Getting through cold and flu season

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Transcript

Chrissy Billau:

Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. I'm your host, Chrissy Billau. Although colder weather has moved in and that means holiday gatherings with friends and family aren't far behind, and along with winter comes a variety of health issues. I'm already hearing on the national news about a nasty trifecta of the flu, COVID and RSV. So our guests this week to have a conversation about what you should be aware of this winter for your family's health is UTMC Chief Medical Officer and Infectious Disease Specialist Dr. Michael Ellis. Dr. Ellis, thank you for taking time to talk with me today.

Michael Ellis:

Thank you. I'm really happy to be here.

Chrissy Billau:

So we're recording this podcast episode in late fall, just before Thanksgiving. I woke up to see a thin layer of snow outside my home this morning, and it feels like a lot of people are starting to get sick as this weather starts to turn. And the timing and volumes seem a little unusual to me, but I am not a doctor. So what are you seeing in our area and at UTMC?

Michael Ellis:

So your observation for the snow is accurate and probably also for the respiratory viruses we're seeing as well. So I'll just kind of summarize some of the key things. Right now we have something called RSV or respiratory syncytial virus circulating, and we have influenza circulating in the community. And right now we're seeing more in particular influenza or flu, and we're seeing more RSV.

Chrissy Billau:

Is this normal? At a normal rate that you would see like last year or the year before? Or maybe, I guess, pre pandemic. I'm not sure how to put that.

Michael Ellis:

So there's a couple of interesting things that are going on right now. First of all, it seems like the influenza season is going to peak earlier. It's starting a little bit earlier. Normally influenza peaks in February on average. Right now, it seems like that peak may come sooner than that. It's hard to tell exactly, but definitely the volume of cases that are being seen around the country is higher than what would be expected on your average flu season.

Chrissy Billau:

Are these the normal health issues that come up in the winter time? What are normal ones that you normally see?

Michael Ellis:

So absolutely this is the time of year when we see respiratory viruses. It's the normal flu season, which normally runs through the spring, really through April and sometimes into May. But there's some interesting wrinkles that Covid has created. And so besides Covid being out there, with the measures that were taken over the last couple of years with Covid, there's some viruses that were kind of muted or tamped down, and now you have a group of children who normally would've seen these viruses a couple years ago, are now seeing them for the first time. So that's probably something that is contributing to not just the frequency of the cases but maybe even the severity.

Chrissy Billau:

So we're talking about the flu season and what kind we're expecting this year. You said it, you expect it to peak earlier. Do you expect it to be much worse in terms of more people coming down with it?

Michael Ellis:

That's a great question. So we expect probably to see more people with influenza this year. How severe that turns out to be, nobody quite knows just yet, but it looks like the season is starting earlier and that there will be probably more cases. Again, that's in part because of just some of the effects of what happened with Covid. We've seen in the southern hemisphere, we kind of take a look at what happens in the southern hemisphere and what their flu season does, and ours seems to be paralleling that right now. The other thing is it seems that nationally there's a lot of vaccine fatigue. Not everyone who might normally have gotten a flu vaccine has gotten one this year. So the uptake of flu vaccines is lower than it usually is, and so you're going to have two things that happen. One is fewer people have generally gotten vaccinated and the flu season is coming earlier. So that's kind of a double whammy, especially if you assume that it takes a couple of weeks for people to ramp up their immune system from a flu vaccine, you could see that you're going to have more vulnerable people in November or December or January than you might normally have had.

Chrissy Billau:

My next question was going to be about flu shots. When should you get them and who in particular should be getting them?

Michael Ellis:

So if you're listening to this, you should get it now is the answer. So it does take a couple weeks to develop effective antibodies. The CDC recommends that anyone over the age of six months gets a flu vaccine. There's some high risk people who should definitely be getting flu vaccines. Immune compromised women who would be pregnant during the flu season, those with respiratory conditions, and definitely those over the age of 65.

Chrissy Billau:

Dr. Ellis, before we get into Covid-19, would you please explain what's the difference in symptoms between Covid, the flu, and the common cold? Because I have no clue anymore. Someone comes down with a respiratory thing and I don't know.

Michael Ellis:

Yeah. Again, I think this goes back to your observation with the snow. You're not going to be able to tell based on the symptoms what kind of respiratory viral pathogen somebody has. Without testing, you're not going to know. There's some general things, but really you can't hang your head on it. There's so much overlap in the symptoms with respiratory viruses that it's hard to say without testing.

Chrissy Billau:

And the Covid ones, you can take those at home and we have a whole stockpile of them, but the flu ones, would you have to go to your doctor for that?

