Sorting through the advice on holiday respiratory bugs
There’s a new approach to dealing with COVID, the flu and RSV this holiday season.
“Treat everything the same,” said internist Peter Crosson, MD, who practices at Osterville Primary Care.
Rather than issuing separate guidelines for COVID and the other two viruses, the federal Centers for Disease Control and Prevention has unified its advice on respiratory viruses.
“It’s about infection control, in general. It’s about trying to protect your neighbor,” Dr. Crosson said.
What’s Changed and Why
The CDC cites several factors that led to the change:
- More effective vaccines. COVID and flu vaccines reduce the risk of severe illness by about 50 percent. Plus, RSV (respiratory syncytial virus) vaccines for the three main groups – older people, pregnant women and young children – became available last year.
- Widespread immunity to COVID. An estimated 98 percent of Americans now possess some level of immunity, either from vaccination and/or infection.
- Effective treatments. For COVID infections, the medication Paxlovid slashes the chance of hospitalization by more than 50 percent and the risk of death by 75 percent. Early treatment of influenza with antiviral medicines – Tamiflu (oseltamivir) and related drugs – can reduce severity and length of illness.
It’s a different world than when COVID-19 roared around the globe, killing millions. In March 2020, the World Health Organization declared the virus had become a pandemic. On May 11, 2023, the CDC ended its public health emergency declaration for COVID. The CDC now considers COVID’s dangers to resemble those of RSV and the flu.
Since January 2022, COVID hospital admissions have plummeted 75 percent. Deaths dropped even more, by 90 percent. Complications, including long COVID and, in children, multisystem inflammatory syndrome, are down, too. As a result, the CDC has stopped recommending that people who test positive for COVID isolate themselves for five days. It has also ceased using COVID tests to determine when to isolate and now relies upon symptoms.
New Respiratory Virus Guidelines
The CDC’s new guidelines for COVD, flu and RSV incorporate strategies of getting vaccinated and staying home away from others until 24 hours after your symptoms have generally improved and you have no fever when not taking aspirin or other fever-reducers.
Because you may still be infectious after isolating, the CDC recommends practicing good hygiene (washing hands often and covering sneezes and coughs, for example) and trying to improve air quality (such as opening windows and wearing masks) along with keeping a safe distance from others and doing home COVID tests to limit exposing others. Testing before visiting family for the holiday, boarding a plane or attending big events is just common courtesy, Dr. Crosson said.
“If you’re sick, don’t go to family gatherings. Seems like dumb advice, but it’s amazing how that happens all the time,” he said. “Think about the people you’re going to be around.”
Dr. Crosson said the simplified guidance is welcome as it makes it easier for people to follow. The diminished threat of COVID makes it no longer the main reason to get vaccinated.
“Obviously, flu is the most important. It’s probably the most dangerous,” he said.
While just an unpleasant few days for most people who contract it, influenza still resulted in 380,000-900,000 hospitalizations and 17,000 deaths in the United States since Oct. 1, 2023, according to the CDC. Similarly, though its threat has greatly diminished, COVID caused about 76,000 deaths last year.
RSV vaccinations are important for people over 70 and others with respiratory conditions, Dr. Crosson said. And it’s a one-and-done shot, not an annual vaccination. Older people and those with some chronic diseases should also consider getting a pneumonia vaccine, which is “now a single dose,” he added.
“I would consider it mandatory for anyone with lung disease,” he said.
For certain vulnerable groups, the CDC recommends:
- Older people may get an extra COVID shot or a stronger version, and the RSV vaccine, in addition to a flu shot.
- People with weak immune systems should get COVID and flu shots and may get an extra COVID shot.
- Pregnant women should get vaccinated against COVID, flu and RSV to protect themselves and their babies. Young children can be vaccinated against RSV.
- People with disabilities, notably those living in congregate settings, should get fully vaccinated. They or their caretakes should take extra care to maintain good ventilation with clean air, proper distancing, use of well-fitting masks (N95 or KN95), if possible.
Dr. Crosson acknowledged many people rejected CDC advice during the COVID pandemic due to their political perspective, and “a lot of vaccine fatigue” remains. He said of the CDC combining the public health recommendations for COVID, flu and RSV into a single uniform approach, “maybe it takes the politics out of it.”
