• Tue. Dec 6th, 2022

A message from the Center for Closing the Health Gap

By Clyde E. Henderson, MD

Cincinnati Medical Association

With all the current focus on other respiratory viruses one might again get the impression that COVID-19 is through with us, although many voiced that they are “through with COVID-19.” The data shows that the USA is still seeing a two-week running average of 39,090 cases per day (up 3% vs two weeks ago) along with the unfortunate 345 deaths per day (down 6% over two weeks). Hospitalizations have risen 2% to a level of 27,161 day. The USA maintains the dubious distinction of leading the world with 97.6 million known cases and 1,071,578 deaths. Be reminded that the actual number of cases is much higher because of the level of home testing in our country. The CDC’s Community Level of Covid-19 remains LOW for the nine counties composing the Greater Cincinnati Area.

Health news is sensationally and rightfully dominated by the respiratory syncytial (sin-sish-ul) virus, RSV. This virus was first identified in 1955, so it clearly is not new. What is new is the timing and the ferocity of the current outbreak. Cincinnati Children’s Hospital Medical Center’s emergency rooms and urgent care facilities have been overrun with patients requiring treatment for at least the last two weeks.  Hospital admissions have spiked in Cleveland, Columbus, and Toledo. Across the country pediatric intensive care units are at or over capacity in 23 states. The peak impact of this virus in previous years has been seen in the late fall and winter seasons. This early fall surge is not only sooner than usual, but the infants and young toddlers being affected are sicker than usual and requiring more healthcare services.  The virus also affects adults especially those who are immunocompromised and those with preexisting conditions such as COPD, asthma, and congestive heart failure. Reportedly, RSV is responsible for over 14,000 deaths per year in US adults.

RSV is an extremely common respiratory virus. The vast majority of children have been infected by this virus by the age of 2. Although symptoms can range from mild cold-like symptoms to high fever and severe difficulty breathing, most children have little difficulty recovering from exposure and illness. Babies under the age of one year old are the ones who more frequently experience the severe course.  The diagnosis is made when symptoms are present and confirmed by a nasopharyngeal swab test. Infected individuals can spread this extremely contagious disease for two days before and 3-8 days after they are diagnosed. The virus is spread not only through the air, but also through direct contact such as shaking hands. The virus can stay alive for hours on hard surfaces as well. Treatment is symptomatic and depends on the severity of the clinical presentation. There is an antiviral which can be given preventatively for susceptible children.

Influenza is the third virus of concern at this current time. Flu season typically runs from early October through late May. The very important news to know is that the CDC is recommending that everyone 6 months and older get an annual flu vaccination. Those citizens 65 years of age and older should get a vaccine that is different than younger adults. Even though it is recommended that the annual flu vaccine be given before the end of October, vaccination at this time, early November, is likely to be effective in preventing severe disease and death. The CDC specifically recommends one of the following three vaccines for individuals 65 and older: Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine or the Fluad Quadrivalent adjuvanted flu vaccine. If one of these is not available, then a standard flu vaccine is preferable to none at all.

Last Fall and Winter we were concerned about a “twindemic” but now we are vexed by a “Tripledemic,” so to speak. When COVID-19 was raging, there was more Wearing of masks, Washing of hands, and Watching our distance. The paucity of influenza deaths and the absence of raging RSV last year should make us consider these measures as helpful. We know that the COVID-19 and flu vaccines can reduce deaths and severe disease. A vaccine for RSV is in clinical trials. Please get the available vaccines and consider wearing a mask.