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Respiratory Viruses Update · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

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  Our clinics are full, the waiting rooms are full of snotty, wheezing, coughing people.
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  The hospitals are full. We don't get the nice mix of fun and interesting diseases.
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  It's just like RSV bronchiolitis, RSV bronchiolitis, RSV bronchiolitis,
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  you know, influenza, pneumonia.
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  I'm Holly Wayment and this is Pediatrics Now. cases, updates,
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  and discussions for the busy pediatric practitioner.
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  Don't forget to click on the link in this podcast for free credit that may include
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  CME, MOC, or ethics credit, depending on our topic or podcast.
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  It's the heart of respiratory virus season, and joining me here today is Dr.
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  Tess Barton, our pediatric infectious disease doctor.
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  Tess, thank you so much for being here today on Pediatrics Now.
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  Thanks for having me back.
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  First, I had a question the other day from a community pediatric clinician,
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  and she was asking about, she got an alert saying there's been a warning put on the RSV vaccine.
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  And can you clarify for us that, you know, what is that? And that's for the adult RSV vaccine.
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  It's not for the one for babies, correct? Since that's the actual antibody? That's correct.
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  So there is an RSV vaccine that was initially approved for older people,
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  60 and over, and has now also been approved down to age 18 for adults,
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  also for pregnant women.
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  And because those are populations who, for older people, are particularly at
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  risk of severe hospitalizations and death related to RSV disease.
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  And for pregnant women, providing them with good immunity allows them to pass
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  those antibodies across the placenta to the fetus so that in the first months
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  of life, the baby is also protected from RSV.
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  So there's been an adult RSV vaccine available since 2023, and the FDA just
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  gave a warning regarding a thing called Guillain-Barre syndrome.
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  So Guillain-Barre syndrome is a rare condition where the body's immune system
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  damages the sort of protective coating around the nerves,
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  usually down in the legs and in the arms, and causes weakness and potentially
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  paralysis of the muscles in your arms and legs.
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  So it's a known, it's like an autoimmune disease where the immune system attacks the nerves.
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  And it's a known side effect of multiple different vaccines,
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  as well as a side effect of multiple different viral illnesses.
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  So there have been some cases of Guillain-Barre syndrome following RSV vaccine in adults.
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  And so the FDA issued a warning regarding that. And it does not pertain in any
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  way to the vaccine for babies.
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  That's correct. So what we're giving for babies is a monoclonal antibody.
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  It's an entirely different type of mechanism.
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  And what advice would you have for, I know our listeners are likely getting
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  questions from parents, from pregnant moms in particular, or maybe about their grandparents?
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  Mm-hmm well so this is
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  I don't off the top of my head I don't know the the incidence
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  of vaccine associated Guillain-Barre but for
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  for the other vaccines that have a
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  known association with Guillain-Barre it's quite
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  rare like you know down the realm of of one and hundreds of thousands of doses
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  so so it's certainly not something that is common it does happen I mean like
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  I personally have known a couple of people who've had Guillain-Barre following vaccines.
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  So it, you know, certainly, certainly does happen.
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  And it is maybe, it's probably the worst of the side effects that we think about
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  when it comes to vaccines.
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  It is most, usually it's a resolving illness.
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  Like it comes and then it goes, but it does, it can't take many months to resolve.
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  So but i
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  think that it you know every everything that we do
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  every medication every vaccine every illness
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  that we get has a potential for having a severe complication and so it's you
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  know something to certainly know can happen i suppose but the likelihood that
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  any one person who gets that vaccine is going to have that problem is actually extremely low.
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  And the people you know who got this, are they doing okay? They are.
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  In fact, one of them was one of my physician friends.
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  He's doing fine. That's great to hear.
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  And would it affect your decisions if you were in the age group where it was
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  recommended to get that?
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  No. So, but I think, so for myself, no, I am in the age range for getting this vaccine.
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  Really? Yeah.
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  Yeah, no, I absolutely would be fine with getting the vaccine.
