As the holidays approach, travel and get-togethers are increasing. University of Virginia immunologist and COVID-19 researcher Dr. William Petri, who has answered reader questions about COVID-19 for more than a year, will answer your questions weekly during December in an effort to stop the spread of these diseases at this time of year. Send your questions to Lynne Anderson at email@example.com, and she will forward them to Dr. Petri.
I’ve read that Covid case loads as well as flu cases increased after Thanksgiving. Do you think it’s OK to fly without masking during the holidays?
I think it is a good idea to start wearing masks again in indoor public spaces, including airports, until we are out of the cold and flu season. This is especially true if you are, like me, over 65, or immunocompromised, or have underlying medical conditions such as diabetes, heart or lung problems, or live with someone at higher risk. This is different advice than I offered last week, as two things have changed: COVID-19 cases are on the rise and influenza has reached its highest levels in 10 years.
COVID-19 transmission in Albemarle and Charlottesville remains low, although there are disturbing trends: patients hospitalized at UVA have increased from 10 to 17 this week, a third of communities in the US are now at moderate to high levels of transmission, and nationwide cases have increased from 300,000 up to 450,000 each week.
Prevention is not just masking. Together, wearing a mask and social distancing is one of three things we should do to prevent catching COVID-19. The second is to stay up to date with our COVID-19 vaccines by getting the new bivalent booster (if you remember we talked last week about how that bivalent booster improves protection by about half). The third thing to do is to stay home if you get cold or flu symptoms, and test yourself for COVID-19, so as not to expose others.
Influenza, which is also prevented by wearing a mask, is not only at record high levels, it is 80% this year due to a type called H3N2, which is more deadly. Like COVID-19, adults 65 years and older are at greatest risk of ending up in the hospital with influenza. The good news for flu is that there are new improved flu vaccines this year that match this year’s flu variants and do a better job of protection. The vaccines use a higher dose of flu antigen and/or add an adjuvant, which is a substance that boosts the immune response.
In a study of 31,989 adults published in the New England Journal of Medicine, a higher dose vaccine gave a better antibody response and was 24% more effective in preventing the flu. Additional good news is that there is no viral resistance to the two pills we can use to treat flu, the antivirals baloxavir and oseltamivir.
Offering some relieve from the “tripledemic” is that RSV hospitalization rates have fallen by half from the record highs a month ago. RSV is most severe in children under age 4 years and adults older than 65 years. New mRNA vaccines that are under clinical trials from Moderna and Pfizer are 80% effective in adults 60 years of age and older.
So the future is bright for preventing RSV infections through vaccination, as these vaccines complete testing and are approved. Until these vaccines are approved for children, our best approach to prevent RSV in high-risk children is with an injection of a monoclonal antibody called palivizumab, which targets the RSV fusion or spike protein, which is 50% effective.
Along those lines, are large family gatherings safe for this year’s holiday season? Should I mask at holiday parties and get-togethers?
Wearing a mask will undeniably reduce the risk of catching COVID-19, flu, and RSV, and in giving it to someone else. As important is to stay home if you have cold or flu symptoms or were just exposed, and to be up to date with your flu and COVID-19 vaccines.
I am sure you do this, but it is a good reminder to me to base our behavior on the most vulnerable person at the family gathering. The elderly grandparent with underlying medical problems needs our help.
I had a bit of a sore throat I tested myself because my husband was infected and found out I have COVID-19. I am 66 years old and have received the vaccine and the bivalent booster. Is it worth getting treated with Paxlovid?
Yes. We all heard the results of the clinical trial that showed Paxlovid was 90% effective at prevention of severe COVID-19 when given within five days of symptom onset – amazing! But since the clinical trial excluded those who were vaccinated, we did not know until recently if it also makes sense to give Paxlovid to people like you who have been vaccinated. Thankfully recent “real world” data from 109,000 patients with omicron showed Paxlovid was 75% effective at preventing those 65 years and older from hospitalization.
What can I do to boost my immunity so I can weather the holiday travel OK?
Wonderful question! Improving our immune system includes regular exercise (nothing dramatic, just going on walks each day will help), watching our diet if overweight, keeping our blood sugars under good control if diabetic, and using common-sense. My friend Mark Lorenzoni makes the point that taking care of our bodies today is an investment in our future, so that we can all be in good health to enjoy our grandchildren!
I also don’t want to forget to mention that if you are immunocompromised and not responding to the vaccine that there is a monoclonal antibody “cocktail” called Evusheld that passively protects by giving anti-Spike antibodies, although there is some risk of failure from the new viral variants evading it.
Finally, there is a recent study from Tunisia that taking a zinc supplement during COVID-19 if beneficial, although I would suggest waiting to see if someone else sees the same thing.
I could have sworn I had COVID-19 last week, but two at-home tests were negative. What to do in a case like that? Can I count on these tests for accuracy?
Well, you may have had flu or RSV. If you are having fever or a cough with the illness, and the at-home tests are negative, it makes sense to be tested for flu since we are in the middle of the epidemic of influenza, and if you had flu there are two antivirals that are effective if taken within the first 4 days of symptoms. Unfortunately, we don’t have at-home flu tests yet, so this means a trip to a health care facility.
You did the right thing, by the way, by repeating the test to be certain you are not leaving home with a COVID infection and risk exposing others. Thank you!