Nov. 8, 2023 – Getting COVID-19: No enjoyable. The identical is true of flu or RSV. However getting multiple of them on the similar time? Now you’re speaking about what may very well be a extremely harmful scenario. 

Because the colder months creep up on us, so does the unfold of the massive three respiratory viruses: COVID, influenza, and respiratory syncytial virus. The excellent news is we now have an up to date COVID vaccine, flu pictures that shield towards a number of strains of the virus, and RSV vaccines for older of us, pregnant folks, and infants. But regardless of our prevention efforts, some unfortunate few might contract not simply considered one of these viruses, however two directly or in shut succession through the winter season. 

Whereas we are able to’t predict what the season will seem like this 12 months, final 12 months’s information from the CDC confirmed that RSV, COVID, and flu didn’t all peak directly – which is sweet information for each sufferers and well being care techniques. 

Right here’s why that’s excellent news: Final winter was the primary time Panagis Galiatsatos, MD, a pulmonary and significant care physician at Johns Hopkins, noticed sufferers coming in with each COVID and flu. Far most of the time, he mentioned, sufferers had solely considered one of these viruses; nonetheless, the variety of these with each flu and COVID he noticed final 12 months was “alarming.” 

“Sufferers that had co-infections have been by far our sickest sufferers,” Galiatsatos mentioned. “That is additionally a medical bias as a result of I’m a vital care doctor, however all the sufferers I met with co-infections have been within the intensive care unit.”

How Do You Know If You Have Extra Than One Virus? 

With regards to simply how many individuals expertise co-infections like this, it’s exhausting to inform. Most of those diagnoses come from being hospitalized, the place docs will sometimes take a look at for all three viruses. For individuals who don’t find yourself in a hospital, they may not know they’ve multiple an infection, particularly as a result of the signs are comparable. A runny nostril, cough, fever, and physique aches can occur with all three viruses. 

Due to the accessibility of COVID checks, it’s extra seemingly that for those who get sick and take a look at optimistic for COVID, you in all probability gained’t hunt down a flu or RSV take a look at at a medical facility in case your an infection isn’t dire sufficient to immediate a hospital go to. 

Testing for all three isn’t a necessity for everybody, mentioned Peter Chin-Hong, MD, an infectious illness professional on the College of California, San Francisco. The aged, very younger, and other people with weakened immune techniques ought to positively search additional testing as quickly as they’re capable of. 

Nevertheless, those that don’t fall into these classes can nonetheless get examined for all three viruses. Based mostly on what docs have seen up to now, there’s a better likelihood that when you have two viruses, it’s in all probability COVID and flu, not RSV. And early testing in these instances can save sufferers lots of grief as a result of we’ve got antiviral therapies for flu and COVID that we don’t have for RSV. 

What to Do If You Have Flu and COVID 

“Very first thing is, don’t panic,” says Chin-Hong. When you take a look at optimistic for COVID at house and you’ve got signs, hunt down the drug Paxlovid inside 5 days of being sick. If it seems you’ve got the flu in addition to COVID, you will get antivirals like Tamiflu inside the first 48 hours of signs, which can shorten the sickness by a day or extra. 

There’s been some confusion round who precisely qualifies for Paxlovid. The FDA has mentioned that it’s permitted for the remedy of “delicate to average COVID-19 in adults who’re at excessive danger of progressing to extreme COVID-19,” however some might assume they aren’t within the high-risk class and don’t search it out. 

There’s nonetheless a reluctance to take Paxlovid, from sufferers who’re nervous in regards to the “rebound” and from docs who’re hesitant to prescribe it, mentioned Bernard Camins, MD, an infectious illness professional at Mount Sinai in New York Metropolis. 

“We must be extra prepared to prescribe Paxlovid as physicians,” Camins mentioned. “Generally docs will say, ‘Oh, you’re not feeling too dangerous, let’s not do it.’ The issue is it may be too late by the point [the patient] does get sick sufficient.” 

Relating to the notorious COVID rebound — the place sufferers develop COVID once more shortly after recovering — that many have related to Paxlovid use, docs like Chin-Hong and Camins need sufferers to know that this rebound is fairly typical, with or with out Paxlovid. 

And within the respiratory virus season specifically, Chin-Hong mentioned, what you may suppose is a rebound of COVID signs might very properly be one other virus, like influenza or RSV. 

Does One Virus Make You Extra Inclined to Getting One other? 

The brief reply: It is determined by who you might be, what actions you do, and the timing of your an infection. 

Research on COVID have proven that there might be long-term harm to immune techniques after recovering from an an infection. Generally having two viruses directly could make you sicker, as was the case for Galiatsatos’s sufferers. Researchers have additionally discovered that sufferers who examined optimistic for influenza had a decreased danger of testing optimistic for COVID; however for individuals who did have co-infections, the illness was way more extreme and left much more long-term harm to the lungs. 

Having COVID is the commonest denominator in terms of folks with a number of infections, Galiatsatos mentioned, as a consequence of its capacity to invade the immune cells, weakening sufferers and making them extra weak to catching different viruses. 

However there may be nonetheless loads we don’t find out about co-infections with COVID, flu, and RSV. Based on William Schaffner, MD, an professional in preventative medication and infectious ailments at Vanderbilt College in Nashville, a non-immunocompromised particular person isn’t extra more likely to get contaminated with one other virus in the event that they have already got one. 

“That’s, except their behaviors make them better publicity,” Schaffner mentioned. “If folks aren’t vaccinated, don’t put on masks, or have a private behavioral disposition to always expose themselves to vociferous crowds, properly, they’re extra more likely to decide up a number of of those infections through the course of the winter. 

“That’s just because they’re exposing themselves. It would not have something to do with their immune techniques.” 

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