This webinar was Recorded on December 14, 2023

As winter approaches, it’s very common to get sick from respiratory viruses like COVID-19, flu, and RSV. There are things you can do to protect yourself and others and this webinar will help you prepare to stay healthy all winter.

Speaker:

  • Purvi Parikh, MD
    Medical Director, Allergy & Asthma Associates of Murray Hill
    Clinical Assistant Professor, Department of Pediatrics and Department of Medicine at NYU Grossman School of Medicine

Dr. Purvi Parikh is an adult and pediatric allergist and immunologist. She is currently on faculty as Clinical Instructor of Medicine and Pediatrics at New York University School of Medicine. She completed her fellowship training in allergy and immunology at Albert Einstein College of Medicine’s Montefiore Medical Center. Prior to that, she completed her residency at The Cleveland Clinical Foundation in Cleveland, OH. Dr. Parikh is board certified by the American Board of Internal Medicine and the American Board of Allergy and Immunology.

Dr. Parikh is passionate about health policy and sits on the health and public policy committee for the American College of Physicians. She is also the Allergy and Asthma Network’s national media spokesperson and has made numerous press and TV appearances on our behalf.

CE is not available for this webinar.


Transcript: While this transcript is believed to be accurate, errors sometimes occur. It remains your responsibility to evaluate the accuracy and completeness of the information in this transcript. This transcript is not intended to substitute for professional medical advice.

De De Gardner: welcome to this afternoon’s webinar. We want to welcome our presenter. A few housekeeping items before we start to today’s program. All participants will be on mute for the webinar. We will record today’s webinar and post it on our website within a few days. You can find all of our recording — recorded webinars on our website. Scroll to the bottom of the page to find our recorded webinars and any upcoming webinars. This webinar will be about one hour and that includes time for questions. We will take those questions at the end of the webinar but you can put your questions in the Q&A at any time. The Q&A box is at the bottom of your screen. We do have someone monitoring the chat if you have questions or need help. We will get to as many questions as we can before we conclude today’s webinar. We will not be offering continuing education credits for this webinar but we do have a certificate of attendance if you need it for your records. A few days after the webinar, you will receive any mail with the supplemental information and a link to download the certificate of attendance and we will try and add the link to the certificate in the chat so let’s get started. Today’s topic is COVID, flu, artistry, how to stay healthy this — RSV, how to stay healthy this winter. It is, to get sick from respiratory viruses. — common to get sick from respiratory viruses. This webinar will help you stay healthy all winter. It is my pleasure to introduce our speaker. He is an adult and pediatric immunologist. She completed her fellowship and training at allergy and immunology from Albert Einstein College medicines Medical Center. She completed her residency at the Cleveland clinic foundation including Ohio. She is board certified by the American Board of allergy and immunology. She is passionate about how policy. — about policy. She is the national media spokesperson and has many numerous press and TV appearances on our behalf. Thank you for being here today. I will turn it over to you.

Dr. Parikh: thank you. Thanks for having me. With that, we will get started. What is on everyone’s mind is respiratory viruses this time of year. COVID, flu, and respiratory virus, RSV. Next slide. We will start with a quick overview of each and then some details on how you can prepare yourself and then go into some Q&A as time allows. Next slide. So COVID-19, which everyone is familiar with by now, is caused by the SARS-CoV-2 virus. You know, it spreads between people with close contact. We have over 760 million cases worldwide. Sadly, 6.9 million deaths, and we are just about approaching the 40 year anniversary of the outbreak. I can’t believe it has already been four years. A person can get COVID after vaccination but the whole idea of vaccines are that they protect against severe illness and death and hospitalizations. The high-risk populations are people over 60, those with existing medical conditions. They obviously also have a higher risk of getting seriously ill. Next slide. What are the common symptoms? that also has evolved since the early days thanks to both the vaccine as well as the population developing some natural immunity as well. You know, sore throat, persistent cough, chest pain, tightness, shortness of breath. Lots and change in sense of smell is less common but we see it from time to time. Headache, sore throat, sore eyes , dizziness, and fevers. People are still getting temperatures at least of 100.4 and higher. Next slide. So prevention. To prevent the spread of COVID-19, avoid crowds and keep a safe distance from others, even if they don’t appear to be sick because sometimes, people can be carriers even if they are a symptomatic where properly — asymptomatic. Wear a properly fitting mask. If you are sick, it is best to stay home. Do frequent handwashing as well. Cover your nose and mouth when you are sneezing and coughing to avoid the spread of those particles and dispose of used tissues right away. If you do develop symptoms, you know, self-isolate so he recover and contact your medical provider because we do have therapeutic options like Paxlovid which might be an option for you. Next slide.

