Hackensack Meridian Doctor Discusses Respiratory Viruses and How to Protect Yourself

Edison, N.J.-- Some call it the triple threat–fall and winter bring an uptick in COVID-19, influenza and respiratory syncytial virus (RSV).

Then there is also the common cold, which shares some symptoms with the more serious viruses, making it difficult for many people to know when congestion, sneezing and a scratchy throat is the start of a condition that may get much worse.

Dr. Adeel Butt, an infectious disease expert at JFK University Medical Center and the Chair of Medicine for Hackensack Meridian Health’s Central Region, discusses the viruses, how to distinguish among them, and how we can protect ourselves from infection.

Q. What are the viruses we're seeing most this time of year?

We always worry about the three big respiratory viruses, which spike most in fall and winter–they’re RSV, influenza and in the last five years, COVID-19. There are other viruses, which cause the common cold, and are more common but are less severe.

While common cold, influenza, RSV and COVID-19 are detected year-round in the United States, the prevalence of these viruses tends to increase in the fall and winter months.

Historically, we see big spikes in December and January. The cold weather forces people to be indoors more and people gather together for the holidays. We also have immune defenses in our nose against these infections–they’re microbrushes which brush mucus outward, like a mop. In colder weather, these become less effective at brushing. (One way to mitigate this is) stay warm, have adequate layers of clothing when it’s cold, and keep yourself hydrated.

Q. How can people get a sense of which virus they might have?

Generally the symptoms are quite similar, with some differentiating symptoms. However, we must always test–more often than not we are surprised [by the test results], and while not very common, we may see a positive result for more than one virus.

Symptoms that may be seen in all upper respiratory infections are sneezing, coughing, watery eyes and runny nose. But then, also, with influenza, we may see a sudden high fever–101 degrees or higher–muscle pain and shaking chills. Other viruses might produce chills, but don’t commonly produce high fevers.

With COVID, we see loss of taste and smell, and these are quite distinguishing for COVID-19.

Since they are different viruses, the short and long consequences of infection vary. The common cold rarely causes significant consequences. The flu (influenza) usually is an upper respiratory virus, affecting the nose and throat, but it can affect the lungs and cause pneumonia, and also cause secondary bacterial pneumonia. (This can also occur after contracting RSV and COVID.) The flu and COVID can have more severe consequences than the common cold.

Since young children are unable to articulate the symptoms they’re feeling, we may have more difficulty diagnosing them. The first sign or symptoms we see in young children may be decreased activity and eating less. We should always take children’s temperature. When there’s a fever in children or the elderly, accompanied by decreased activity, lethargy or unwillingness to eat, you should seek medical care immediately.

Q. When should you seek medical care vs. trying to nurse symptoms at home?

If you feel significantly different from your baseline and how you normally function, and if you are concerned, go see a doctor. You know your body the best, so please do come and see us, don’t wait for a checklist of symptoms to appear, or for someone else to tell you to see a doctor.

For children or elderly, if you see high fever, change in eating habits, confusion, lethargy–those are big ones for seeking medical care immediately. If a person has a fever, if there are changes in their daily activity, like they are unable or not willing to get out of bed, to eat, to walk, they should see a doctor.

Q. What groups are at higher risk for infection and serious illness?

The very young and the very old (for example, children 5 years of age and younger, and adults over 60 or 65), and those with comorbidities, such as diabetes, heart disease, cancers or those receiving chemotherapy, COPD or emphysema. In children under 5, the immune system is not mature. In elderly people, immunity gets blunted. These groups tend to get more severe infections.

Q. The holidays are coming up. What do you advise people to do to keep from getting infected or getting others infected?

First, make sure you have appropriate vaccination as recommended by the Centers for Disease Control and Prevention (CDC). Vaccination is important for preventing or reducing the severity of the infection and the likelihood of ending up in the ICU–we saw that during COVID.

Regardless of what environment you’re in–whether in school, a nursing home, an office–if you have symptoms, you should get early, rapid testing. You should be isolated from other people–I’m not necessarily talking about quarantining, I mean social distancing. Hand hygiene is critical. If you have others in your house, using the same spaces as you, wash your hands with soap and water, or use a hand sanitizer regularly..

Cough or sneeze into your elbow, not your hand because you will spread germs when you touch surfaces.

For gatherings, if you have a diagnosed infection, we recommend not attending. If you must attend, then maintain appropriate social distance, hand hygiene and a protective mask.

To boost immunity, stay well-hydrated, maintain a healthy diet and maintain physical activity.
Get vaccinated. You don’t want to acquire immunity through infection. Natural infection can give you immunity, but it can also give you all the consequences of infection.

Q. What are the biggest misconceptions about cold, RSV, flu and COVID?

One misconception is that these happen only in cold weather or in the winter. While it’s true that they occur more often in the colder months, they can infect all year around.

The other misconception is that the vaccine gives you the virus. We do not give the active virus when we vaccinate. If you become ill after you get the vaccine, there are two possibilities for why that happened. One is that you got another virus, or strain, or you’re in the window, the time period, where you’re still not protected.

Vaccines don’t give you immediate immunity. It could take from a few days to a couple of weeks.

The third big thing we try to educate people about is that no vaccine gives 100 percent protection, but if you have vaccination against a virus, even if you become infected, you will get a less severe case. We saw that during COVID,and we have seen that with influenza.

For additional information, visit Hackensack Meridian Health’s infectious diseases page.