about preventing, or trying to prevent, obtaining the different battery, and we’ll get to the different ones, but just in general, preventive medicine, i.e. vaccination?

Dr. David Banach: Well, I think vaccine is really a key piece of protecting against these infections. I echo all of the points that Nancy made, I think, in terms of general infection prevention. I think they’re all very relevant for respiratory virus season and even other infections as well.

But when we think about respiratory viruses, really vaccines are becoming a critical part of our toolkit in preventing infections, particularly among those who are at the highest risk for more severe infections.

Chris: And the big ones this time of year, influenza, COVID could really go year round, but there’s a new version of it coming out as we speak. And then certain people are eligible for the RSV. So let’s break down that. First of all, what’s the word on the latest version of the COVID shot?

Dr. David Banach: Sure. So there is an updated formulation vaccine to help protecting against the more recent circulating variants, particularly the KP variant that circulated during the spring and into the summer. So the updated formulation, which is now the 24-25 seasonal. vaccine is now available. It’s available through the three different products that were previously available, so Pfizer BioNTech product, Moderna, and Novavax. And now that’s becoming available in the retail pharmacies, and even here at UConn Health we have COVID vaccines that are available for our patients.

Carolyn: How quickly though does the strain change? Because I’m thinking I want to wait a little longer before I get it because I’m thinking maybe they’ll come out with another vaccine like in the middle of winter and that might be better to take the shot then.

Dr. David Banach: I think that’s a great point. What we’ve seen with COVID, similar to other coronaviruses, is that they do mutate. That’s why we get these new variants that are circulating. I think the vaccine producers tend to, they try to do their best with keeping up with the more recently circulating variants, but unfortunately due to the lag time that’s needed to produce vaccine, it’s never going to be in real time.

But I think that’s the benefit of this updated COVID vaccine, that it does include the more recently circulating variants. But I think we’re going to continue to see these vaccines evolve in future years to try to match circulating variants, similar to what we see with flu vaccines that try to match the circulating flu strains each season.

Carolyn: Do you feel like if you’ve had COVID a few times, especially in the summertime, do you need to get a vaccine or do you have enough immunity?

Dr. David Banach: I think that’s a great question. I think what we’ve seen is that both vaccine and prior infection do offer some degree of immunity. We do know that the immunity does wane over time. That’s probably very variable from person to person. There’s some thinking that older individuals may have a quicker waning of that immunity. So I think when it comes to vaccine, some factors to consider for the COVID vaccine are your risk factors, so, folks who are older, at higher risk, those individuals should be prioritized for vaccination. Those who because of their medical conditions are at higher risk should be prioritized for vaccination. And those people who had a recent COVID infection, they probably have some protective immunity, at least in the short term, so maybe they would be sort of less prioritized when it comes to who needs a vaccine sooner rather than waiting a little bit longer to go ahead and get the updated COVID vaccine.

Carolyn: For people that are afraid of vaccines, is there really anything — because it has been around now for the COVID vaccine, right, for a few years — anything that’s showing that it could be dangerous to put another vaccine in your body?

Dr. David Banach: Well, I think when it comes to all vaccines, we have to be mindful of what we see in terms of safety and efficacy. And the safety for the COVID vaccines has held up well. There are situations where people get a very robust immune response, often get symptomatic after COVID vaccine, and many people have experienced that.

Chris: But that means it’s working, right?

Dr. David Banach: Yeah, I mean, that’s an indication that you’re generating that robust immune response, which is needed for protection as well. But so different people do experience different symptoms after vaccination, but in general the preponderance of data shows that these vaccines, in terms of effectiveness and safety, are holding up.

I think it’s something that we continue to look at, collect more data as it comes out on the vaccines. And we’ll have to see how this moves in the future. But I think the overwhelming data really supports safety and efficacy for the vaccines.

Chris: The recommendation, though, is to get the updated COVID vaccine after a certain distance from your previous one or from your previous infection, is that the prevailing wisdom?

Dr. David Banach: Yeah. So the CDC just issued its recommendation, which is very broad, a recommendation for COVID vaccine for almost all individuals from age I think six months, I believe is the lower threshold, and up. I do think about this in a way to kind of prioritize who it’s most important for, and really, it’s those older individuals, and individuals who have those higher-risk medical conditions. Those are really the priority for when it comes to the COVID vaccine.

Chris: And for flu vaccine, the standard recommendations apply year to year. This year, anything different, Nancy, this year?

Nancy Dupont: Not to my knowledge. We’re actually not seeing very much flu right now, but as we know over the years, the flu season has extended. But in terms of the recommendations for the flu vaccine, I think that it’s remained pretty stable.

Chris: And ideally by Halloween is kind of the benchmark for that, for most people?

Dr. David Banach: Yeah, the CDC recommends vaccination by the end of October. That’s not to say that if you don’t get a vaccine by then, you shouldn’t still get one later on, in November or December. Typically, I think in recent years, November is when we start to see flu activity really increase, and the idea is to get your vaccine a little bit before that time period when cases start to really increase.