[NO AUDIO]

hello? Sorry. I lost you for a second. Some of the recommendations — get your COVID-19 vaccine. It is recommended for everyone age five and older to get the updated COVID-19 vaccine. At least two months after the last dose of any previous COVID-19 vaccine. Those who are immunocompromised make get additional doses of the updated COVID-19 vaccine which is discussed on an individual case by case basis. Immunocompromised is such a broad term. The younger kids from six month to five years, since they likely do not have any baseline immunity, they need to get two or three doses depending on which vaccine they receive so Pfizer is a three dose shot. Immunization, whereas Moderna is two. If previously vaccinated, then they can also get either one or two doses of the updated vaccine so you can discuss that with your pediatrician based on the age and other factors of the child and then, you know, many — there’s been a lot of controversy and sometimes hesitation with mRNA vaccines even though I think they are very safe and effective options. The nice thing is there is another option if you are hesitant so for those who are 12 and up who want another vaccine option, there is Novavax or if you had intolerance of some kind to Pfizer or Moderna such as an allergic reaction or very severe side effects, or you know, myocarditis, or any of those things, there’s likely other options as well, too. So that is another plus. This is only for 12 and up. Next slide. There’s two main types of COVID vaccines as we mentioned. There is the mRNA vaccines and their brand names are Pfizer and Moderna and there is the Novavax which is more like our traditional vaccine platforms that we have been using for many years for hepatitis and flue and tetanus. This is more of a protein based vaccine technology. The Moderna or mRNA vaccines are basically the way the messenger RNA works is that it is a molecule that contains instructions or a recipe that directs yourselves to make a protein using its national machinery to enter cells smoothly as well as, you know, have this protective bubble. Once inside, those instructions are delivered and these proteins are assembled by your own immune system that is resembling the antigen, right, but is not really making you sick. It’s basically telling your own immune system that this is what the protein looks like it and to start mounting that immune response, and then once that occurs, you know, your immune system kind of kicks into action with antibodies and T cells to start training the immune system for future potential attacks from the real virus and that is how the immunity is made. The Novavax which is the traditional type of vaccine we have been all getting for decades, it’s the type where they inject a version of inactivated spy protein along with another ingredient that also helps stimulate the immune system. It is in all vaccines, and this leaves the production of — leads the production of antibodies and T cells that this is a different method of getting the same result. Once this is done, the idea is that you have met hopefully long-lasting immunity against severe forms of the illness but again, this also is an activated vaccine so you cannot get sick from either of these nor get infected from either of these. Next slide. So what would the ideal COVID vaccine look like? Ideally of course, we want long-lasting immunity. We don’t want to have to keep having to re-vaccinate. We want few side effects. We would obviously want one that is easy to store and administer because of course there is a lot of issues in terms of cold chain and keeping things under control . And so, it’s always — some have been difficult to store because they have to be kept in subzero refrigerators that most facilities and doctors offices and things do not have. So this might be a niche for Novavax in that it is easier to have an air — have in areas where those cold chain issues occur so low and middle income countries that just don’t have the capacity for cold storage. It would be a lot easier for them to kind of store these vaccines and administer them. Next slide. Again, you know, this is a much older technology. It’s a great option for people who have had adverse reactions to mRNA or are hesitant. Again, these tend to have less serious side effects because they are less of what we call immunogenic so if you had very bad side effects with some of the mRNA vaccines, you might tolerate this better. And there’s no doubt that this also comes with side effects. Nothing is perfect, but for all three of them, you know, I would argue that the risks far outweigh, you