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  For instance, influenza vaccine is actually the vaccine that is most commonly
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  associated with Guillain-Barre syndrome.
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  And I get my flu vaccine every year regardless.
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  And so the people who should consider maybe deferring or not getting the vaccine
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  because of that issue are people who have a known previous history of Guillain-Barre,
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  because what that means is that your immune system is already sort of primed
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  to know how to attack your nerves.
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  And if you trigger it again, it might decide to do it again.
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  So people who have Guillain-Barre syndrome or people who have other autoimmune
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  diseases, because again, if your immune system already has a predisposition
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  to attacking your own body, then anytime you give it the proper trigger,
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  it can kick in again.
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  So, shall we start with RSV? What's there?
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  And is it right now it could be more difficult or it is more difficult to get
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  certain information from the CDC or NIH? age?
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  Sure. So a few questions there.
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  So how RSV is going, so we should be hopefully on the downswing and the tail
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  end of RSV season and looking at kind of more recent sort of the dashboards,
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  both for the CDC and Texas.
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  It looks like RSV is declining for the past several weeks, So it's not gone,
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  and it will continue to kind of fizzle and percolate and circulate around at
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  some degree, usually until April or May.
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  So we have a long RSV season in Texas, but we should have already peaked our
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  RSV season and seen the worst of it. So that's the good thing.
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  You mentioned the communications from the CDC.
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  So there was just a presidential executive order mandating that there be no
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  further external communications from health and human services departments,
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  and that includes the CDC and the NIH.
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  So until they have put in place their appointees to approve any further communications.
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  So what that means is that things like the influenza dashboards and the disease
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  dashboards are probably not going to be updated.
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  They're included in the sort of list of those communications that are available.
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  Are being halted, our website updates. So I think that if for those of us who
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  look at those information to try to see what's going on right now,
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  what's the status of certain diseases, what are we seeing?
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  We may not be getting much updates for the next several weeks, I'm guessing.
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  The gag order is in place, I think, for like 10 days, but it could be longer than that.
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  Maybe more importantly, I think we might, I mean, I don't know for sure,
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  but it might inhibit publication of the MMWR,
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  the Morbidity and Morbidality Weekly Report from the CDC, and that's actually
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  a really useful resource when there are new outbreaks or things like that that are coming out.
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  What it won't stop, things like
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  FDA safety recall alerts, those are still being allowed to go through.
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  So what's your advice for clinicians given this?
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  I mean, I think so the state level reporting should still be in place.
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  And so you can still rely on your state Department of Health websites in the meantime. Yeah.
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  If I can, I actually want to make one comment about the state dashboard,
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  because I was looking at it this morning for Texas, trying to get some influenza information.
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  And there's on the Texas DSHS website, there has been like an influenza website
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  that gives you kind of all the influenza information.
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  And when I looked at that, I noticed it wasn't updated at all.
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  Like it had the most current influenza numbers for the 2023-24 season, which is last year.
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  And there was zero information on the 2024-25 information.
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  And so it turns out that they've actually switched all that information over
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  to what they're calling the respiratory illness dashboard.
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  So if you do a Google search or whatever for Texas DSHS respiratory illness
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  dashboard, you'll get all the updated information. But that old influenza website
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  is still in place, but it's not being updated.
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  And for our listeners in other states or other parts of the world,
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  so it may take a little bit of digging and try different searches to find your
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  area's dashboard or record keeping. Yeah.
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  So as you know, I've just moved to Seattle and there is, so I was also on the
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  Washington website and they have an influenza dashboard as well.
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  Most states do influenza-like illness monitoring because it's actually a federally
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  mandated thing that they do.
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  Okay and we're so happy
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  that you're still on faculty for ut health even even though
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  you're in seattle yeah yeah so i'm well i'll be around to be able to provide
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  some remote consultative advice do you want to mention quickly a couple of things
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  that are important regarding rsv before we move on to flu as our listeners are
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  in the trenches right now i was talking to one.