Michael Ellis:

You would have to go to your doctor for that.

Chrissy Billau:

Okay. What kind of Covid-19 season are we expecting?

Michael Ellis:

So it's yet to be seen, and I think again with Covid, it's still such a new virus that we kind of have a tiger by the tail and it's going to do what it's going to do. Right now, the Covid cases, they went up and they've kind of been flat. Sometimes what happens with viruses is one will come through and then the next will come through and then the next will come through. So it's hard to say if you'll have kind of sequential viruses passing through the community or you'll have a lot of them mingling and overlapping. I would expect that we'll have Covid all throughout the winter and then who knows what happens after that.

Chrissy Billau:

Covid-19 boosters. I know you're less than impressed with the flu shot distribution. How is this vaccine distribution going?

Michael Ellis:

So again, it's been reported that people are kind of fatigued when it comes to vaccines, but again, if you're listening to this, you should get a Covid vaccine and you should get a Covid booster. So flu vaccine, Covid vaccine. It may not prevent you from getting an infection, but it definitely prevents you from having severe infection.

Chrissy Billau:

And when you're talking about Covid leveling off, are you talking about local numbers?

Michael Ellis:

Local and national numbers.

Chrissy Billau:

Okay. Where can you get vaccines here and what kind of treatments do we offer at UTMC for Covid-19?

Michael Ellis:

So you can get vaccines for Covid and influenza at your doctor's office here at UTMC. You can get these in the pharmacy, in the outpatient pharmacy. You can get these at local outpatient pharmacies as well. When we talk about these three different viruses, RSV, Covid, and influenza, we have treatments for influenza and for Covid. We really don't have any antiviral treatments for RSV. So for certain individuals who meet the criteria for being at risk for developing severe influenza or Covid, we have therapies. Oral therapies and IV therapies.

Chrissy Billau:

And if you've been vaccinated, if time has gone on and you're like, oh, I wonder if I'm still getting the benefits of this or is it worn off and I need to go back again, how do you know the timing?

Michael Ellis:

The immunity from the vaccine will wane over time depending on when you got the vaccine. The strains of the virus have changed as well. So again, if you're listening to this, you should get a Covid vaccine or a Covid booster, especially if it's been a number of months since your initial vaccination.

Chrissy Billau:

Should you get your booster be the same kind as you had before? Should I stick with Moderna or can you go to a different one?

Michael Ellis:

You can go to a different one and usually it's whatever they have available is what you should go with.

Chrissy Billau:

Okay. Well then moving over to the common cold. This time of year, it feels like it pops up so quickly. Are you seeing a lot of the common cold right now?

Michael Ellis:

So there are a lot of common colds going around. Again, especially because of children who hadn't seen some of these other viruses. So a lot of the common cold viruses are things like rhino viruses. There are viruses like adenovirus that can cause a whole host of different infection syndromes, and then RSV can look like a common cold in your average adult. But in a younger child or an elderly person, they can have more of a severe RSV infection that is going to look more like pneumonia or a bad respiratory tract infection.

Chrissy Billau:

Is it kind of like that cough that won't go away?

Michael Ellis:

Well, so why coughs don't go away is kind of a whole other issue. When people have a viral respiratory tract infection, it can disrupt the lining of the airways. And so those can be very sensitive and they can constrict sometimes. You can be more prone to coughing while your body is healing.

Chrissy Billau:

How concerned should we be about RSV? I know we were talking about kids and adults. I normally think about it just for kids, but adults can get it too. How concerned should we be about that this season?

Michael Ellis:

RSV may be worse this year because your average kid would get exposed to this, but with kids being home from schools and a lot of the other protective measures, the masking, they probably weren't exposed to it, so they don't have much immunity. And so that probably pays a big part into why we're seeing more RSV infections. But again, the kids who are going to be most prone to severe RSV are going to be younger kids, younger than five, and especially infants. And then again, the risk will go up in the elderly. Your average adult will get over RSV in a week or two, and it would be more like your common cold with runny nose and cough and things like that.

Chrissy Billau:

But it's very serious for a child. Enough to go in the hospital and maybe deadly in some cases.

Michael Ellis:

It can be, yes.

Chrissy Billau:

Yeah. Now we're heading into the holiday season. Thanksgiving is right around the corner. What are some ways to stay healthy when gathering with friends and family? Are any precautions we can take when we're all together anymore? We weren't before. You always hear that germs stay in the house if you don't have the windows open, but it's really cold and you can't open them. Does, for example, an air purifier help? So what can you do in your home?

