Mass. General Hospital pediatric infectious disease expert, Dr. Vandana Madhavan, MD talks about a tripledemic on the rise – the flu, COVID, and RSV.
Interview conducted by Ivanhoe Broadcast News in October 2022.
If children catch pediatric infectious disease, it is the same medical care?
MADHAVAN: It’s the same medication for kids down to age 12 and who weigh more than 40 kilos or more.
What if a parent suspects and then takes the test and may have COVID and it’s early?
MADHAVAN: There are clinical spaces on other floors of the building, but it’s our admin. It’s admin’s space for pediatrics.
What viruses and infections have you been seeing in children?
MADHAVAN: I think we’re already in the heavy season. With the pandemic, we’ve really seen different patterns of viral transmission. When COVID first hit the US in March 2020 and hit really hard, we stop seeing normal transmission of other respiratory viruses even into the fall and winter of 2020, 2021. But then starting in late spring of 2021 and we started seeing those winter viruses re-emerging, starting to- starting to circulate. For the last year-and-a-half, we haven’t really been able to predict things while influenza has certainly remained a winter concern here in the northern hemisphere. We have been seeing RSV, for example, respiratory syncytial virus, which it’s typically a winter concern. We have been seeing it in the spring, we’ve been seeing it in the summer. It hasn’t really gone away the same way that we typically see. This past summer, for example, we’ve been seeing RSV, adenovirus, pair influenza virus, rhinovirus, enterovirus, all of these viruses that some of them, we do see a little bit more in the summer and others are more fall and winter viruses. There really has been no easing of this burden. I would say we’re in the heavy season already with the added concern of influenza starting to peak a little bit as well.
What has happened that’s throwing those patterns off?
MADHAVAN: It has been different patterns of our lives. When things shut down, people don’t circulate, viruses don’t circulate in the same way. When schools had masks and spacing requirements in place, things didn’t circulate in schools which are such a hotbed of viral transmission for our children, and activities were different. Activities weren’t happening with the same intensity and frequency. In 2022, things are back in a lot of ways to our pre-pandemic normal for children and they’re going to school masters still encouraged, but they’re not required activities or back to their usual levels. Kids are playing, kids are getting together, and it’s wonderful for their social development. In terms of their- in terms of their exposure, A, they’re getting exposed to more because they’re being exposed to more people. Also remember, they’ve had two plus years where they haven’t had that ongoing exposure to this virus and that virus. Their immune systems are not on that same level of constant vigilance. W are seeing that viruses are hitting kids harder in recent months, especially because they just haven’t had that same ongoing vigilance of their immune systems.
With flu season coming up, how do parents differentiate between the flu, COVID, and just a typical cold?
MADHAVAN: It’s hard because there is so many of the symptoms, are really overlapping. An older child who is saying that things taste different, smell different, that’s really been a more of a unique set of symptoms that we’ve seen with COVID. Fever, malaise, fatigue, respiratory symptoms, all of that can happen with any of these viruses. Often we can’t tell for sure. That’s why the increased availability of home testing for COVID is great to be able to know that if a child is old enough and has underlying risk factors, knowing that, hey, this is the situation we need to reach out to the child’s medical team to think about home antiviral therapy if that’s an option, knowing about that. Same thing for influenza. Once we start seeing even higher numbers of influenza, especially if there is a close contact. It’s important to know if you’ve had a contract influenza might have concerning symptoms because for children at higher risk antiviral therapy early maybe of benefit. It’s symptoms alone might not be enough, but it’s more about knowing about exposures and reaching out if there are questions to think about, is this a situation where we need to think about more detailed testing?
Have you seen an uptake in COVID vaccine in age over five and 5-11 now that it is available?
MADHAVAN: In terms of the bivalent booster, which has two parts, one against SARS-CoV-2, the original version of the virus, and then the other part with the Omicron booster as well. Just became approved and recommended for the 5-11 age group in mid October. We hope there will be interest. I’m not sure how to answer this just because it really just became approved yesterday afternoon.
