- [Announcer] The region's premier medical information program, "Call The Doctor."

- It's the heart of the winter season, the holidays are over, skiers are making their plans and it seems like everybody is sick with something.

This is an infectious time of year with people mostly indoors, nothing new there.

But in the past few months we've had not only flu and COVID19 to worry about, but also RSV.

How do we determine what that cough or headache really means?

We turn to the professionals to find out what they're seeing right now to get some clarity about when or when not to worry, what to keep in mind about wintertime illnesses in this episode of "Call The Doctor."

So glad you are with us for this brand new season of Call The Doctor."

Let's get right to tonight's panelists.

I am joined by Dr. Riddhi Shah and Dr. Swathi Gowtham.

And I would love for them to tell us a little bit about themselves.

So Dr. Shah, we'll start with you.

Thank you so much for being here.

- Thank you for having me.

I grew up in New York and completed my internal medicine residency training in Connecticut, and have lived in Pennsylvania since 2018, and I'm working as a hospitalist, both as a locum and a per diem hospitalist.

- All right, very good.

What about you Dr. Gowtham?

- Thank you for having me.

I'm a pediatric infectious disease specialist, at Geisinger in Danville, Pennsylvania.

I've been with Geisinger for about nine years.

I trained at Rutgers University for my medical school degree and for my residency in pediatrics, and I did my infectious diseases fellowship at Johns Hopkins in Baltimore.

- Great.

Welcome to both of you, it's been great talking with you so far.

We were chatting a little bit off the set here, but I'd like to get right into, like we can start with RSV, I think we probably should only because of the three major viral illnesses we were talking about, that's the one I think people know the least about even though it's been around for a while.

So we'll start with you 'cause I think we see this a lot in pediatrics, right?

- That is correct.

So even pre-COVID we used to see a lot of RSV.

RSV season generally used to start for us pre-COVID from November until the end of March in Pennsylvania for example.

And a lot of the hospitalizations used to occur in children under six months of age in particular, and under a year of age generally tend to get more severe disease.

By the time a child is two years of age, 90% of them have seen RSV.

So what was especially different with COVID was that in 2020 everybody was practicing social distancing and wearing masks, etc, and we saw zero RSV in 2020.

And in 2021 we started to see again an unusual season.

And in 2022 we started to see pretty large numbers as things started opening up a little bit more.

So not only were we seeing the under six months of age children being hospitalized as we normally would in any other RSV season, but we're also seeing two and three year olds who have never seen RSV before and don't have that immunity as well, and so that was what was overwhelming the hospitals.

And this is not unusual, people predicted this back in 2020 'cause sometimes when we see a milder respiratory season, either with flu or with RSV, the next season generally tends to be a lot worse because there are just overall rates of immunity within the community are a little bit lower.

So nothing unusual to worry about.

That being said, some people are like maybe we should not have done masking and all those things, now we're kind of, that was one of the downsides.

My perspective on that would be if we didn't do those things then we would've dealt with all the RSV, all the flu in 2020, as well as be overwhelmed with a new virus that nobody knew what to do with.

So at least with RSV, at least with flu, and now with COVID we kind of know what to do, how to treat patients, etc.

- What does it stand for?

- So it's respiratory syncytial virus.

- I've never really heard that said out loud.

- Yes, yes.

- And Dr. Shah, do adults also get RSV or is that something we only see in kids?

- We have so many respiratory illnesses in adults, but RSV unfortunately is not one of them.

So there's the COVID, there's the flu, the metapneumoviruses, the rhino viruses, the respiratory viral panels that we have in hospitals are very good at testing up to 20 different viruses, and it can tell you right off the bat what it is we're dealing with so we can offer the appropriate therapeutics.

- Was this region hit very hard with RSV more than other regions?

I mean anecdotally is it hard to say so far?

- All parts of the country were pretty hit hard.

Generally, it starts out in the South in Florida and then kind of moves up.

As you remember in Connecticut, people had to call the national garden, 'cause a lot of the hospitals were overwhelmed.

And that again, that's not unusual because there's very few pediatric ICU beds compared to adult ICU beds across the state.