But that’s always difficult to predict; it varies a lot season to season, so we’ll see. But yeah, the general Gestalt is, the end of October is really what we should be shooting for.

Chris: And RSV, that’s a more limited segment of the population for that one, right?

Dr. David Banach: Yeah, so RSV is really mostly targeted towards older individuals, so age over 70 is really the focus for RSV. That one’s a little different; there’s no recommendation now for repeated vaccine. So if you got your RSV vaccine last year, you don’t need to get any subsequent vaccines at this point. That recommendation could change in the future. That’s another area where there’s ongoing study.

But at this point, if you’re over 70, it’s recommended to get that RSV vaccine as a one-time vaccine. And then for those who are in a younger age group, depending on medical conditions, you might be a candidate for RSV vaccine. So it’s something to discuss with your health care provider.

Chris: So what do we need to watch for with all the different versions of respiratory illness: COVID, flu, RSV, avian flu, then I guess other ones we mentioned like bronchitis and pneumonia might be byproducts of these things, sinus infections? I mean, obviously, it’s going to be a case-by-case basis for everybody, but are there general things that folks should watch out for to kind of know, “OK, this is just stay home, fluids, rest, and be by myself for several days “ versus “This is, I got to bring my kid to the urgent care “?

Dr. David Banach: I think these are great questions. There’s certainly a lot of overlap between the different viruses. And then you mentioned bacterial pneumonia, bacterial sinusitis, also something to consider. I think the general principles are kind of the same. If you’re sick, really stay home. If you need to go out, do, take some extra measures, like wear a mask if you’re still symptomatic and you’re going out with any of these infections.

If your symptoms don’t get better quickly, reaching out to your health care provider to determine if you need any additional testing. In some situations, if there’s a bacterial infection, antibiotics would be needed. But I think that’s the kind of discussion that you’d want to have with your health care provider if your symptoms aren’t getting better.

Chris: And telemedicine can help with this too, right? Like it maybe put a little bit less of a strain on the health care system. Maybe there’s enough people who can kind of wait it out at home as long as there’s like a breathing crisis that requires an emergent situation. And we can kind of see after a couple days where it goes and whether an antibiotic is appropriate or something else?

Dr. David Banach: Yeah, I think telecommunication, certainly during the COVID pandemic, proved to be an effective way to provide health care in these kinds of situations. I think in some situations, um, an in-person visit with the health care provider may not necessarily be needed, particularly if it’s with a health care provider that you know well, that you can communicate pretty readily with, that may not require an in person visit. But I think reaching out to your primary care doctor or your health care provider is sort of the first step to determine whether or not a more detailed or in-person visit is needed.

Carolyn: How about moving on to dispel some of the myths that we’ve all heard many times? Nancy, I know this is your favorite: I’m afraid I’m going to get the flu from getting the flu shot.

Nancy Dupont: That is something we hear frequently and actually have done grand rounds on this, et cetera, after sending out a survey, a very interesting survey that was sent out to our more high-risk outpatient areas and our staff as well. And interestingly enough, If they had the same answers to the question: they’re afraid they’ll get the flu from the flu shot. I think one subtlety that we miss oftentimes is that even if you do get the flu, you may have lesser symptoms if you’ve had the flu shot. So it may not be a hundred percent effective, but it would still prove to lessen the severity of the illness itself.

Chris: Which in theory also might make you a little less contagious, and might help with the spread a little bit? Or no?

Dr. David Banach: So, yeah, I think these are important questions, and Nancy’s point about flu and the vaccine protecting against a more severe infection seems to apply to COVID and RSV as well. So really the goal of the vaccines isn’t to necessarily prevent all infections, that would be ideal, but it’s really to prevent just more severe infections and hospitalization and mortality from these different viruses.

Nancy Dupont: I also think that something that happens once in a while is, people may have had a previous exposure and have been incubating the flu and they just, it’s coincidental that they get the influenza immunization and develop the flu shortly after. So in their minds, it’s clearly that it seems a natural reaction that they got the flu from the flu shot, which we know as untrue, but it’s a coincidental occurrence.

Chris: Sounds like people who waited too long to get their flu shot to me.

Nancy Dupont: Absolutely.

Chris: All right, so wash your hands, stay home if you’re sick, take the recommendations on your vaccines, be ready to call the doctor and do some telemedicine to figure out kind of what it is you’re dealing with, and be ready to take a more urgent step afterward if the situation warrants.

And Nancy, you did a fantastic video about hand-washing technique a couple years ago. We’re going to include that among the links that we put in our show notes today.

Nancy Dupont: Well, thank you.

Chris: Along with the latest CDC recommendations and information about influenza as well. Dr. David Banach. Nancy Dupont from UConn Health, thank you so much for being our guests today.

Nancy Dupont: Thank you.

Dr. David Banach: Thank you.

Chris: That is our time for today, and for Nancy Dupont and Dr. David Banach and Carolyn Pennington, I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe so you can catch us next time, and please share with a friend.