know, the risks of not getting it are far more dangerous than the risk of any vaccine. It’s because many of these side effects are few out of hundreds of thousands or few out of millions whereas the risk coming from the real virus is much more common. Next slide. So in terms of treatments, treatment must be started fairly quickly, like within a few days of when symptoms develop, but anytime is better than none. Of course, vaccines are not treatment. This is a preventative thing. If you are already vaccinated, you are much less likely to get sick so the mainstay of treatment we are using these days for the outpatients and people who are not in the hospital is Paxlovid. It is an antiviral. It can be used in age 12 and up. And it is important to start it as soon as possible because it helps drop that viral load. The sooner you begin, the better outcome that you have from it. And shorten the duration of your illness. People who are admitted to the hospital, there is an anti-viral option as wall cloud Remdesivir — well called Remdesivir. It can be given in the hospital or health care facility when symptoms start. We sometimes use it for outpatients that can’t get back surveyed or are very sick. It can be a limiting factor. And then finally is an antiviral that should be started as soon as possible. It is approved in 18 and up and again, as soon as symptoms start, within five days of that and you should take it at home, you know, by mouth. It is an oral medication. Again, there are options so please get in contact with your physician if you do get sick because you don’t have to suffer, especially if you are high-risk. Next slide. So moving on to influenza, this is caused by various viruses because often, as we know, the influenza virus can shift within a season and there can be different strains of it and it spreads similarly by airborne droplets, by coughing, sneezing, contaminated surfaces, and again, the flu vaccine lowers the risk for severe complications, and high-risk populations here are children, which is unique to flue as we do see pediatric deaths every year. And then any child of any age range, but especially those who are 12 months or younger, they are especially high-risk. Pregnant women, adults over 65, and people who work in facilities with many residents. Like nursing homes, prisons, dorms, those type of areas. Next slide. And again, a lot of these symptoms can be very similar so I have been advising people these days, as everybody is getting sick, to test yourself. If you have an out home COVID test, test yourself. If you can get a viral swab, that’s also very helpful, and then the other thing I would recommend is just to look out for certain things like fevers, muscle aches. Usually, flu almost always has a fever of 100 degrees or more. Again, nothing is an absolute. But headache, dry, persistent cough, shortness of breath, chills, sweats, tiredness, we is, stuffy nose, sore throat. This can cause stomach upset, as can COVID. Next slide. So prevention, very similar. You know, avoid crowds, crowded spaces, get your annual flu vaccine. Masking helps for flu, too, just like COVID, and maintain a healthy lifestyle, too, all year-round. Everyone always asks me for quick fixes to boost their immunity and there is no quick fix except the vaccine. That is the fastest thing. Outside of that, you just have to live healthy. Get enough sleep every night, drink enough fluids, take care of yourself, eat good food, healthy food. Unfortunately, there no shortcuts. Next slide. Current vaccine recommendations for the flu is for everyone six months and up to get the updated vaccine. As we know, it updates every year. Those who are immunocompromised should get the age-appropriate one. There is one that is a higher dose or stronger flu vaccine for those 65 and up. And then, so for those with an egg analogy, this is very important. There is a misconception that people with egg allergies cannot get flu shots. Even with, you can still get the flu vaccine because there is no egg in the flu vaccine itself. Unfortunately, the medical community is still behind on this fact. Often, you may get asked when you go for your flu shot but there is really no reason to ask that. Next slide. So treatments. Again, drink plenty of fluids. You know, water, juice, warm soups. You want to prevent dehydration, get plenty of sleep, take it easy. Any of these viruses, rest is very important and staying home is very important so take care of yourself and don’t spread it to others. If you need pain relievers, that can help. Tylenol, Advil, etc. The mainstay of treatment is supportive care.