So for example, as I was saying before, with Wilkes-Barre and Scranton, we have like 15 ICU beds down in Danville for children.

So we don't generally have Wilkes-Barre general doesn't have regular pediatric ICU beds even though it has a NICU.

So that's what's kind of overwhelming the system.

- So you mentioned the testing and I kind of wanna go back to that.

There's not one test for RSV versus one test for a different kind of virus, it's one test that can get all of it done at once?

- Yeah, so it's a nasal swab or a nasopharyngeal swab where you just goes in the nose and then within a few minutes you have an answer as to what it is that you're dealing with.

There's the extended respiratory viral panel which can test up to 20 different viruses, and then there's the condensed version which can look at flu COVID and RSV.

- Is that on the decline now, RSV?

Have we seen- I know we saw an uptick a few months ago, are you still seeing that in the hospitals?

- So there's definitely been a decline.

So once you get RSV in the first part of the season, the chances of you getting hospitalized from RSV are less than 0.5% if you're a child.

So when we saw the big peak with RSV, we knew as pediatric infectious disease doctors that eventually that was gonna get better, what we were bracing for was influenza to happen as well.

So yes, one can get RSV multiple times, but to be hospitalized from RSV in the same season is rare.

- So I'm at home and the typical person, couple, family, whatever, and someone says I have a cough and a sore throat and a headache or a runny nose, or any number of these very common symptoms, what are people to do?

Is there a way to figure out, or is there something that we should know at home before we call the doctor?

Or is that what we're just supposed to do if we have one of these issues to immediately find out what it is.

I'd love your perspective from a public health perspective on how informed we need to be about what that minor symptom might be.

I'll start with you Dr. Shah.

- I think it's really important to balance personal safety with public health.

And I think that while you can manage some of your symptoms at home with Tylenol and fluids and vitamin C and all of those other things, it's definitely worth it to get a nasal swab just to see what exactly you're dealing with to see if there's a risk of spreading this to other people.

- So you would recommend that swab, is that something that you could do at your regular doctor's office?

- Absolutely.

- And I'll let you answer that as well.

- Yeah, I'm pretty much a swabber.

- All about it.

- Yeah exactly all about it.

'Cause not only can you get an answer, but there's, as we said before, there's therapeutics that we could offer.

So for influenza, if you present within 48 hours, we give you Tamiflu to make sure that it doesn't turn into anything else.

With COVID it's also very important to balance that public health aspect to make sure that you're not spreading it to others.

And even pre-COVID, we as infectious disease doctors, not that anybody would listen to us, used to say, if you're sick, try to stay away from other people, don't have that party, don't go visit your grandparents, don't go visit that newborn.

So just common sense stuff that you would do still apply.

- Did the pandemic, did COVID19 change the way, in your opinion, people deal with things like that?

Do you find that they are listening more often, less likely to go out in public, or perhaps are they more inclined to be vaccinated?

I mean do you think that those couple of years changed the way people feel about viruses in general?

Dr. Shah?

- I think there's been a lot more vaccine hesitancy now than there was a couple of years ago.

I think people are less inclined to get vaccines, they're less inclined to get repeated vaccines, and I think that part of the thinking is, well if I'm gonna get COVID anyway because everyone else is getting it, what good is this vaccine going to do?

And I think that's where it's worth reiterating to people that, yes this is cold and flu season, all of these viruses are spread via droplets but getting a vaccine is a relatively inexpensive, hassle-free way to prevent risk of hospitalization, risk of severe disease, all those other things.

- But the more hesitancy rather more hesitancy and fewer people getting vaccines, or you think there's a possibility?

- Yeah, I definitely agree with Dr. Shah.

There's actually studies to show that flu vaccine rates in particular have dropped post COVID.

So that hesitancy that is there and the mistrust that's there regarding the COVID vaccine has spread into other other illnesses.

And when we talk about vaccinations and respiratory illnesses, let's not forget like we're also seeing with the viruses, we're seeing some bacterial infections, particularly in children.

So we're seeing a lot of group A strep, I'm sure you've heard of that, like the CDC had put out a call saying that there's been a rise of cases of the group A strep.

Group A strep is a bacteria that causes strep throat but it can also cause bloodstream infections and pneumonia.