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  Community pediatric clinician and we were having lunch together and then she's
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  headed to see 25 more patients for the rest of the day. And it's kind of like, yeah, me luck.
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  She said, you know, where it's, this is just a tough time every year seasonally. Right.
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  It is. I mean, yes, this is a, you know, for, for pediatricians,
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  this winter virus season is the time, but, But the bright thing is that,
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  you know, RSV, I think, is on the downswing.
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  So maybe there's some light at the end of that tunnel.
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  And for respiratory viruses in general, anything you want to mention there?
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  There are a bunch of different respiratory viruses. And so the three sort of
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  big ones are RSV, influenza, and COVID.
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  But, you know, there's enteroviruses, rhinoviruses, para-influenza, et cetera.
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  There's a bunch of different viruses. And they all have their own sort of little
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  seasonal blips and waxing and waning.
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  So I guess one thing that's helpful to know is that it is good to be able to
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  identify influenza and COVID in particular.
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  So, you know, utilizing those rapid tests or various, you know, or whatever nasal swab,
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  flu, and COVID testing that you have available to you for influenza because
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  there are antiviral medicines.
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  So if you diagnose it early enough,
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  you can use an antiviral medicine to shorten your duration of your symptoms
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  and the severity of your symptoms and get you back to work and school more quickly.
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  And the same for COVID.
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  If you're 12 and over, you could take also an antiviral medication if you catch
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  it early enough to be able to reduce the severity of your COVID illness.
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  And probably more importantly, we sound like a broken record when we talk about
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  viruses, but more importantly, to not spread your virus around to everybody else.
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  When talking to parents reinforcing that
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  staying home if you can hopefully yeah
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  yeah i mean i think you know from from the standpoint of
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  like everybody getting sick with all of these viruses probably you know the
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  most effective thing that we can do is when we are sick don't go be around a
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  whole bunch of other people and get them all sick not everybody has the luxury to do that but But,
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  you know, if you're sick,
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  you really shouldn't be going to school and coughing on everybody else.
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  And if you are going, you know, when you do go back to school or work and you're
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  recovering from your virus and maybe you're still a little bit contagious,
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  it's a good idea to wear a mask so that you're, again, when you're not breathing
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  out your virus all over the other people around you.
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  One practitioner, she was saying to me, she has quite a few patients who they
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  think that it's probably allergies, but then, you know, so it's easy to kind
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  of say that and then go on with your lives.
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  And really, it's just like a lot of the time it's a virus and they're getting
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  people, including grandparents, possibly sick.
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  Yeah. And this is actually super classy for COVID. I,
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  you know, for some reason, I, you know, COVID seems to present with either the
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  sore throat variety where you like the first thing you get is just like terrible,
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  terrible sore throat, or the, you know, it feels exactly like my allergies variety.
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  And so, yeah, I think if, you know, if you feel like it's your allergies are
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  kicking in or something like that, like do a test.
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  And, you know, these tests are, of course, available over the counter.
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  So you don't even have to go to the doctor's office to get tested for COVID.
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  Where are we with COVID right now? I know a lot of clinicians have told me that
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  not a lot of patients or pediatric patients are getting vaccinated for it where
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  the parent might choose the flu vaccine,
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  but for some reason declining the COVID vaccine.
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  Yep, that is true.
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  I mean, we have COVID vaccine. We have flu vaccine. They are available as tools
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  that we can use to prevent ourselves from getting these viruses.
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  They're not perfect vaccines. They're not 100% effective, but they're still
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  reasonably effective. They're effective enough to cut your risk at least in
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  half and sometimes more, at least in the case of the flu vaccine.
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  So, you know, we should be using those tools.
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  My three teenage kids, they all got the flu and COVID vaccine on the same day.
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  And it was kind of, there was one day of not wanting to do much other than watch
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  TV and be on the couch. But other than that, it was fine.
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  Well, maybe those vaccine companies will get together or one of them will decide
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  to co-formulate their COVID and their flu and, I don't know,
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  their pneumococcal and their RSV.