A few individuals might be candidates for Tamiflu which is an antiviral for influenza A but again, it only works with flu a and that is time sensitive so it has to be started in the first 72 hours. If you are someone who is high-risk, your doctor may opt to prescribe that for you. Next slide. So moving on to Rsv, this is a virus that has been around for many years but people just understanding it this year because we actually have a vaccine now RSv. This virus is actually, there’s just as many cases as COVID and flu right now, and it can have just as big a burden. Express the same way,”. We are seeing a lot of cases right now spread by secretions of those who are coughing and sneezing and we have vaccines now. They are approved for age 60 and up, for pregnant women in their third trimester because babies are especially at high risk for RSP. — RSV lot. Certain high-risk children are also eligible. It’s very important to know if you’re somebody who is in a high-risk group because often, people thought of this virus as a pediatric thing but it can actually be just as dangerous for adults and many of my colleagues who work in the hospital setting, pulmonology, critical care, they are all telling me their hospitals are getting very sick adults with RSV who are meeting to be on ventilators because it can cause a secondary pneumonia and it can increase your risk for lung disease and heart disease. Next slide. Symptoms again, almost identical to all of these respiratory viruses. Runny nose, coughing, wheezing, fever, sneezing. You can have temperature and that is why testing is key here. Because it usually, with viruses, they have to run their course and that much we can do but in this case, I would strongly recommend, at the very least, taking an at home COVID test or if you can get to a medical facility and take a viral swab, it is helpful because now, we have certain viral specific medications that you might qualify for. Next slide. So prevention. Again, stay home. Mask. Wash your hands. Avoid close contact with others. You know, such as hugging, kissing, shaking hands, sharing cups or utensils, and clean frequently touched surfaces like doorknobs and mobile devices because that can spread by contaminated surfaces as well. Next slide. The two RSV vaccines that are currently approved our — by Pfizer. They have already been FDA approved. For adults 60 and up. And discuss with your physician if you should get the vaccine. Most people, I say, yes, you should, because like I said, we are seeing adults get very sick from this but the highest risk groups are those with heart disease, COPD or asthma, anyone who has any type of immune compromise, but you know, being sick puts you in an immune compromised state because all of us start to lose our immunity in general past that age. And then one RSV vaccine has been licensed and recommended for women between 32 to 36 weeks of pregnancy and this will protect the infant. As well as the mom. And there is an RSV preventative antibody that we have been using for years for infants and young children. It is a monoclonal antibody and we usually will give it to high-risk babies so babies who are born with congenital heart problems or who are immunocompromised or have another chronic illness that puts them at risk from getting very ill from this. Next slide. So again, you know, the current — the new immunizations from the CDC, highly recommended. I recommend it to all my patients. Adults 60 and up. Talk to your doctor first. I cannot really think of any reason not to get it. It can only help. For babies, you know, again, depending on their risk factors, we might give an antibody to protect them or you know, all infants that are being born during the RSV season are getting this vaccine and a small group of older babies are getting it as well. And again, we are giving it to pregnant women, especially in the third trimester. Go ahead.

So again, the mainstay of treatment is supportive care. There is no antiviral specific to RSV like there is for flu and COVID. Again, manage fever, pain, drink plenty of fluids, and speak with your doctor, especially if you are not getting better because then, it might be a sign that you might have to go to the hospital. Sorry. I think I absently muted myself. If you are not getting better or you or your child — please speak with your doctor because it might be a sign you have to go to the hospital to get more in-depth care. Next slide. So the three important health issues, how can we tell them apart? this is the million-dollar question. Next slide. There are some telltale signs but as you can those very similar symptoms across the board. Fever, chills are in all of them. Sore throat, pretty much all of them. Cough, all of them. Most lakes, two out of three. This is why the testing is so key and we can still get free tests delivered to us from the government. You know, so it’s another reason that if you are somebody who is eligible for that to please make sure that — which is everyone — get four free tests to get that done. Otherwise, most urgent cares, primary care’s, ERs, they can be the respiratory viral swab as well. Next slide. All right. These are more symptoms. Many of them are just identical between each of these subgroups. I always recommend testing. It is virtually impossible to tell if someone calls me with the symptoms because it can be any of the three. Next slide. Now, I wanted to briefly touch upon long COVID because many people are over COVID in general. Despite all the mortality from COVID come along COVID remains an issue. Many people are suffering even years after infection. Next slide. So long COVID is broadly defined as signs and symptoms that continue or develop after acute COVID-19 infection. And it’s usually a month after.