So we're seeing a lot of that post COVID, just getting the viral illness initially and the virus and bacteria kind of play together a little bit, so they'll destroy the mucus membranes of your nose where the bacteria usually lives and allow the bacteria to go down into your lungs and cause issues.

So that's happened before COVID and with all these other viruses come back, all the secondary bacterial infections that we've been seeing have also risen.

So I also say not just the COVID vaccine, don't forget about your regular vaccinations.

There's a vaccine for pneumonia, so there's obviously the vaccine for influenza.

In particular, I wanna emphasize because we're seeing a lot of hospitalizations under six months of age, the babies may not be as protected with their vaccines 'cause they haven't gotten their primary series of all their vaccines yet.

So it's really important for pregnant women to get vaccinated, particularly for influenza 'cause you need to be about six months old to start your influenza vaccine.

So pregnant women, what moms do for their babies is that they transfer all of their immunity to their babies through the placenta.

So vaccinating pregnant women for pertussis and influenza is part of, even pre-COVID and now COVID vaccine has also been added to that.

And so particularly for influenza and pertussis, pregnant women should definitely get vaccinated as well.

- If you get one of of these viruses, these so-called wintertime illnesses and your immune system takes a little bit of a hit, are you more likely to get the others as well?

Is there anything to, once you're down then more of them are able to get in, or is that not necessarily the case?

They're separate viruses and they all affect you differently?

- Yeah, that's a myth that when you have a virus, your immune system's down, and you're more vulnerable for other viruses.

Your immune system- Viruses do definitely alter your immune system a little bit and that's very transient or temporary, and all viruses kind of do that to kind of escape your immune system a little bit.

So you'll see a decrease in what we say are a white blood cell count and things like that, and those come back up normally.

And people have said like COVID decreases your immune system and so far the studies have not panned out that it truly decreases your immune system, because these viruses, as I said, existed before.

And when you actually look at the studies, your immune system comes right back if you're a healthy person.

That being said, COVID can cause probably hyper inflammatory states where there's a lot of inflammation, that has nothing to do with your low immune system or anything like that, that mainly has to do with the long COVID and other stuff like MIS-C. which is the myocarditis that we were initially seeing in children.

But that's completely different from a low immune system and we don't think COVID causes any low immune systems.

- Dr. Shah, what about flu?

I was getting tempted to say regular old flu, but not to minimize it, I know flu can be very, very dangerous, but what have we seen so far in flu this year?

- This year has been a really, really bad year for the flu.

The virus peaked at a much higher level in terms of number of cases and much sooner than it has in previous years.

Coupled with vaccine hesitancy, with an older population in this area, people who have history of smoking, or asthma or other lung disease, that's a setup for really severe infection and hospitalization.

What we've been telling people is to get vaccinated.

The thinking behind the flu vaccine is that your body creates this antigen library, meaning that over a period of years you get the flu vaccine every year and then your body can say, oh well you know, the 2030 flu was just like that vaccine I got 10 years ago and it remembers how to treat it and it prevents severe illness.

So it goes back to it's important to get it every year just so you have that future benefit of the vaccine as well, so to speak.

- You said it peaked early, about when was that or we're over that now?

- We are definitely over that hump.

It's trending down but we were looking at mid-December where it peaked.

- Were you concerned if this is mid-December and now no one has gotten together yet for all of their holiday celebrations, was there concern maybe at the hospital level, now what happens if this gets worse?

- Absolutely.

We were anticipating it would get worse with people getting together for the holidays and especially because I can tell you now a month later that, that was a peak and things trended downwards, but we didn't know where that inflection point was going to be at the time.

- Mm, you were nodding as well.

- I would agree, yeah.

So, most of the flu right now has been influenza A, there's still influenza B, although we like you to get your flu vaccine before the flu season starts, generally by October, by end of October we like you- That's the best time to get your flu vaccine.

It's still not too late to get your flu vaccine.

So there are other strains of flu that the vaccine protects you from just 'cause you had flu with one strain, it's kind of like the COVID variant, there's different strains.

The vaccine protects you from four different strains, two of influenza A and influenza B, so generally influenza B happens later on, so we'll have to see what that does.

