Everyone is sick!

-or at least it seems that way in our clinic!

Nov 19, 2022

Many classrooms are half empty. Kids are sick. Parents are sick. ERs and clinics are full.

What are the major players?

This week we've seen a LOT of Influenza A, a few cases of Influenza B, and a lot of (presumed) RSV. Presumed because testing for RSV is usually not covered by insurance and testing doesn't change treatment, so most cases aren't tested.

Wastewater COVID levels are about as high as they were last November in our area but we haven't seen a lot of positive COVID tests in the office. This may be due to the fact that we’re testing for COVID less often since families can test at home. We did have one patient with both COVID and Flu A positive testing.

What are the symptoms?

Primary symptoms of Influenza are fever, chills, fatigue, sore throat, cough, body aches, headache, and sometimes vomiting & diarrhea.

Primary symptoms of RSV are runny nose and cough. It can appear very mild in older kids and adults, but be VERY CAREFUL to not share with anyone who is around young children. It can cause severe respiratory distress in at risk people and our children's hospitals are full.

Don’t run into the clinic, urgent care, or ER

If your family member has symptoms of one of these viruses, you do not need to have them seen unless they are high risk for severe infection (infants or those with chronic disease that can cause severe respiratory infections).

At this time all across the US pediatric offices, urgent cares, and ERs are full. Wait times are long. Risk of exposure to a different virus is very possible, so weigh the risks and benefits of running in to be seen.

Certainly if you are worried about how your child is acting, they should be seen. This may include any difficulty breathing, signs of dehydration, or discomfort not controlled with usual comfort measures.

Any child at risk of severe infection should be monitored very closely for signs of increasing distress and get seen if there are concerns. If you have an infant or child under 2 years of age, they are higher risk - the younger the child, the more risk. Kids with a history of asthma, diabetes, or other chronic condition that increases risk with respiratory viruses also should watch closely.

If your child is able to be managed at home with treatments discussed below, there is no benefit to being seen. If the situation changes, they should at that time seek medical attention.

When are you contagious and how is it spread?

A big question on everyone’s mind with Thanksgiving coming soon is how long someone’s contagious.

Please do not go to a family gathering if you’re sick. Even if it’s mild because what’s minor for one person can be life threatening for another. Really. Very young, elderly, and people with chronic conditions may get sick and suffer.

It is great to see everyone, but horrible to get them sick. If you start to feel sick once you’re there, put on a quality well fitted mask and avoid others as much as possible.

RSV

RSV is spread through droplets often spread with coughs and sneezes.

It can survive for many hours on hard surfaces and then infect when a contaminated hand touches eyes, nose, or mouth. Frequent wiping down of commonly touched surfaces and handwashing is helpful.

Our kids often cough and sneeze directly into our face, so wearing a mask and eye covering can help prevent direct spread.

Adults infected with RSV are usually contagious for 3 to 8 days and may become contagious a day or two before they start showing signs of illness.

Infants and people with weakened immune systems can continue to spread the virus up to 4 weeks, even after they stop showing symptoms.

Flu

Flu is also spread through droplets, but doesn’t survive on surfaces as long as RSV. (Good old hand washing and wiping down surfaces is still recommended though!)

People with flu are most contagious in the first 3-4 days after symptoms begin, but infants and people with weakened immune systems who are infected with flu viruses may be contagious for a longer time.

Symptoms typically begin 1-4 days after infection. It is possible to spread the infection before symptoms develop. Some people can be infected with flu viruses and have no symptoms, but may still be able to spread the virus to their close contacts.

Immunization against the flu may lessen symptoms, but does not prevent spread to others who may be more at risk of severe symptoms.

What treatments are there?

Treatments used for all respiratory infections:

I always say, “water, water water” is the best treatment for cough and colds.

Water in the air.

Water (saline) in the nose.

Extra water to drink.

Water to wash hands frequently.

