The Johnson Memorial Hospital campus in Franklin is seen in this April 2022 file photo.
Daily Journal File Photo
Flu season has arrived, and RSV and COVID-19 are coming along for the ride.
All three viruses have similar symptoms, including fever, runny nose and congestion. They also all are respiratory viruses, according to the Centers for Disease Control and Prevention.
‘Normal” flu season expected
Earlier than normal, the first flu death of the 2022-23 flu season was reported by state health officials last week. Officials are encouraging Hoosiers to get a flu vaccine to protect against strains of the flu that are expected to be the most dominant this year.
It is still early in the flu season, but Johnson Memorial Hospital, so far, hasn’t had any hospitalizations for the flu. However, cases have begun to turn up at outpatient offices and the immediate care center, said Dr. David Dunkle, the hospital’s president and CEO.
Dunkle expects a more normal flu season this winter, with case levels seen in pre-pandemic years.
“One of the positive side effects from all the precautions people were taking because of COVID was we literally saw no flu for almost two years,” Dunkle said.
While doctors have no reason to expect anything more than a normal flu season, Dunkle says there is a chance it could get worse. Vaccine fatigue is expected to reduce the number of flu vaccines nationwide. Locally, the rate of vaccination is a bit slower than usual, Dunkle said.
“One of the things that I think a lot of medical experts are worried about is just people have so much COVID fatigue per se that we’re not seeing the normal uptake of influenza vaccines … maybe we have in the past, and as you know, most people are not masking (up) anymore,” Dunkle said. “The environment is set up to have a worse season as we move further into winter or toward the end of fall and into winter.”
RSV cases are increasing
RSV, or respiratory syncytial virus, is another seasonal virus doctors see which tends to be worse in numbers from November to April. Like other respiratory viruses, symptoms tend to be fever, wheezing, coughing and difficulty breathing, Dunkle said.
This virus tends to be worse for children, and is one of the leading causes of hospitalization among children. Adults can get RSV too, but symptoms tend to be milder, he said.
Hospitals across the state have seen an increased number of RSV cases. Earlier this month, it was reported that Peyton Manning Children’s Hospital in Indianapolis was at capacity due to seeing a greater number of RSV cases, according to several Indianapolis media outlets.
Doctors at JMH have seen a lot more RSV cases come through their physician offices, immediate care center and ER recently. JMH has transferred several pediatric RSV patients to other hospitals, Dunkle said.
“It mirrors what’s going on in the rest of the state,” Dunkle said. “Riley (Children’s Hospital), Peyton Manning Children’s Hospital, has been seeing greatly increased numbers of RSV-positive patients, and obviously, that’s where the sick kids go. We’re seeing increased infectivity out in the community.”
Though there has been an increase in cases, RSV is not a new virus. Due to COVID-19, there was a brief reprieve from the virus because of mask-wearing. Now that fewer people are wearing masks, the numbers are returning to more typical levels, Dunkle said.
“We always see an uptick in respiratory virus transmission, both in the community and then requiring hospitalizations, as we enter the winter months,” he said.
Steady number of COVID cases
In terms of COVID-19, JMH has seen a couple of admissions a day due to the virus over the last 3-to-4 weeks. It’s been pretty steady, Dunkle said.
Over the last 2-to-3 months, the trend Dunkle has seen is more people who are admitted only because they have COVID-19 symptoms. Six-to-seven months ago, it was more common for people to be admitted for other ailments and coincidentally also have COVID, he said.
“They were in for something else; that wasn’t their primary diagnosis,” Dunkle said. “They were just found to have COVID upon admission. But we’re back now to seeing people with pneumonia, respiratory failure due to COVID.”
A majority of COVID patients the hospital is seeing are people who are unvaccinated. However, doctors are also starting to see more people who were vaccinated early on when vaccines came out come in with the virus. These patients have not received booster shots, he said.
Nationally, most hospitalizations and cases are due to the BA.5 variant, which is specifically targeted by booster shots. However, a new variant — BQ.1 — is now making up 1-in-10 cases nationwide, Dunkle said.
“What we’re seeing is … there’s going to be a roller coaster of cases,” Dunkle said. “You’ll have peaks as new variants evade the immune system, then we’ll go through those valleys between vaccination rates and natural immunity. We will have times when we don’t see as many cases.”
Dunkle isn’t as worried about COVID as he was earlier in the pandemic, but he is disheartened because the virus appears to be here to stay.
“I think we missed the boat when we had a chance to potentially eradicate this back in the day,” Dunkle said. “I think the issue became too political, but that that that’s behind us. All we can do is move forward from this point.”
Why are cases increasing
Due to universal precautions such as mask-wearing being implemented in 2020 due to the coronavirus pandemic, both flu and RSV cases were down. If people were hospitalized for a respiratory illness at that time, it was COVID-19, not the flu or RSV, Dunkle said.
“If you had a respiratory illness, it was COVID,” he said. “We weren’t seeing hospitalizations for influenza and RSV, but some of that was also because … people were working from home, people weren’t in school. That’s where a lot of these viruses are spread.”
When people are inside, respiratory illnesses tend to spread more easily as people are in close contact. If people are outside, the air quickly dilutes anything people breathe out, Dunkle said.
During the winter months, doctors always see an uptick in respiratory illnesses. It just happens to be that COVID is joining the ranks as well, he said.
“It’s just we now have on top of influenza and RSV, which has been around for many years, now we have another virus that is very transmissible and results in hospitalizations, that virus being COVID,” Dunkle said.
How to prevent illnesses
There are many steps people and children can take to prevent respiratory illnesses. Dunkle encourages people to wash their hands frequently, use hand sanitizer, avoid contact with people who are ill and use universal precautions like mask-wearing.
“If you have any respiratory symptoms whatsoever, wear masks,” he said. “If you try to look for some good from the COVID pandemic, what it’s told us is that these universal precautions will actually work. It’s not just us saying, the medical profession saying they work. We just sometimes have to do a little better job embracing those populations.”
Children need to be in school, but parents shouldn’t hesitate to put a mask on their children if their child has respiratory symptoms, he said.
“It’s not the end of the world, and mask-wearing is more ubiquitous now,” Dunkle said. “I was on a flight recently, and the announcement said, ‘We don’t require masks, but if somebody chooses one respect their decision.’ That is a much better way to look at it, and I do feel if you have respiratory symptoms, wear a mask. Protect those around you.”
Dunkle is a believer in personal choice and feels that people should have the right to dictate their own healthcare decisions. However, from a medical standpoint, if people want to decrease their risk of being ill, being hospitalized, missing work, or infecting loved ones with COVID-19, they should get vaccinated, he said.
“There’s compelling data that they’re efficacious. There is compelling data that not only are these vaccinations efficacious, they’re very safe.”
Data from the CDC shows that being up-to-date on COVID-19 vaccines continues to provide strong protection against severe disease, hospitalization and death in adults.
Regardless of the virus, if people are not feeling well and have respiratory illness symptoms, they should see a medical provider. Treatments differ between flu, RSV and COVID, and medical providers will need to test patients to distinguish between the viruses, Dunkle said.
Additionally, the earlier people get treatment — if there is one available — the better.
“Where people get into trouble is when they wait too long,” Dunkle said. “My public service announcement would be don’t wait too long. … See your medical provider if you’re not feeling well.”