Dr. Parikh: sorry about that. I don’t know why it keeps muting but these symptoms are usually occurring about one month after — if they are persisting one month after COVID infection, it counts as long COVID. Next slide. So post-COVID conditions, they have different names now. Long COVID, long-term effects of COVID-19, also known as chronic COVID or postacute — PASC. That is the official name. Next slide. In the symptoms of long COVID can include post exertional malaise, fatigue, brain fog, dizziness, G.I. symptoms, palpitations, changes in sexual desire or capacity, — changes smell or taste, chest pain, or abnormal movements. It affects everything, head to toe. And majority of people with post-COVID symptoms RPC are negative. This — are PCR negative. This is not the active case. It is the post-COVID state, so you are not contagious during this phase. But it can be dishabille attending, or even more so than the acute infection, and last weeks, months, or years, as we are seen. Post-COVID syndrome is a time lag between the recovery. — biochemical and radiological recovery. . So 11 things that doctors have learned from a recent study of long COVID is that fatigue is the number one symptom seen at the clinic, which I would agree with. I see that very prominently. SSRIs can help some. And symptoms are not generally caused by widespread inflammation. Inflammation is actually rare. Initially, we thought it was an inflammatory illness. And there is no typical long COVID patient. It can affect anyone. Most of the patients generally are not obese or diabetic, or have any specific risk factors, what we have seen that in women more so than men it can be a little bit more common as well. But again, we are seeing it in all age groups and all individuals. Next slide. Sorry. I don’t know what is going on with this slide. Sorry. My slides seem to — there we go. So what we have learned about this as well is that exercise can help. There is some improvement in some individuals after getting the vaccine. It could be due to a reactivation of a previous virus. Next slide. There is no test, unfortunately, available for long COVID as of yet. It is most largely a clinical diagnosis, and in the long run there is no clear one-size-fits-all treatment. So we are using all different treatment modalities. Most do get better, but it does take a while. Some are lucky that eventually it gets better on their own, or they have minimal symptoms. Next slide. So what does the future hold? I know everybody is kind of sick of this. We are in a much better place now than we were before, as Dr. Fauci says. The absence of a dramatically different variant, we are moving to a place where it is more endemic further than a pandemic, and the vaccination will be similar to the flu vaccine, where we get updated shots on a yearly ASIS. Next slide. And then where do we go from here? Next slide. So, again, we are moving from pandemic to endemic. We need to be prepared for everything, so that is why I recommend all three vaccines, because these are endemic viruses we are going to be living with for the indefinite future. So make sure you get them. Get them early. They take about two weeks for you to become immune. So if you are planning on traveling during the holidays, now is the time to get it, because we are getting close. Make sure you practice good hygiene. Wash your hands, with the masks, and stay on top of the current spread and treatment. Keep an eye on your local public health department’s recommendations. Next slide.

De De: This is De De. Before we go on to our next few webinars, we have a couple of questions we would like to touch base with you about. One of our community partners is asking, if someone is scared of having myocarditis, should they get the Novavax instead of the other COVID vaccines?

Dr. Parikh: absolutely. I actually recommend it to those individuals who have a similar concern, because I find that the immunity is just as good with the Novavax as the other vaccines, so yes, it is nice to have that option. Absolutely, it is a great vaccine.

De De: Great. Another question that we have here — we know there are COVID treatments that you discussed earlier. If practitioners are not offering the treatment, can the committee themselves ask for it? If so, how should they go about doing that?

Dr. Parikh: absolutely, and we have hit that roadblock were sometimes providers for some reason don’t offer it, but if you get turned down, there are a lot of other ways to get it. Most urgent cares will provide it. Now, there is a lot of telehealth platforms where you can call and they are able to get it. It is better to go to and in person place, because then they can test you and see exactly what you need. But if you do have a positive at-home test, you can use one of the telehealth platforms as well.

De De: Thank you. Is there a magic time to receive the flu vaccine?