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  And, you know, I have to come up with like a clever, I was calling it coflumonia,
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  but a clever, some other like clever, you know,
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  pharmaceutical brand name to let you know that you're wiping out your winter
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  viruses, winter respiratory diseases. That's a great idea.
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  Looking at pneumonia, are we out of the mycoplasma wave?
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  The mycoplasma wave continues. We haven't seen as much of it in the past couple
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  of months, but it's still around.
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  Tess, what's important for us to know about the flu right now?
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  So I think the important thing is that the flu is fully here.
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  So we are currently at the sort of what I think is the peak of the flu season.
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  It looks like actually one or two weeks ago might have been the peak.
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  There's a little bit of a downtrend if you look at the overall numbers.
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  Although when I was looking at the Texas dashboard for influenza-like illnesses,
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  the ER visits for respiratory illnesses and influenza-like illnesses was up 33% this past week.
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  And hospitalizations were up 16%. So we are currently in the thick of the full
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  part of the influenza season right now.
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  So it's not too late to get your vaccine because flu will continue to circulate
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  usually for another month, you know, six, eight weeks after the peak of the season.
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  I mean, it takes a couple of weeks to develop your immunity after getting your vaccine.
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  But we are certainly right in flu season.
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  And so this is the time for, you know, pediatricians to stock up on all their
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  rapid, rapid flu tests and, and, and, and get ready.
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  So with that happening, do you have any advice on, on treating the flu?
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  There's really nothing particularly new or exciting about influenza.
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  There is, looking at the strains that are currently circulating,
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  at least the CDC reporting,
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  we can talk about those strains if you want, but the CDC's reporting,
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  100% of the ones that they've tested have been susceptible to oseltamivir,
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  which is also known as Tamiflu.
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  So oseltamivir is usually the first-line antiviral medication for influenza.
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  It is more effective when you begin it in the first 24 to 48 hours of the illness.
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  So if you think that you might have the flu, go get tested.
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  Don't wait for three or four days to then say, oh, maybe it's the flu and go
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  get tested because then the effectiveness of the medication will be less.
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  And it could be hard to gauge when a parent comes in with their child who's sick.
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  And I mean, what, how many days if they've been sick for more than four or five
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  days, is that too late to get, to get that medication if they have the flu?
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  I mean, yeah, probably. So pediatricians, I think, we're mostly nice and we
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  want our patients to get better.
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  And so many times we'll be like, well, we can try it anyway or prescribe it anyway.
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  But honestly, you're already probably at three or four days from the standpoint
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  of the virus, you know, going to begin getting better regardless.
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  And so you may have missed the window of opportunity.
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  If you're not, if you feel like you're getting worse at three or four days,
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  though, you know, don't skip going to the doctor because that's sort of when
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  you begin seeing some of the complications of the flu, particularly pneumonia.
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  You know, influenza is a booger of a virus.
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  It actually causes a lot of different complications that can be pretty severe.
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  You know, the most common is a pneumonia, a viral pneumonia.
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  But you can also get a superimposed bacterial pneumonia on top of your viral pneumonia.
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  And influenza notoriously causes myocarditis, causes Guillain-Barre syndrome
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  that we talked about earlier. It can cause an encephalitis or a transverse myelitis.
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  So influenza is a virus that has a lot of scary complications.
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  And I like how you said that, a booger of a virus.
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  I can't wait.
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  It is scary. And I think a lot of parents may not realize that.
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  And then at the same time, we don't want people to panic.
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  But I know a lot of clinicians are likely being asked, you know,
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  I want my kid to have antibiotics.
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  What advice do you have there? Well, this is actually where these viral tests come in really handy.
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  Because, you know, I think that, you know, we're sort of brought up to think
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  that, oh, and a really severe illness or when you feel really bad that that's a bacterial infection.
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  But in fact, you know, viruses are just as bad and maybe sometimes worse than
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  bacteria for making us incredibly ill.