How important is it that the parents know that this has been approved? What would you recommend to parents in terms of protecting their young child 5-11 from COVID?
MADHAVAN: My blanket recommendation is that whatever COVID vaccines Your child is eligible for by age and- based on the vaccines we’ve gotten so far, they should get them now. Sometimes there is a recommended delay if they’ve had recently had COVID to wait to get the booster. But if they are eligible based on timing of vaccines or illness and they’re eligible by age, they should get their vaccines. How I like to look at COVID is that while the story of adults illness really been the main focus that unlike influenza, unlike RSV, unlike so many other respiratory viruses that affect the very young and the very old and very severely. COVID does affect the very- the very old, much more severely than the very young. However, if we just look at children, COVID disease- severe disease that causes hospitalization, that causes the need for ICU care. Severe COVID disease has killed more children than all other vaccine preventable diseases combined in the last two plus years. If we just look at children, it’s a no brainer. We have a vaccine that while it doesn’t prevent all infections, it prevents severe disease and severe disease can cause severe morbidity, severe illness, and severe mortality can cause death. If your child is eligible, they should get vaccinated now.
What’s the benefit of this particular booster that was just approved?
MADHAVAN: This booster not only continues to protect against the original SARS-CoV-2 virus, the virus that causes COVID-19, but has a specific component that helps protect against Omicron variance, which is- which remains the vast majority of circulating COVID virus right now. We have Omicron variants that have been circulating since last fall. They’ve taken over. Right now, to help your child get the most protection possible as we head into an even busier respiratory viral season, as we head into a winter of more indoor activities, indoor family gatherings, you want your child as best protected as possible.
Can my child get both the COVID booster and the flu shot at the same time, same visit to the pediatrician?
MADHAVAN: Absolutely. I would say that we don’t want to wait until influenza rates tick up a little bit more or COVID rates tick up a little bit more, and you’re part of the country, the time is now. Remember that it takes a couple of weeks for vaccines to do their work and for the immune system to develop full protection from a particular vaccine. Rather than waiting until oh, things are a little bit worse and then we’ll see the time is now to get protected before things tick up, before that Thanksgiving travel, before the holiday travel in December.
Is it ever too late? How long does it take again, to get that full measure of protection?
MADHAVAN: It’s never too late. In many years we see two different peaks of influenza. Sometimes there’s a peak even in spring. We have definitely seen springtime waves of influenza and for that reason it’s never too late to get as protected against influenza as possible. For that, it takes a couple of weeks for a vaccine to do its job to get the immune system up to full strength protection against a particular vaccine. Rather than waiting until things get a little bit worse, when then you have to hope that your child stays well as there’s more influenza. I say get vaccinated now. Influenza vaccines are available at pediatrician’s offices at pharmacies. A lot of schools have clinics as well and take advantage of whatever options are out there.
Is there anything else that you want people to know about the upcoming viral season?
MADHAVAN: I think just knowing that, we don’t really know how COVID is going and continue to evolve. Remember that Omicron was identified as a variant of concern last Thanksgiving in 2021. We don’t know what’s in store as the world has opened up more, are they’re going to be new variants. Omicron was much more transmissible, meaning that it was easier to catch Omicron from someone else. But it didn’t cause as severe disease as the Delta variant, for example. We don’t know what future variants might do. We also don’t really know what will happen when there is a huge influenza surge and a huge COVID surge at the same time, or a huge COVID surge with other viruses as well. Even if COVID isn’t causing a lot of hospitalizations, isn’t tying up resources, other viruses absolutely already are tying resources in pediatric hospitals and pediatric wards around the country. It’s really important to get as well protected as possible. Now, knowing that there are a lot of unknowns as we head into later into the fall, and on the winter.
Is flue season is already on us?
MADHAVAN: We have started to see an uptake nationally and confirmed influenza cases. It’s starting there. It’s nowhere near the peak of past surges, but it’s ticking upward it’s- we’re in the fall, we’re going to be seeing higher cases.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
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