- So B, there could be something coming with influenza B that we don't- I mean it's only early February here so.

- Yeah, correct, correct.

So we just still have to see.

So that's why we test and that's how we monitor.

- We were talking about, we talked earlier about what happened this winter, what happened this winter, flu, RSV COVID, all of it all at once.

What will you take from this winter?

Either you personally, or you and your departments wherever you are, what will you take from this winter on?

What lessons are there to be learned, either at your level, or what you would like parents and other people to know?

- I can't overstress the importance of hand washing.

It sounds so simple, but just washing your hands frequently, especially if you're going out.

All the grocery stores in this area have been great, they have little hand sanitizers at the entrances, they have little wipes for the carts, things like that that you can do.

But I think the main lesson from COVID that we have learned working in healthcare is don't ignore symptoms.

Don't just say, oh this is a little cold and show up to work and run the risk of getting your colleagues or your patients sick.

- Yeah, I definitely would agree with that as well.

Yeah, I'm still a proponent of masking and vaccinations to prevent severe disease.

RSV generally is from contaminated surfaces, so definitely hand washing is key to that.

But influenza and COVID and some of the other respiratory viruses are mainly through coughing and sneezing.

So the respiratory etiquette, teaching your child if you're a parent on how to cough into your elbow.

Again, the common sense stuff that we kind of talked about, if you're sick, try not to visit people and spread your illness.

And particularly be really careful with those that are high risk, again, your grandparents, the babies, pregnant women, you really wanna be careful.

- I know a lot of people are really tired of hearing about COVID19, but it is still out there, it is still infecting people and affecting people.

I wanted to talk about the status of COVID as you see it now.

What are you seeing there?

- I think it's appropriate when people refer to this as a tripledemic.

The winters are always cold and flu season, flu has always been around, different strains of COVID have been around, the coronaviruses have been around not just COVID19, and then you have enteroviruses, rhino viruses, things along those lines.

COVID has continued to evolve and I think that mentally people are tired of hearing about it because how long can you be on guard against one particular thing that you may not fully understand, or you've never experienced, or you've never seen in front of you.

But it's still very much there.

Unfortunately people are still getting hospitalized with it.

There are people whose bodies don't necessarily produce the necessary immune response to the vaccines, and so absolutely vaccination is definitely the key moving forwards.

- Are you seeing people get as sick still?

- I haven't seen anyone in an ICU recently with COVID like we were seeing a couple years ago.

But you're still seeing COVID affecting people's quality of life and having long-term effects as far as still difficulty breathing, prolonged fatigue, prolonged joint digs.

And there's a lot as far as this inflammatory cascade that happens with COVID that leads to these prolonged symptoms that we still don't fully understand.

- We touched on that just a little bit, if masking and the pandemic for those few years was enough to really shake up RSVs two years down the line, who knows what we're about to see in the coming years?

I suppose no one can answer that question, but, is there something that you can plan for, or is it waiting to see like the rest of us?

- So as a pediatric infectious disease doctor, there's always gonna be a new virus.

I'm always gonna be in business.

Viruses mutate, they're strange, and the like the most replicated virus, the virus that mutates and spread faster is the one that's gonna survive.

So with all the different variants that we've seen with COVID, you have the omicron variant and the XBB of the omicron variant, and a lot of people just kind of like don't pay attention to that.

But what I really care about are hospitalizations.

So if you get a little bit of a cold, that's fine, and as long as you're not spreading it to other people, that's great and you recover well, that's wonderful.

But hospitalizations, overwhelming the hospital system as we talked about, there's very few pediatric ICU beds as compared to adult ICU beds.

So that is gonna be key.

And just this week we've had a two month old baby with COVID19 in the ICU, with a group A strep pneumonia on top of that.

- Oh.

- So again, COVID still exists.

All the children that I can tell you that have been hospitalized due to COVID are either too young to be vaccinated, under six months of age, or they have not been vaccinated.

So we have not seen hospitalizations, even with just the primary series of those first two shots.

In children who get those primary series, we haven't seen hospitalizations in them.

- Is the treatment different for someone who is six months old, or six years old?