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  So I think that, But antibiotics have zero effect on viruses.
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  Certainly, bacteria like mucus. They like to eat mucus.
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  And so you can get bacteria that begin to overgrow when you've got fluid that's
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  built up in your middle ear, regular kind of mucousy fluid from a viral infection
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  that's built up in your middle ear.
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  And that can become infected with bacteria because bacteria want to go there and eat that mucus.
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  The same with your sinuses.
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  But bacteria do take a little time to grow and to fester.
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  So, you know, they don't, I think that most of the time when you feel terrible,
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  when you have influenza or a viral illness, It's because you have influenza
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  or a viral illness and not a bacterial infection that requires antibiotics.
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  So most of the time it's that rest and liquids and time. Yeah, yeah, yeah, exactly.
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  Good old chicken soup. Good old chicken soup and that nurturing from parents.
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  Do you want to say anything about, I know Dr. Brooks was talking about in a
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  recent interview about mucus, though, how with viruses that that's helping the virus to get better.
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  Our culture, there's so many products to get rid of mucus. Yeah.
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  So our bodies have, you know,
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  over the millennia have developed, you know,
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  we have really good mechanisms to try to fight off the germs that are hurting us.
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  And so, you know, we do that in a couple of different ways.
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  So that's right. So mucus is important for catching things, right?
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  It catches bacteria and viruses, and then you cough or blow it out to get them out of your body.
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  And so it's very annoying, mucus, you know, snot and phlegm and all those fun things, boogers.
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  But but and of course if you're
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  a little baby it can be so you can
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  get so bogged down with mucus that you physically
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  can't breathe because it closes off your
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  airways but but usually the the best way to address mucus is to actually liquefy
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  it and get it out of your body right so like doing saline squirts or sprays or, you know,
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  humidifying treatments or whatever to liquefy that mucus and then blow it out
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  or cough it out to get the viruses and the various cooties out of your body.
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  And so the problem with decongestant medicines is that many decongestant medicines
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  will dry up the mucus, but that, you know, you continue to make it because your body.
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  Is appropriately responding to try to get something out of your body that it
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  doesn't want in your body.
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  And so you continue to make mucus. So then you get this like dry mucus and then
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  you put more mucus in there and then you dry it up.
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  And so you end up getting this mucus that's like glue that you can't get out.
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  And so it's a little bit counterproductive. So, honestly, it's better to keep
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  it liquid and keep pushing it out of your body than to try to dry it up with a medication.
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  Plus, all those medications for children have side effects. So, you know, they have...
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  It can have, you know, antihistamines can make you very sleepy.
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  Decongestants are sort of the opposite. It can like jazz you up and make you sort of speedy.
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  They can decrease your appetite and then you're not eating and drinking well.
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  So there's, you know, sometimes it's better just to let your body do its natural
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  thing and to sort of help it in what it's trying to do rather than hinder its
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  ability to do what it's trying to do.
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  And can decongestants could open us up to getting a secondary infection?
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  Sometimes. So for instance, you know, one of the things that we will sometimes
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  use are like nasal steroids, like Flonase and things like that.
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  And steroids, the job of steroids is to blunt your immune system response.
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  So on the one hand, you've got an immune system that's creating all of these,
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  you know, these effects that make us feel bad.
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  So yeah, if you stop the immune system from doing that, you know,
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  some of the symptoms and the sensations that we're having feel better.
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  But then we've also, your immune system is responsible ultimately for fighting off those germs.
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  And so you do potentially impair your immune system's ability to fight off the
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  germs or leave it vulnerable to other ones. The other thing I'll mention is fever.
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  We all feel miserable when we have a fever,
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  but our bodies make a fever to actually try to create a temperature where viruses don't replicate.
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  So fever is actually a natural, our body's natural ability to actually kill viruses.
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  And so, you know, if we can tolerate the feeling, the sensations of a fever,
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  in some ways it's actually better
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  to let your body have a fever as long as it's not a crazy high fever.
