🦠 A COVID, RSV & flu update 🦠
It's deja vu all over again!
ICYMI 👉
Today is an update on the COVID, RSV and flu vaccines. Giddy up for fall virus season!
COVID shots
The new COVID shots are here! The big question is: Should you get the shot now, should you wait, or should you skip the shot altogether? Of course you should talk with your doctor for more specific advice, however here is what I will recommend to my patients:
If you had COVID recently, I suggest waiting at least 4 months after a COVID infection to get another booster. Why wait? Because getting COVID itself provides a “boost” of your immune system’s ability to fight the virus the next time you are exposed.
If you have not had COVID in the last 4 to 6 months and you are considered at higher risk for serious outcomes (e.g., age over 65, underlying health problems, immune deficiency), I suggest getting a shot now. Why? The shot should offer modest protection against infection starting approximately two weeks after the shot and lasting a few months, plus added protection against serious illness. Recall that those who are at highest risk for requiring supplemental oxygen or hospital care from COVID are the ones who stand to benefit the most from another shot.
If you have not had COVID in the last 4 to 6 months and you are not considered at higher risk for serious outcomes, you could get the shot now for the same reasons above. Alternatively, you could wait until later in the fall, trying to time the shot in advance of an important live event or in anticipation of the next wave. Note that COVID doesn’t seem to care if you’ve got a wedding or a family reunion on the calendar—not to mention that you can get a shot and still get infected during the window of added protection!—so I wouldn’t overthink the timing if you aren’t high risk.
RSV shots
The RSV shots are FDA-approved for ages 60 and above. They are suggested for those over age 60 and strongly encouraged for ages of 75. Note that RSV is not a yearly vaccine. In other words, you only need one RSV shot. If you got the RSV shot last year, you are done!
The downsides of the RSV shot seem to be minimal. I’m glad we have another year’s worth of safety data because when the shots first came out last year I was a little hesitant to recommend them to all. The risk of Guillain Barre syndrome is real but also is small. It seems to be on par with that of the flu shot.
In general, I recommend the RSV shot this year to patients who are most likely to get seriously ill from RSV—that is: my patients with respiratory problems, diabetes and/or immune deficiencies, and those who are elderly and frail.
Flu shots
The ideal time to get a flu shot is October, in advance of the usual November/December wave of influenza. Which flu shot should you get? The short answer: Get whichever flu shot you can get your hands on. The longer answer: There doesn’t seem to be much difference between Flublok, Flucelvax, Fluzone, Fluarix, Fluad. However a new study came out a few weeks ago suggesting that the adjuvanted flu vaccine (Fluad) might work better in individuals over age 65.
Additional Protection Against Viral Illness
Getting vaccinated is an important step toward preventing disease, but so is taking care of your underlying health. Recall that patients with diabetes, heart disease, obesity and other medical conditions are at higher risk for serious outcomes from these viruses. So, be sure to schedule your check-up with your doctor. Work on managing your blood sugar, blood pressure, metabolic health, and weight. Do your best to prioritize sleep, exercise, and eating nutritious meals. Limit your intake of alcohol, and use this moment to finally quit smoking! Work on expanding your toolkit to better manage stress. Prioritizing your physical and mental health will improve your innate immune system and help you fight whatever virus comes your way.
Bonus Section: FAQs 🥳
Q: Can I get the flu, COVID, and RSV shots on the same day? Or is it better to separate?
A: While it is technically safe to get the COVID, RSV and flu shots together, I suggest my patients separate them by at least one week because the side effects can be more pronounced if they are taken together. As for flu and RSV shots, a few of the participants in the clinical trials for the RSV vaccines had severe side effects when they got the flu vaccine on the same day.
Q: How can I tell if I have COVID vs. RSV vs. the flu?
A: Testing. Because the viruses mimic each other (i.e., cough, fever, body aches, etc), diagnostic testing can be important for symptomatic people. PCR tests exist for all three viruses. PCR tests detect the genetic material of the specific virus and are highly sensitive tests; i.e., rarely do we see false positive tests in actively sick people.
For COVID, rapid antigen tests (RATs) can be useful. RATs are essentially “contagiousness” tests. In symptomatic individuals, a positive RAT suggests that you have contagious levels of the virus in your nose. A negative RAT means one of three things: a) you don’t have COVID, b) you do have COVID but not enough viral particles in your nose to infect other people, or c) you have some other respiratory infection altogether.
Q: How long do I need to isolate when I’m sick this season?
A: The CDC recommends isolating from other people until your symptoms are improving and you are fever-free for at least 24 hours without fever-reducing medications. I agree with this recommendation. You also can use the rapid antigen tests (RATs) to more elegantly guide your isolation period. The downside of this plan is that the RATs can’t determine degree of contagiousness, and some people can test positive for weeks when they likely aren’t that contagious—if at all—after a few days. In other words, the “common sense” rule (i.e., stay home when sick, return to work/school when better) is probably the best plan!
Q: Do I need to test myself every time I have a runny nose?
A: Great question. Testing is most important for the cohort of patients for whom a positive test would change medical management or personal behaviors. For example, I need to know if my 80-year-old patient’s cough and body aches are due to COVID, flu, RSV, or something else in order to direct treatment. However, testing isn’t always needed for a healthy young person who can manage their symptoms at home and who isn’t living in close contact with someone at high risk.
Q: What’s the best way to prevent spreading these viruses?
A: The best way to prevent spreading the virus is to stay home when you are sick. During the pandemic, we learned that masking non-sick people is an inefficient and ineffective way of preventing the spread of respiratory viruses on a population level. On an individual level, my advice is to wear a well-fitted, high-grade mask if you want added peace of mind, for example in the presence of a household member who is actively sick.
Q: What non-prescription treatments are best for viral symptoms?
A: Fun fact! There is new data to support the use of saline nasal spray to reduce the symptoms of respiratory infections. This is great news because nasal saline is cheap and pretty darn harmless—unlike decongestants such as Sudafed (which can elevate blood pressure and heart rate) or antihistamines such as Benadryl (which can be sedating).
In addition to nasal saline, I often suggest Ibuprofen and/or Tylenol for aches and fever. I also like nasal steroids such as Fluticasone (Flonase) for congestion and Mucinex for cough. Maintaining adequate hydration is also critical—and free!
Disclaimer: The views expressed here are my own and are not a substitute for advice from your personal physician.
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Got questions? Ask away in the comments below!
Why does the CDC or the FDA not require the pharmaceutical companies behind these boosters to do any randomized control studies on the effecacies of their drug? I am a healthy 70 year old who has had Covid a year ago and don’t plan on getting any boosters. What research has been done on Paxlovid? Why is the CDC recommending boosters for 6 month olds? How do we trust the medical community?
In this article you suggest using ibuprofen or Tylenol for aches and fever. Dr. Paul Offit says that fever should not be treated because the purpose of fever is to kill the virus and reduce the time that you are sick. What is your opinion of that?