Is it different just no matter where you are throughout your life?

- Well, some of the drugs that are approved for adults like Paxlovid, is just a great drug that prevents hospitalizations, is 12 and older and above like 40 kilos.

So we don't have great data in using it in younger populations.

Things like Remdesivir, which is another antiviral agent that we give to people that are hospitalized, under like, again 12, it's just kind of hard, there's not that great data.

So the options are a little bit more limited and we try to do our best.

- So there is something you can take if you've determined it's COVID, what about for flu?

- For flu, there's Tamiflu, you can call up your primary care doctor and get Tamiflu, take that at home, and given within a short amount of time from a positive test, it actually does decrease symptom severity and your risk of hospitalization.

- Do you have to get to it early in the infection?

Is there a window where you- - It's 24 to 48 hours.

- Yeah.

- So another reason to call the doctor kind of early, really.

- Right.

- And just get tested, 'cause there's something that you can do about it if it's early.

Same thing with COVID, if you're a high risk person and high risk of being hospitalized, if you have preexisting medical condition, there's paxlovid, and most people don't know that.

So you can get it within four days of symptom onset, that's the best way it works and actually prevents hospitalization.

- So with these last few minutes, I'm just curious if people are watching this and what's the one message you would love them to get?

Wintertime illnesses are gonna happen, everybody in the broader it seems has some sort of sickness here.

But what would you like people to know most of all?

- I have so much respect for all the primary care doctors in this area who are pushing for people to get vaccinated, to prevent not just the this round of disease, but any future disease.

And while you're at it, just make sure you're up to date on all of your age appropriate cancer screening as well.

- Just keep up on it.

- Yeah.

- Before there's a problem, get there.

- Yeah.

- And what would you say to that Dr. Gowtham?

- The same thing at preventative care is very important, screens are important, seeing your doctor's important, getting medicine, getting tested, like paxlovid and Tamiflu before things become too late is very important.

Pregnant women getting their vaccines and seeing, talking to their OBGYNs, if you have any questions about the safety of the vaccine or how the vaccines work, please go to your doctor and try to get information on that.

A great website to kind of go to is if you Google CHOP vaccine education center, it goes through all the childhood vaccines, including COVID vaccine and influenza.

And it goes through every ingredient, what the disease does and how the vaccine protects you.

So that's something that I give as a resource for parents.

And it's really, really important to make sure your child is up to date on everything.

- And I guess it might be a silly question, but if say as a parent you've determined, okay, good, it's not flu, it's not COVID or RSV, it's one of the viruses that pops up every winter.

Is it as simple as what we're all used to hearing, you stay at home, you drink your tea, fluids and rest.

How do you best tell people to take care of themselves at home?

- Sleep hygiene is very important.

Getting appropriate sleep, taking medications to help with symptoms, whether it's cough medications, fever medications, lots of fluids.

You wanna make sure you're eating and drinking and giving your body the fuel it needs to fight this infection really.

- So those are all pretty simple steps.

- Pretty simple steps.

And kids, I would add, signs of respiratory distress.

So when the baby's not breathing right, so if you see muscles of the neck and of the chest being used, the baby's breathing fast, there's sometimes blue color around the mouth, you really have to call 911.

Don't put the baby in the back of your car and drive to the nearest emergency room, no matter how close the emergency room is.

If the baby's having trouble breathing, just call 911.

The ambulance can give you oxygen and give you the necessary meds, the EMTs can do that, you can't do that at the back of the car.

- Better care- - Yeah.

- While you're getting to the care that you need.

- [Dr. Gowtham] Correct, exactly.

- Well, I really wanna thank you both for being here.

It was an interesting conversation and I think you've eased our minds a little bit, at least as we try to get through the rest of this winter.

That's gonna do it for this episode of "Call The Doctor."

We are so glad that you joined us.

If by chance there's something you missed, something you wanna listen to over again, you will find this entire show at our website, WVIA.org, as well as episodes from the past to check out out if you like.

All you have to do is click on watch and then "Call The Doctor."

You can also find us on the WVIA mobile app.

I'm Julie Sidoni thanks again for watching and for all of us here at WVIA, we'll see you next time.

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