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  I love that. I remember reading this quote of a scientist whose area of expertise
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  is on fevers where he writes that it's our bodies doing its finest work. It's amazing.
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  Yeah. Yeah. I mean, our bodies are pretty amazing and very intricate machines.
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  And we have a lot of different responses.
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  And sometimes those responses go wrong, right?
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  But in general, we would do better to let our bodies do what it is that they
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  need to do to help protect us.
• 30:06
  And our culture, too, it tends to be where there's a lot of parents.
• 30:12
  And in general, in adults, I have a fever. I need to, let's get rid of the fever.
• 30:17
  Yeah. Yeah, I mean, I think that I think as Americans, culturally,
• 30:21
  we like to do stuff about stuff.
• 30:23
  Yeah, like we want to fix it. And, and I love that about us.
• 30:27
  But yeah, maybe it's not always so helpful. We also have a little bit of an
• 30:31
  obsession with productivity, like, oh, I've got to get rid of my fever so I
• 30:35
  can send my kid back to school.
• 30:36
  But I have to send my kid back to school because I have to go to work.
• 30:39
  Right. And so like, rather than, you know, unfortunately, our lifestyles don't
• 30:45
  allow us to sort of naturally weather.
• 30:47
  A disease that we could otherwise weather in let's
• 30:50
  say four days like three or four days
• 30:53
  we could be like totally on the mend and doing fine but
• 30:56
  instead we want to get back to we need to get back to
• 30:59
  whatever we're doing within one day so we start like
• 31:02
  pounding ourselves with medications to try
• 31:05
  to make that happen more quickly but uh
• 31:09
  but yeah our bodies have you know organisms organisms have evolved mechanisms
• 31:19
  to protect themselves against the onslaught of things that are trying to harm them,
• 31:26
  which is actually one of the problems with antibiotics, because when you give
• 31:29
  antibiotics to bacteria.
• 31:32
  You'll kill off a bunch of them, but the ones that you don't kill,
• 31:36
  they have their own mechanisms of defense, which is antibiotic resistance, right?
• 31:41
  They have mechanisms where they develop resistance to those antibiotics.
• 31:44
  They turn on genes, or they kick in some enzymes that deactivate the antibiotics,
• 31:50
  and now you've got an antibiotic-resistant bacteria that you can't treat.
• 31:55
  And so if a parent gives a child antibiotics and the child starts feeling better,
• 32:02
  is there any benefit to, like, you have to say they are all bettered.
• 32:07
  Do you really need to keep giving the antibiotics for the full prescribed amount?
• 32:12
  Or do you want to say anything about that? Or is it better to stop it?
• 32:16
  So I will say yes to give them for the full prescribed amount.
• 32:23
  I will, as a caveat to that, I will say that we, you know, scientific research
• 32:28
  is, is continuously trying to determine what is the optimal duration,
• 32:36
  what's the optimal prescribed amount.
• 32:37
  Because over the years, we
• 32:40
  have been working on trying to reduce how much exposure to antibiotics we have
• 32:54
  because we also have friendly bacteria that live inside of us.
• 32:58
  They help us to digest our food and to fight off some of the meaner bacteria.
• 33:03
  And so when we kill our friends that are inside of us, we potentially also do harm.
• 33:11
  So what may have been the duration of antibiotics that you got 15 years ago
• 33:19
  is not the same as we're giving now. We're trying to get things shorter and shorter.
• 33:25
  And our goal is, let's treat something until it's totally gone and no more than that.
• 33:31
  But it's a scientific process to prove what's the best way. And I think a lot
• 33:42
  of people don't realize, I thought Dr. J.B.
• 33:45
  Canty on our team, our colleague who's double-boarded in neonatology and infectious
• 33:51
  disease, where antibiotics, he says, are chemotherapeutic agents.
• 33:56
  And we need to be very careful about prescribing them, taking them,
• 34:00
  and very helpful when needed. Yeah.