Michael Ellis:

So I think that the fundamentals apply, which are things like coughing or sneezing into your elbow, using tissues and the disposing of them, and then frequent hand washing. The other thing is if you're sick, especially if you have a fever, you should not be around other people. And that's just a courtesy. So a good way to show the people you love that you love them is if you're sick, especially with a fever, you might want to stay away. There's other things that people can do and take extra precautions like wearing a mask.

Chrissy Billau:

And if your kid's sick, keep that kid home and the rest of the family can go. But you really can't bring that kid in that situation.

Michael Ellis:

These are really tough. It's easy for doctors to talk about what people shouldn't do, but where the rubber meets the road and you want to be with your family, you really have to weigh the pros and cons and do whatever you can to make it a good experience for as many people as you can.

Chrissy Billau:

Everybody just wants to be together.

Michael Ellis:

So yeah. Those are tough things that families have to sort out, and I usually advocate for finding the safest way for everybody to get together and enjoy themselves.

Chrissy Billau:

Next question. So say you have come down with something. At what point should you talk to your doctor about your symptoms versus stopping at the pharmacy to get cold medicine?

Michael Ellis:

Wow, that's a great question. So your average person is probably going to be able to weather any of these viruses, but there are times where you would want to get evaluated or get a prescription for something. So fever is a big thing that is going to probably set some of the more mild viral infections apart. So things that would prompt you to go to a doctor. There's markers of severe things. So obviously things like trouble breathing or really feeling unwell, especially in a setting of somebody having risk factors for getting a bad infection that we kind of talked about a little bit with either elderly or immune compromised states and things like that.

The other thing is that if you need to be work, say you have a fever and there's a lot of influenza circulating, which it is now, it would be reasonable to go to your doctor, be tested, and especially early on to get a medication. We would use, for example, oseltamivir or Tamiflu, which are going to shorten your symptoms and allow you to get back to work sooner. That benefit is in the first couple of days. With Covid, pivoting over to C, we really kind of tailor medications for Covid people who are going to have severe disease. So again, your average person, they can usually weather the storm with over the counter medications and staying hydrated and getting extra rest and things like that. But for people who are immune compromised or elderly and have risk factors for developing severe Covid, for example, especially if it's in the first five days, we would have them be evaluated for whether or not they could get an oral medication.

Chrissy Billau:

I know for my family, back in, was it January, omicron went through our house and we were all more bored than anything. We are not the risk people. So yeah. I hear what you're saying there. Personally, when you come down with a cold, what do you do? As the expert. Do you take care of yourself? Is it one of those do as I say, not as I do, and you're so busy and there's a lot of work to be done. Do you stop and take care of yourself?

Michael Ellis:

So doctors are probably some of the worst patients, and they're awful whiny sometimes. And especially men. Men are whiny too. But moving away from me, my personal whininess, you do have to take care of yourself. And some of the best things are rest and drinking plenty of fluids and not trying to eat and things like that. Certainly if you have a fever, that's the big marker right there. The other is obviously if that people in your household have Covid, you have to be mindful of that because you don't want to spread that in your workplace.

Chrissy Billau:

I going to say for people, if you're going to work, how do you avoid spreading things? And I think the number one thing is if you're sick, you don't go in. Use a sick day.

Michael Ellis:

Right. And then the CDC has put out recommendations on what to do if you're exposed to Covid or if you test positive for Covid based on your symptoms and when you're okay to be around people and what you should do in those circumstances.

Chrissy Billau:

And for all the at home tests, our youngest, over the last several years, I've tested him so many times, he's been sick, and he has never tested positive for Covid. I can guarantee you this kid has had it, but I've never been able to test him positive. He's come home from school, they've sent him home, and they're like, well, he has to go to the doctor and get one of those tests, not the at home test. He's negative there. And I don't know if I'm catching him at the wrong time, but sometimes it just is this it doesn't feel like a regular cold. I'm not sure what to do.

Michael Ellis:

Yeah, well the testing is not perfect, and the timing of the testing is important too. And each test has its own limitations and some of the tests can remain positive for a long time. Testing negative for Covid doesn't exclude it, and sometimes the serial testing is needed to confirm that that's the case. So I think almost everybody who's had Covid, which is hundreds of millions of people in the United States, if they were tested, they may have a story that says I tested on Monday and I was negative and I tested on Tuesday morning and I was positive. And so that's kind of the nature of some of these tests.

Chrissy Billau:

Thanksgiving right around the corner here. If I test positive for Covid, how long do I have to be isolated? Not go out.