Dr. Parikh: Ideally, September and October are best. I know now we are in December. If you have not gotten it, as soon as possible is best, because the flu season is going to go until March or April, and right now we are seeing cases peaking. They are already up 30% from the week before. You know, usually, September/October is the best time to get it, so you are covered for the whole season.

De De: Absolutely. Someone has typed in, now that the FDA has ruled phenyl ephedrine as ineffective and major pharmacies have pulled it from the shelf, what should be recommended for nasal cysts — nasal symptoms or relief of these conditions?

Dr. Parikh: I actually recommend a lot of the over-the-counter nasal sprays that are not afferent. Afferent, which is pseudoephedrine, is in the same class as phenyl at three and, and is not good for long-term use. I have been recommending ASTA Pro, which is an antihistamine available over-the-counter. Also, all the nasal steroid sprays are very good for cold and flu symptoms. Such as Flonase, Nasonex — these are all over-the-counter know. Believe it or not, some of the 24-hour antihistamines, like Zyrtec, Allegra, Claritin — those go a long way as well. I would come if you can, avoid that pseudoephedrine which can have side effects for some people, such as increased heart rate, high blood pressure. But the plane antihistamines are very good, as well as the nasal sprays I mentioned.

De De: Absolutely. We have someone asking about could you share why COVID may cause someone to experience intermittent sharp mid to sternal pain?

Dr. Parikh: it is a respiratory virus that causes inflammation. For any of these, it is not the virus that is the problem, you know? It is the inflammation that comes along with it that is so dangerous. That is why people get some sternal pain. Your lungs are inflamed. All your muscles around your lungs are inflamed. And your heart can even get inflamed with COVID. So everyone is focused on myocarditis and the vaccine, but it is much more common to get myocarditis from an actual COVID virus, and other inflammatory heart conditions. So all of those things can cause that some sternal pain. Usually, it is not anything to worry about. But if it is very severe, please seek medical attention, because there can be cardiac involvement.

De De: absolutely. Thank you. A couple other questions that we have here. One is what are your thoughts about pulmonary rehabilitation for loan COVID.

Dr. Parikh: it is very good, actually. It depends, because people have very different symptoms. The patients that I know that have things like shortness of breath or fatigue, the pulmonary rehab does go a long way, especially for someone who had pneumonia from COVID, or lung manifestations. That can be very helpful in recovery for sure.

De De: another question is, do you know of any resources that parents who have a child diagnosed with lung COVID, in delaying the return to school — is there anything we should be telling our community about delaying the return to school if a child has long COVID?

Dr. Parikh: yeah, that is a good question. It is usually kind of decided on a case-by-case basis. There is of absences for people with long COVID, or disability available for adults with lung COVID, but what I would do is discuss that either with your pediatrician or your primary care doctor. If that is necessary. And that may be necessary in some cases, but it is really that decision is made on a case-by-case basis, because not everyone with long COVID may need to do that.

De De: yeah, absolutely. I appreciate that. Well, I recognize that we are done a little early. I don’t see any other questions. I don’t know if you have any other last-minute statements he would like to share about these three viruses or treatments.

Dr. Parikh: Sure. The main thing I would say is please get your vaccines. I know the uptake on especially the COVID boosters is very low. I think the most recent number I saw was less than 20% of Americans have received the updated one, so please just get all three. It is OK to get them all together. I personally like to separate them by a few days or a few weeks because, you know, I am an allergist, and I always think about how somebody will feel afterward. But it is not too late if you have not gotten any of them, so please get them and encourage her family members, especially as we move into the holidays. Even if you might not be high-risk, you might be meeting with somebody high-risk like your grandmother or a new baby that is born in the family. So it takes a village and we should all protect each other. That is the last thing I would say.

De De: Absolutely. Thank you. This has been extremely informative. This is our last webinar of 2023, but we have some webinars coming up at the beginning of 2024. The first one is that — is not everything that causes — that coughs is asthma. There is a time change for that one. Then we have Dr. Kimberly Blumenthal presenting on the importance of proactively addressing and deal able antibiotic allergy. You will receive an email from zone — zoom in a few days with a link to the recording, evaluation, and resources. Thank you for all of us and allergy asthma network. Join us as we work every day to breathe better together. Thank you.