• 34:05
  But not just, you know, I guess, do you feel like it's changing in medicine
• 34:09
  and, you know, just as a precaution, take this antibiotic, that that's changing?
• 34:14
  You only... Yes, I do think that's changing. And I think that's,
• 34:18
  it's good that that's changing.
• 34:19
  So Dr. Canty is 100% correct.
• 34:24
  Like, antibiotics can be absolutely life-saving for life-threatening bacterial
• 34:30
  infections, of which there are many, and which have historically killed children,
• 34:35
  you know, especially in early childhood.
• 34:39
  And so, we need those tools when we need them.
• 34:45
  But we also need to be judicious with them and understand that antibiotics don't
• 34:51
  treat everything. And so we shouldn't just be throwing them around willy-nilly.
• 34:57
  We need to be targeted about it and use them appropriately.
• 35:05
  Because when we overuse them, we do create superbugs and we don't need more
• 35:10
  superbugs. That's right.
• 35:14
  So, Tess, in this time of respiratory viruses, so when is it time for antibiotics?
• 35:20
  Do you want to give us a quick refresher on that, if it's pneumonia, bacterial pneumonia?
• 35:27
  Yeah. So, you know, antibiotics treat bacteria. So if you have a bacterial pneumonia,
• 35:34
  then absolutely, that's the time for antibiotics. A bacterial sinusitis,
• 35:40
  bacterial otitis media, an ear infection, those are the most common bacterial
• 35:48
  complications of virus infections.
• 35:50
  But if you identify a virus,
• 35:55
  I would not jump to giving an antibacterial medication unless you have.
• 36:04
  Some other finding that suggests that there's a bacterial complication of that virus.
• 36:13
  And that can be hard to know.
• 36:16
  Yes, it can be. This is why doctors exist, right?
• 36:21
  Because that's why we do training and this is why we exist and why you can't
• 36:25
  just go to the vending machine and say, oh, here's my symptoms,
• 36:31
  And it will just determine,
• 36:33
  you know, oh, yes, you need antibiotic. No, you don't need antibiotic.
• 36:37
  This is the art of medicine.
• 36:40
  And this is why you have people who have trained for many,
• 36:45
  many years to develop professional expertise in trying to determine what type
• 36:55
  of problem is this person's body having. Hmm.
• 36:59
  And is there any more advice to those experts that you want to say about antibiotics
• 37:04
  and just with probably, you know, like we mentioned, a lot of parents or caregivers
• 37:09
  asking for them so their child could get better faster?
• 37:14
  Yeah and yeah and this is
• 37:17
  how when pediatricians need you know people it's
• 37:21
  it's it's great when a person can have their own
• 37:24
  pediatrician and i know our health care system doesn't always make
• 37:26
  that possible but this is this is the value of having the trusted pediatrician
• 37:32
  the person that you have a relationship with who knows your child's health knows
• 37:39
  understand what's happening inside your child's body and can give you advice on that.
• 37:45
  Well, and I know we were talking about staying home when you're sick.
• 37:48
  My son was on the high school basketball team and the directive from the coaches
• 37:53
  was that you have to show up for practice and games when you're sick.
• 38:00
  I guess because they wanted to make sure the child was telling the truth.
• 38:02
  I don't know. I don't see the logic in that.
• 38:06
  I don't either. I will tell you that when I'm on rounds in the hospital and
• 38:12
  I'm on service and I have medical students or residents and if they show up
• 38:17
  for my rounds coughing and sputtering and snotty,
• 38:23
  I send them home.
• 38:24
  I know that your job is not to be my worker bee, to see the patients on my behalf.
• 38:37
  Your job is to learn stuff, but I don't need you giving your cooties to our
• 38:45
  patients in the hospital.
• 38:47
  So if you don't feel well, please go take care of yourself and come back when you feel better.
• 38:54
  And that's great advice for also staff at pediatric clinics who might feel like
• 39:01
  to show up when they're probably catching on with this too.