Saline can be more helpful than many imagine. For infants, use a nasal spray available at your pharmacy. For older kids and adults, sprays can also work, but washes are even better! I wrote about using nose sprays previously - see the “For more” section for information about washes.
Honey has been shown to help coughs but can only be used over 12 months of age.
Older kids can use cough drops if they aren’t at risk of choking.
Anyone with a history of asthma should use their Action Plan to step up therapy. Make sure you have all the medications and equipment needed to treat symptoms. If you don’t, schedule a visit to update the Action Plan and get refills that are needed.
Use fever reducers to make kids comfortable, not to bring the temperature to normal.
Push water and other fluids to help kids stay hydrated. They can eat foods if they feel up to it, but fluids are important!
Help kids rest when sick.
If the fever lasts more than 3-5 days, your child looks dehydrated, is having trouble breathing, is in extreme pain, or you are concerned, your child should be seen. A physical exam (and sometimes labs or x-ray) is needed to identify the source of illness in these cases. A phone call cannot diagnose a source of fever.
Any infant under 3 months or immunocompromised child should be seen to rule out serious disease if the temperature is more than 100.5.
For children over 3 months, there is NO MAGIC TEMPERATURE that we worry more about. Look at your child, not the thermometer.
If there are signs of difficulty breathing (rapid breathing, sucking in ribs or at the bottom of the neck, grunting, or looking scared) seek medical attention.
Signs of dehydration include lethargy/very tired, no tears, dry tongue, and decreased urine output. If this occurs, your child should be seen. (Note: if there is high urine output and other signs of dehydration this is a sign of diabetes and your child should be seen.)
If your child has ear pain, treat the pain. Most ear infections are due to a virus, but if your child is under 2 years, the symptoms persist more than 3-4 days, or if the symptoms are not manageable, antibiotics may be considered. Learn more about ear infections here.

Things that are not helpful:

Cough and cold Medicines. There are no cough or cold medicines approved by the FDA for children under 6 years. None have been shown to help people of any age. They are not safe and can cause serious side effects. See my post on cough medicines for details.
Allergy Medicines. They are not helpful unless your child also has nasal allergies. Nasal sprays with corticosteroid (Flonase, Nasocort, Nasonex) can help with nasal congestion more than antihistamines.
Antibiotics. Antibiotics are not helpful for viruses or colds. They may lead to side effects or allergic reaction, so should only be used when the benefit outweighs the risk. Antibiotics may be used if your child gets an ear or sinus infection, though many of those are also from a virus, so talk with your prescriber about the need for antibiotic. At this time there are shortages of the antibiotics typically used for sinus and ear infections and pneumonia, so we must be especially cautious to only use them when needed.
Menthol on the feet. This is a popular online suggestion. I don’t know why it’s so popular. Some menthol products may help, but not on the feet. Learn more on Menthol for coughs and colds.

RSV Specifically

There are no medications used to treat RSV other than a lot of saline (with suctioning) and acetaminophen or ibuprofen. All of these are available over the counter.

If a child is wheezing we will often try a breathing treatment with a bronchodilator (albuterol). This doesn’t help in every case, but if it does, this can be continued at home or in the hospital.

There is no vaccine (yet) for RSV but there is a preventative injection given monthly during RSV season to high risk infants. If your baby has congenital heart disease, Down Syndrome, a neuromuscular disorder, or was born at or before 35 weeks gestation, talk to your doctor to see if they would qualify for this treatment.

Flu Specifically

As with RSV, standard comfort measures and at home treatments are used for managing influenza.

Flu vaccines are an important preventative measure. You cannot get the flu from the injectable vaccine because it is not a live virus vaccine. The nasal spray vaccine is an attenuated live virus, so may cause mild symptoms and should not be used in certain people. It is possible to be infected with the flu after vaccination (as with any infection you’re exposed to) but generally the illness is more mild and vaccines help keep people out of the hospital.

Antivirals can also be used and are recommended for those in high risk categories. They do have side effects, which need to be considered in the risk to benefit decision making process of whether or not to use them. Unfortunately every flu season they are hard to find in pharmacies, and this season it is already difficult, so I recommend only people who have risk factors take an antiviral. Learn more here.

Prevention is key!

Stay home when sick to keep from spreading germs. It's generally okay to return to work/school when fever - free 24 hours without the use of fever reducers unless you know you are still in the contagious window, such as the COVID rapid test is still positive.
Protect your family from spread of the infection within the home, regardless of what is causing it. No one likes to be sick and we have many ways to prevent spread, including
- Encourage everyone able to wear a mask to wear a quality well fitted mask, such as a KN95 or KF94 (kid sizes available!). The person who is sick is the most effective mask wearer, but if your child is too young or uncomfortable to wear a mask, your mask can help protect you.
- Filter the air.
  - You can make an effective but less expensive HEPA filter box fan with these DIY instructions.
  - Clean Air Stars has this helpful spreadsheet to help choose the right filter for your needs.
  - Run your heater or AC fan all the time by changing from “Auto” to “On” to help filter your air through the home’s HEPA filter.
- Open windows to improve ventilation if weather permits.
- Wash hands and surfaces frequently.
- Isolate the sick family member as much as possible from others.
- Stay up to date on all vaccines and boosters. This can help protect against serious illness.