At this time last year, many experts were predicting a winter “twindemic” — simultaneous surges of COVID-19 and influenza with the potential to overwhelm an already over-taxed healthcare system. That public health emergency never materialized thanks to continuing COVID precautions and a milder-than-expected flu season, but we probably won’t be as lucky this winter. Flu season is off to an early start in many parts of the country, COVID restrictions are virtually non-existent, and several immune-dodging Omicron variants are on the rise. There’s also been a nationwide surge in pediatric hospitalizations for RSV, or respiratory syncytial virus, a common respiratory virus that usually causes only mild, cold-like symptoms but can be especially serious for some very young children and older adults.
Are we headed for a “tripledemic” this year? What do you need to know about protecting yourself? What should you do if you or a family member gets sick?
Is it COVID-19 or flu?
“Based on symptoms alone, it’s impossible to tell the difference, especially when one first begins feeling ill,” says Chief of Student Health Shawn Ferullo. “Although they are caused by different viruses, both are respiratory illnesses with similar symptoms.” Symptoms of both viruses may include fever, cough, sore throat, runny or stuffy nose, headache, body aches, headache, chills, and fatigue. Some people may have gastrointestinal symptoms as well.
MIT Medical can test for both illnesses and confirm a diagnosis, says Ferullo. Testing could also determine whether someone has both flu and COVID-19 at the same time, he adds, though this is thought to be uncommon. Testing is most important for people who are at high risk of complications from either virus — older adults, individuals of any age with certain underlying medical conditions, and pregnant individuals. Getting treated early for COVID-19 or flu reduces the risk of severe illness, so getting a quick diagnosis is important.
Treatment and prevention
Treatments for flu and COVID-19 differ, but, in both cases, early treatment can reduce symptoms and speed recovery. Treatment may also reduce the risk of respiratory and other complications that could require antibiotics or hospitalization.
- Influenza treatments include several antiviral drugs that are available by prescription. Treatment should begin within two days of becoming sick with flu symptoms.
- COVID-19 treatments include antivirals like Paxlovid, which target specific parts of the virus to stop it from multiplying in the body, and monoclonal antibodies, which help the immune system recognize and respond more effectively to the virus. Treatment should begin within five days of symptom onset for oral antivirals and within seven days for intravenous antiviral treatment or monoclonal antibodies.
Of course, trying to prevent illness in the first place is the best strategy. “That starts with vaccines,” Ferullo emphasizes. “Get this year’s flu shot if you haven’t gotten it already, and make sure you are up to date with your COVID-19 vaccines, including boosters.” Ferullo urges everyone who is eligible to get the latest bivalent booster that is formulated to protect not only against the original strain of the virus but newer Omicron subvariants as well. “While vaccines may not keep you from getting sick at all, especially with the newer, more contagious COVID-19 subvariants on the rise, vaccination is highly effective against severe illness with either COVID-19 or influenza,” he says.
“And masking remains an option for those who want an extra layer of protection,” he adds. “Wearing a well-fitting, high-filtration face mask or respirator in indoor public settings, especially in poorly ventilated locations, provides additional protection against all kinds of respiratory illnesses — influenza, COVID-19, even the common cold.”
What about RSV?
Respiratory syncytial virus (RSV), the third virus in the mix this year, is of special concern to parents of young children. Pre-pandemic, almost all children got RSV at least once before their second birthday. RSV usually produces cold-like symptoms that resolve on their own. But for some children, it can cause more severe infections such as pneumonia or bronchiolitis, an inflammation of the small airways in the lung. RSV is the most common cause of bronchiolitis and pneumonia in infants under a year of age.
Despite news reports of hospital ERs and ICUs overflowing with young patients struggling to breathe, there’s no evidence that this year’s virus is a more virulent strain. “Masking, distancing, remote learning, and other COVID-19 precautions kept RSV transmission to a very low level over the past two years,” notes MIT Medical Pediatrician Ed Levy. “This resulted in fewer very young kids developing immunity to the virus. It’s not that a higher percentage of kids with RSV are getting seriously ill; it’s that far more kids are getting sick with RSV for the first time.”
Prevention and treatment
Levy notes that all children will eventually be exposed to RSV. “But what is different and quite admirable about our MIT population,” he continues, “is that many of the questions we get come from parents who are concerned that their child will spread it to a vulnerable classmate or family member.” This is a legitimate concern, he notes. While most children will have only mild illness from an RSV infection, others are at higher risk. This includes very young infants, older infants who were born prematurely and are receiving ongoing support for lung disease, and children who are undergoing chemotherapy or are otherwise immune suppressed. RSV can also lead to serious infections in older adults.
“RSV spreads much like the common cold virus,” Levy explains. “There is thought to be more droplet-based transmission with RSV than with COVID-19, so handwashing and cleaning surfaces becomes more important.”
Children who are not sick enough to be hospitalized are not given antiviral medications for RSV, and since most children do not get seriously ill, clinicians do not routinely test for the virus, notes MIT Medical Pediatrician Rosemarie Roqué Gordon. In most cases, parents can help a child feel more comfortable by doing what they would do for any bad cold. For infants and children older than six months, acetaminophen or ibuprofen can be used to reduce low-grade fevers. For infants, the American Academy of Pediatrics recommends:
- Nasal saline with gentle suctioning to allow easier breathing and feeding,
- Cool-mist humidifier to help break up mucus and allow easier breathing, and
- Fluids and frequent feedings to make sure the child is staying hydrated.
“In general,” Gordon says, “whether an infection is due to RSV or any other virus, parents should get in touch with us immediately if their infant or toddler is breathing very quickly, or if there is a lot of extra work going into breathing for the child. In this case, the parent would see the child’s belly moving up and down with extra effort and sometimes see a sort of caving in of the space above the sternum. If a child’s cough or rapid breathing is interfering with the child’s ability to feed, that should also prompt an immediate call.”
Keeping our community safe
Whatever this winter brings, Ferullo is confident that MIT Medical and the MIT community are prepared. “We’ve shown that we are prepared to do what we need to do to take care of each other and protect our most vulnerable community members,” he says. “And MIT Medical’s patients should know that we are just a phone call or portal message away if you need us.”
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