New Jersey Grapples with "Triple Threat" of Winter Respiratory Viruses

EDISON, N.J. — Many refer to it as a "triple threat virus" as three major respiratory viruses, influenza, respiratory syncytial virus (RSV) and COVID-19 virus start to show growing trends in the autumn and winter months.

Adding to the complexity is the common cold, which presents with somewhat similar symptoms to these more severe viruses. This overlap can make it challenging for individuals to determine if their congestion, sneezing, and scratchy throat are signs of a minor ailment or the beginning of a more serious condition that would require medical attention.

Cristina Cicogna, M.D., an infectious disease specialist and the Division Chief for the Center of Infectious Diseases at Hackensack University Medical Center, and Daniel Ruderfer, M.D., chief of Pediatric Infectious Diseases, K. Hovnanian Children's Hospital at Jersey Shore University Medical Center, provide their expertise on these viruses, offering advice on how to differentiate between them and how to stay protected.

Q: Which viruses are most prevalent during this time of year?
We are always concerned about the three major respiratory viruses that peak in the fall and winter: RSV, influenza, and, for the past five years, COVID-19. Some of the other less severe viruses that cause the common cold also tend to be more active at this time of the year.

Historically, we observe significant spikes in December and January. Lower temperatures favor stability of the virus outside our bodies and may also impair our defense mechanisms by drying up the airway passages and preventing our nose “microbrushes” from clearing mucus and viruses. As the cold weather prompts more indoor activities and crowding, it facilitates respiratory viruses transmission. The lower the temperature the higher the detection of influenza and RSV.

To protect yourself from respiratory viruses like RSV, influenza, and COVID-19, it is important to stay up-to-date on vaccinations, as well as practice good hygiene by washing your hands frequently with soap and water, and avoid touching your face. When in crowded indoor areas, consider wearing a mask to reduce the risk of inhaling or spreading respiratory droplets.

Q: How can one tell which virus they may have?
It can be challenging to determine which virus one may be infected with as the signs and symptoms can overlap particularly for influenza and RSV.

Symptoms of upper respiratory infections include coughing, sneezing, runny nose, watery eyes and sore throat. Distinguishing features of influenza are the abrupt onset of high fever with cough, body aches and headache while the common cold viruses tend to cause more gradual nasal symptoms and low or no fever.

A loss of taste and smell is a distinctive symptom of COVID-19’s early stains, more recently people experience severe sore throats.

Since clinical differentiation is unreliable, diagnostic confirmation will require laboratory testing. It is also possible, though not common, to test positive for more than one virus at a time. It is also important to distinguish between viruses as this can determine which treatment strategies to use.
Diagnosing young children can be more difficult since they cannot articulate their symptoms. The initial signs in young children might be decreased activity and a reduced appetite. It is always important to monitor a child's temperature. If a fever in a child or an elderly person is accompanied by decreased activity, lethargy, or a refusal to eat, you should seek immediate medical attention.
Because these are different viruses, the short-term and long-term effects of an infection can vary. The common cold rarely leads to serious issues. Influenza typically affects the upper respiratory system—the nose and throat—but can progress to the lungs, causing pneumonia or a secondary bacterial pneumonia. This can also happen after contracting RSV and COVID-19.

Q: When is it time to see a doctor versus managing symptoms at home?
If you feel a significant change from your normal state of health and are concerned, it is best to see a doctor. You are the best judge of your own body, so don't hesitate to seek medical advice rather than waiting for a specific set of symptoms to appear or for someone else to suggest it.

For younger children less than 6 years old, the elderly and individuals who are immunocompromised or have pulmonary or cardiac conditions then immediate medical care is warranted. Symptoms to look for are high fever, difficulties breathing , changes in eating habits, confusion, or lethargy.

If an individual has a fever and experiences changes in their daily activities, such as being unable or unwilling to get out of bed, eat, or walk, they should see a doctor.

Q: Which groups are at a higher risk for infection and severe illness ?
The very young (children less than 1 year old) with an immune system not fully developed and the elderly (particularly 65 or older ) who have a weaker immune system and more chronic diseases. Other groups at higher risk include pregnant women, as well as individuals with underlying health conditions like diabetes, heart disease, chronic kidney or liver disease, lung disease (COPD and asthma), as well as those undergoing chemotherapy, or received a transplant or are taking medications known to depress the immune system.

Q: With the holidays approaching, what is your advice for preventing the spread of infection?
First and foremost, ensure you are up-to-date on all vaccinations recommended by the Centers for Disease Control and Prevention (CDC). Vaccinations are vital for preventing or lessening the severity of an infection and reducing the likelihood of ICU admission, as we saw during the COVID-19 pandemic. The flu vaccine is the single most important preventive measure in decreasing the need for hospitalization. Being vaccinated does not only protect you but also protects vulnerable individuals from getting secondarily infected.

Important measures for prevention of getting infected include frequent hand hygiene with soap and water or alcohol hand rub, avoid touching your eyes, nose or mouth with unwashed hands, and avoid close contact with people who are sick . Measures to protect others when you are sick include isolating from others, which means practicing social distancing, staying at home if you are sick, covering your coughs and sneezes with your elbow, if using you hand then immediately perform hand hygiene, clean and disinfect objects and surfaces.

If you have a diagnosed infection, it is best not to attend gatherings. If you must be present, maintain a safe social distance, preferably 5-6 feet, avoid hand shaking, practice good hand hygiene, and wear a protective mask.

To support your immune system, stay well-hydrated, eat a healthy diet, and engage in regular physical activity. Again getting vaccinated is key. While natural infection will likely provide subsequent immunity, it also comes with all the potential consequences of the illness.

Q: What are the most common misconceptions about the cold, RSV, the flu, and COVID-19?
A misconception is that vaccines can cause the infection. Most frequently, we do not use live viruses in these vaccines. If you feel sick after a vaccination, it could be because you were infected with a different virus or strain, or you are in the window before the vaccine has become fully effective.
Vaccines do not provide immediate immunity; it takes about 2 weeks to build optimal protection.
Another misconception is that the vaccine does not work since you got “the flu” despite being vaccinated. It is true that the vaccine does not guarantee complete protection although usually the infection will be milder and shorter if vaccinated. It could be because the vaccine does not precisely match the circulating virus strain, or that the immune response was weakened. It could also be that the cold you experienced may be due to another virus.

A third misconception is that you do not need the vaccine if you are young and healthy. You might be less at risk for a severe illness but you will still get ill, miss work and potentially spread the virus to more vulnerable individuals.

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