Given that we are living through THREE global health emergencies (COVID, polio, and monkeypox), new vaccines are being approved, new outbreaks are occurring, and the reality that being healthy is indeed a radical selfless act of loving others (read: we need to redefine what it means to be healthy), “Three Things Thursday” highlights three things I am paying attention to as an epidemiologist each week.
Hoping these posts help to educate and empower you
to be healthy and create healthy communities.
The news this week is full of stories about new variants, new vaccines, and new worries (all discussed in detail below). The tripledemic — COVID, influenza, and RSV — could easily be our next normal; something we will face each winter in years to come. And while the science is important and the news cycle is endless, there are steps we can each take to protect ourselves from illness and break the chain of transmission when we are sick. If we want to create healthy communities, we all must commit to —
Get vaccinated.
We all need to receive our COVID-19 booster (3-4 months after your last shot or most recent infection) and our annual flu vaccine. The new COVID booster is proving to be highly effective against severe illness and death. And the flu shot reduces the risk of being admitted to the ICU by 82%.Stay home when you are sick.
As we are facing a tripledemic, there is no such thing as just a sore throat or just a little cough. A cough, sore throat, headache, fever, and runny nose are all symptoms of the three diseases behind this tripledemic. Regardless of what virus is causing your symptoms, it is best to stay home until you have been symptom-free (without medication) for at least 48 hours. And when you return to work/school be sure to wear a mask for a couple of days to prevent others from getting ill.
Wear a mask when necessary (not always).
Masks can be worn as a form of protection or prevention. If you want to avoid exposure to a respiratory virus, a well-fitting n95 or kn95 mask will reduce your exposure to virtual particles and decrease the likelihood of you becoming sick. If you have to be in a crowded indoor environment with poor air circulation, a mask will provide you with protection. Additionally, an individual can wear a mask to prevent others from contracting their illness. I highly recommend wearing a mask for ~5 days after you’ve been sick to ensure you are not sharing your illness with others. And if you are unable to stay home while you are symptomatic (maybe you don’t have paid sick leave), please wear a well-fitting mask at all times and do not take it off while you are around others.
Practice proper hygiene.
Both influenza and RSV are spread via respiratory droplets. And those droplets can live on surfaces for several hours. To prevent the spread of these diseases, we all need to practice sneezing and coughing into our elbows (to prevent droplets from landing on surfaces). We also need to properly wash our hands and avoid putting our hands near our eyes, nose, and mouth.
It’s ok to stop reading here! Or you can ask a question —
If you want more details about a (potential) vaccine for RSV, influenza cases, or (what some are calling the) deltacron subvariant, read on. Here we go… Three Things Thursday.
RSV Vaccine Update
Respiratory Syncytial Virus, better known as RSV, is usually a mild illness that produces cold-like symptoms in adults but can cause pneumonia and bronchitis in young children. Each year there are approximately 58,000 RSV hospitalizations and 100-500 RSV deaths among children younger than 5 years old. Currently, there is no vaccine or approved treatment for RSV.
HOWEVER, Pfizer’s bivalent RSV vaccine candidate has demonstrated really exciting (some are saying amazing) results. Specifically, the efficacy of the vaccine (which is defined as the proportion of severe infections that were prevented because of the vaccine) was ~82% (with a 95% confidence interval ranging from 40.6%-96.3%, which all of my statistics students know means that in a real-world population we are 95% confident that a baby with vaccine immunity would be protected from severe infection between 41.6-96.3% of the time). This is exciting and welcome news!
Based on the information provided by Pfizer to date, the vaccine is also safe.
The vaccine is given to pregnant women (not to the infant) during their second or third trimester. The immunity is passed from mother to child and for at least three months after birth, the child is protected from severe infection and (possibly) the need to see a physician for RSV infection.
Pfizer has stopped enrolling pregnant women into the trial (currently 7400 pregnant women are participating). They are continuing to monitor the mothers and their babies. The public health and clinical medicine communities are expected Pfizer to apply for regulatory approval before the end of the year.
Obviously, more to come… But this is an exciting moment in RSV history.
There is no such thing as just the flu
Influenza is spreading across the United States. Washington DC is seeing very high flu activity. But there are high rates of flu across the southern United States.
Influenza is a respiratory disease. Symptoms include fever, cough, sore throat, and runny nose. It can also cause respiratory distress (trouble breathing) and death.
During this past week, the first pediatric influenza deaths occurred in the US. Yes, children can die from influenza (so can adults, by the way). There is no such thing as just the flu. Influenza is a severe respiratory disease that should be taken seriously. An individual with influenza should aim to rest, stay hydrated, and watch for early signs of severe illness (rapid breathing, fingernails or lips turning blue, trouble breathing/getting enough air).
While the influenza vaccine is far from perfect, it does stimulate the immune system in such a way that severe illness is prevented. According to the CDC —
“The (flu) vaccine was 76% effective at preventing life-threatening influenza, which included invasive mechanical ventilation, CPR, and other severe complications including death.”
Deltacron
With the winter months, the end of daylight savings time, and the holidays quickly approaching, there is so much talk, speculation, and fear surrounding COVID spread during the coming months. Talk of variants, subvariants, and new variants (when will Pi emerge?) continues (endlessly). The public health community is watching the family tree of Omicron grow and keeping track of BQ.1.1, XBC, XAY, and XAW, to name just a few.
We are also fearing deltacron — a potential new variant that has the virulence (ability to cause severe disease) of Delta combined with the transmissibility of Omicron.
We are fearing. We are not predicting. And we definitely do not know what is next.
We cannot control the future virus evolution. And we need to expect new variants.
Change is the only constant.
Fearing an unknown future is not helpful. Nor is checking the news every minute to see what new variant or subvariant is causing the most trouble in our communities. We need to work with the information in front of us and strike a balance between preventing disease spread and living the one life we each have to live.
Here is what we know this morning about COVID —
Hospitalizations and known cases (remember: we only track PCR-confirmed cases) are stalled/plateaued across the United States. We are in a state of stability — COVID is still circulating but at a (near) constant rate.
BUT there are still more than 300 COVID deaths per day in the United States. The vast majority of these deaths are occurring in people who are unvaccinated.
Omicron subvariants are not responding to treatments that worked in the past.
Vaccines are safe and effective.
In light of all of this information, I get up each morning and enjoy my cup (or three) of coffee. I go to yoga (without a mask) each day. I then head to work where I am teaching amazing students (again, without a mask). Last night I went to a lecture on campus and reconnected with friends I haven’t seen in a while. Today I am going to work from our local coffee shop with my daughter, who has a half day of school. And this weekend I am going to leave my work, phone, and computer behind and enjoy some unseasonable warm November weather.
Because I am vaccinated and have some natural immunity after having COVID in August, I am not living in fear. However, I recognize that I could (and probably will) get sick this winter (COVID, flu, or RSV). BUT I am protected from severe infection; I got my flu vaccine on Tuesday.
I am keeping an eye on case counts and new variants, but I am learning to live with COVID, flu, and the tripledemic. I am not living in fear of it.
Questions? Or need to know more?
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