Michael Ellis:

Yeah. So the CDC recommends that you isolate and stay home for five days. If you have to go out, you should wear a tight fitting mask. And then after that five days, you should then continue to wear a mask when you're in public for another five days.

Chrissy Billau:

And if you do just not feel well and even you're not testing positive, but hey, today's Thanksgiving and my husband's 94 year old grandmother is going to be there, I'm just not going to go.

Michael Ellis:

Yeah. Those are tough decisions. And again, obviously it's going to be safer for the 94 year old for people with respiratory viruses to stay away. I think that in general, people should not worry as much. We've been inundated with so much, so many warnings and so many dangers out there that I think people should focus more on what they can do proactively, things that they can control rather than all the dangers that are being voiced and that we're being bombarded with. And those things are, like we talked about, getting flu vaccine, getting Covid booster, hand hygiene, cough and sneezing etiquette, and those are the things that you can do and you know can go about your daily activities and those are the things you can control. I would focus on those rather than all the things that you can't.

Chrissy Billau:

Every single UTMC expert who's been on this podcast I've asked them the same question, so I'm going to ask it to you as well. What is the most common question you get asked by your patients and what do you tell them?

Michael Ellis:

They do ask me about antibiotics. So they'll ask me about is it harmful for me to take antibiotics? So when it comes to antibiotics, doctors give the right antibiotic for the right amount of time to limit any potential downside or side effect. So if your provider says you need an antibiotic for a certain period of time, that's what you need and do that. So if you need it, you need it. And we'll account for the side effects and the potential downsides. There are complications that you can get from an antibiotic, so we don't give them willy-nilly. And antibiotics can affect your microbiome, the normal bacteria that live inside you and on you, and so we don't want to disrupt that. And the more we learn about that, we know that that can impact things. Especially people can get antibiotic related diarrhea with things like [inaudible 00:23:32]. That can be severe sometimes. So when we give antibiotics, we want to give it for the right reason, the most narrow antibiotic, and for the shortest period of time. So if your provider thinks you need an antibiotic, you can always ask questions and every provider should welcome patients who ask questions. But ask the questions, and if an antibiotics needed, then it's needed, and we're going to try to minimize any downside with that.

Chrissy Billau:

And you have to finish it. Even if you feel better a couple days into it, you have to finish it.

Michael Ellis:

So yes. You should finish the antibiotic that you're prescribed. But again, the doctor or provider's always going to give you the shortest duration so that if the infection can be treated in three days, you're going to get three days. If it's five days, it's going to be five days. If it's 10 days, it's going to be 10 days. But take it for that period of time.

Chrissy Billau:

And we ask everyone else, what have you been working on lately as opposed to all the questions we ask you about.

Michael Ellis:

Over the last couple of years, we've really focused here at UTMC on patient safety and quality, and that's what our team's been focused on. Our Medicare or CMS quality star rating has improved from one star to four stars. So we're now four stars out of five. So our quality has really improved. We're the safest hospital in northwest Ohio. To get to the next level, to get to our fifth star, we're working a lot on our customer service and our patient satisfaction. And a lot of that has to do with the way the providers communicate and making sure that they're answering all the questions that the patients have. Also being available for patients. Patients need you when they need you, and they have questions when they have them, and we have to be focused on being there for the patients when they need us and how they need us. So I'm really happy with the way UTMC has improved our quality over the last few years, and we real close to getting up to that next level, and that next level is focused on improving our customer experience, our patient experience.

Chrissy Billau:

Yeah. UTMC is truly something for the University of Toledo to be very proud of. So if anybody has any of the big respiratory issues happening, the Covid, influenza, RSV, who should they reach out to?

Michael Ellis:

So if people have questions about any of these viruses, RSV, Covid, influenza, the CDC has great resources for general information and guidance on treatments, vaccines, a lot of the preventive measures that we talked about, the isolation measures that we talked about. Another resource here at UTMC would be their primary doctor, primary care provider. Obviously if they're ill and concerned and have any markers of having a bad respiratory tract infection, especially any trouble breathing, then they need to get seen right away, either by their regular doctor or in certain circumstances in the emergency department.

Chrissy Billau:

Well, Dr. Ellis, I know you have a busy schedule, so we greatly appreciate you taking the time to sit down and answer all of our winter health related questions. So thank you.

Michael Ellis:

My pleasure.

Chrissy Billau:

And that's all for this episode of Prescribed Listening. Tune in next time and subscribe for more on Apple Podcasts and Spotify.