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The State We’re In: Tripledemic

Published Monday Jan 9, 2023

Author Granite State News Collaborative and NH PBS

The State We’re In: Tripledemic

COVID-19, itself, was bad enough. But this season we’re also dealing with a tough flu variant and RSV. What should you know? And what can you do to keep yourself and your family safe? Host Melanie Plenda speaks with Dr. Aalok Khole, an infectious disease specialist at Cheshire Medical Center in Keene. (link to episode)

This content has been edited for length and clarity. Watch the full interview on NH PBS's The State We’re In.

Melanie Plenda: How would you characterize this season as opposed to past seasons before the pandemic, when it comes to infection rates?

Dr. Aalok Khole: From a Covid-19 perspective, it's a very different season. Even though we continue to see numbers in the outpatient ward and in the inpatient ward, the severity of illness is very different from what we've seen in the past two years. We are seeing patients in the hospital, but not so many in the intensive care unit. Folks are not needing high levels of oxygen support. I think the other caveat to those numbers is underreporting. A lot of people are relying on home antigen tests at this point, so it's really hard to say what the numbers are like, but overall severity appears less which is reassuring. We are seeing way more influenza than we saw in the last two years because of changed habits, mask mandates going away, and also a comparatively immune naive population across regions. And with respect to respiratory sensorial virus, the same thing. We saw a surge in October and November, way more than what we've done in the previous years, I think primarily because of the same reasons as influenza.

Melanie Plenda: What do the symptoms of these viruses look like? Is there an overlap in symptoms and who's affected most?

Dr. Aalok Khole: The symptom overlap is pretty significant, which is what makes diagnosis tricky and also frustrates individuals. You may have a cough, runny nose, sore throat, nasal congestion, headaches, fatigue, muscle aches. That sort of transcends the boundaries between Covid-19, respiratory sensorial virus, and influenza. That makes it tricky to really diagnose someone, which is why we are saying try and get yourself tested for Covid-19. That's the one that affects us most at this time from an infection prevention and control perspective. We are moving towards a treat rather than test strategy with influenza, at least in the regions where you're not seeing shortages for those medications. When it comes to who's most affected, I think that's pretty uniform as well. It's your infants, toddlers who have naive systems from an immune perspective, your older adults, your immunocompromised adults, pregnant women, and individuals with significant comorbidities like diabetes and high blood pressure, which really limits your immune system’s capabilities to battle an infection.

Melanie Plenda: Some people are also experiencing what's become known as Covid rebound, where those who get Covid seemingly get over it and even test negative and then test positive again. Can you talk to us a little bit about that phenomenon, maybe some misconceptions about that?

Dr. Aalok Khole: Early on when, when people started coming forth with these complaints where you would get diagnosed with Covid, you get treated for it, you start testing negative on an antigen test, and then at about the five to seven days mark, you start having symptoms again. People were testing themselves and finding themselves to be positive after previously being negative. And initially there was a myth associated with this saying it's the treatment doing it. That has since been debunked through studies that have been published since. This is more related to the virus and a viral phenomenon rather than the treatment associated with it. It's more about when someone gets treated for a virus, you may not be allowing your body's immune system to generate enough of a response such that the virus can be curtailed. As a result it has the ability to rebound and cause symptoms again. It has nothing to do with treatment, and I would really urge the public that if you qualify, go ahead and get treated.

Melanie Plenda: We're hearing some areas are reporting a shortage of over-the-counter medications in pharmacies, and we've also seen Facebook users report an increase in parents asking if anyone in their community has medicine to share for their children. Have you seen an impact from that here, and where else can they turn?

Dr. Aalok Khole: I've been in touch with our pediatric colleagues because this has come to the forefront moreso after we started seeing a surge with respect to respiratory sensorial virus and influenza cases, especially in the pediatric population, that people started facing shortages of amoxicillin which is commonly used to treat bacterial super infections in the setting of a viral infection. Folks started facing shortages of acetominophen or ibuprofen in those circumstances. We've seen that in New Hampshire and that's being talked about nationally. I think the key is to understand that there are options available and it's worthwhile using them. So for example, if you don't get a brand name, that's fine, you can totally go for the genetic version. Just ensure that the dosage is appropriate and is equally converted because you don't want to overdose, especially a child.

If there are any questions around that, feel free to reach out to your physician. The other things to consider are you may not get the liquid weight in, but if your kid is able to take chewable tablets or if there are suppositories, these are options as well. Last but not the least, fevers are not entirely bad. You should be really worried about a fever, especially in the pediatric population, if it starts going into the range of 104, 105. Anything less than that, it's actually a body's response to try and help fight the infection. Iit is also helpful to use other non-interventional measures. You could use paper napkins dipped in water to try and get the temperature down. Please do not use icy water. That is not advisable. There are ways and means in which we can get around these shortages. The hope is that these don't last too long.

Melanie Plenda: What advice do you have for people? What precautions should they be taking to stay healthy? For example, do you recommend masks in public?

Dr. Aalok Khole: It all boils down to the basics of infection prevention. Staying away from others if you're sick. We have Covid-19 home tests available, so if you have even the mildest of symptoms, please go ahead and test yourself. That's a responsible behavior for yourself and for those around you. Hand hygiene is crucial. I would definitely recommend masking in crowded indoor spaces, especially in times when we are seeing different respiratory viruses, not only Covid, cause trouble. If you do test positive, go ahead and seek out treatment. There are options available. If people have not been vaccinated against influenza, I would urge them to go ahead and do so.

If you've been vaccinated against Covid-19, but haven't got the updated booster, please go ahead and do so. There's been recent data that has shown significant reduction in risk of acquiring the disease and ending up in hospitalization, especially in the older adults. CDC published that about two weeks ago. It is not too late even if you've not gotten a chance thus far; the season is not over. 

Melanie Plenda: Let's talk a little bit more about the vaccines. There are so many conflicting reports about their effectiveness and safety, so please, can you set the record straight when it comes to vaccines for these viruses?

Dr. Aalok Khole: From the time they got their emergency use authorization, we have two years worth of data. If you count the trials that went into getting that emergency use authorization, it's almost close to three years. The number of vaccines that have been delivered across the US and globally, there are very few other medications that can talk about such robust data backing their safety. Are there some side effects? Are there potential adverse events? That's always the case, but that can be even with routine medications in regular treatments, but that should not prevent someone from going ahead and getting it. The unfortunate part is those things often get highlighted more than the benefit. 

From an efficacy perspective, people need to understand that vaccines are not a hundred percent efficacious. They never were, they never will be. In the earlier phases of Covid-19, the vaccines that were developed were really effective in even preventing infection. As the variants have evolved and become more immune invasive, that may not be the case. However, they still stand the test of time when it comes to progression to severe disease or people ending up hospitalized and what the vaccines can do to prevent that. I think that efficacy still continues to stand tall and especially is made more robust by the updated booster because we've seen variants come and go. However, these vaccines, especially the updated one, does potentially have cross reactivity and protection even against the new variant that's come out right now, which is being talked about in the northeast called XBB-1.5. We continue to monitor the data, we've not given up on looking at the safety and efficacy, and it continues to show glorious results. It's time we move on from that discussion to say whether vaccines are effective or not. They are effective, they are safe, and it's time we get them.

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