• 39:04
  You know yeah i mean i so yeah obviously
• 39:07
  like if every single nurse is sick
• 39:10
  at the same time you you run in that that
• 39:13
  that's a problem right if every single doctor is sick at the same time that
• 39:17
  that's a problem but again that's why we should like get our vaccines and and
• 39:23
  you know certainly i know for
• 39:26
  myself this is winter virus season when i'm going to places you know now,
• 39:32
  the airport the grocery store whatever I'm wearing
• 39:36
  a mask because I don't I don't need whatever those
• 39:38
  people are breathing out right so I don't need the cuties that are flying around
• 39:42
  in the air right now because I have a job that I need to do and so that's partly
• 39:46
  what I'm going to do to protect myself and if someone's been sick for more than
• 39:52
  a week is and they still have that existing cough just wear a mask but it's okay to go back,
• 39:58
  It's hard to say, you know, when exactly is that time when it's okay to go back.
• 40:02
  But, you know, that lingering cough.
• 40:05
  Yeah. Well, so the lingering cough. So the thing is, like, it varies from,
• 40:08
  you know, virus to virus or whatever.
• 40:12
  So, and again, you know, not everybody has the opportunity or the luxury of
• 40:20
  time to be able to look into all of these things.
• 40:21
  But there are lots of studies, for instance, for COVID,
• 40:26
  showing how long do we still detect viable virus in respiratory secretions in people.
• 40:37
  So usually about 10 days or so after the onset of that illness is when we stop
• 40:44
  seeing viable virus in what people are coughing out.
• 40:52
  And so, yes, maybe you're even already better, but you're still actually shedding some virus.
• 40:59
  But on the other hand, RSV and COVID in particular,
• 41:05
  as well as mycoplasma and pertussis, these different infections have these notorious,
• 41:15
  long, persisting coughs, like where you're coughing for a month and a half after
• 41:20
  you've gotten your illness.
• 41:22
  And you're not really contagious during that time, beyond that three days,
• 41:27
  seven days, 10 days, depending on the cootie.
• 41:30
  But you're still coughing. So are you truly contagious?
• 41:35
  Do you need to wear a mask? Probably not. Are you going to freak out everybody
• 41:40
  around you if you're coughing and you're not wearing a mask? Maybe.
• 41:47
  And if you're coughing a month after your RSV illness, that doesn't mean that
• 41:51
  you have pneumonia and you need antibiotics.
• 41:53
  It means that you had RSV and you have your ongoing month-long cough that is
• 42:00
  to be expected after that illness.
• 42:04
  Tess, as always, I feel so lucky to be able to be here talking to you and for
• 42:09
  giving us such great information.
• 42:11
  Is there anything we didn't cover that you want to mention before we wrap up?
• 42:16
  No. I mean, I think that,
• 42:19
  I think that we covered lots of ground. So I just hope that everybody washes
• 42:24
  their hands and stays healthy and tries to not give their cooties to each other
• 42:30
  for the next month or so. This will pass.
• 42:36
  Hang in there, Trishin. Always. Yes, yes.
• 42:40
  RSV is going away. You'll be able to take a breather soon.
• 42:44
  Before we go, what's your favorite thing so far to do in Seattle?
• 42:48
  At the moment, my favorite thing to do is to eat seafood.
• 42:54
  And I guess, do you have any fun trips on the horizon? We usually talk about your adventure travel.
• 43:02
  At the moment, I don't. But that's because I just did a cross-country road trip
• 43:08
  with many animals in my car.
• 43:10
  So I'm still recovering from that trip.
• 43:14
  Yes. And so several cats and there's...
• 43:17
  Two dogs. and two dogs and then
• 43:20
  one cat had to travel alone or i know it's complicated
• 43:23
  on airlines with with cats yeah no and and and you know what she did great until
• 43:29
  the very last second and we were getting off the plane and i reached under to
• 43:32
  pull the carrier out and it was empty and she had escaped and she was loose
• 43:38
  on the plane but luckily she didn't get very far What did you do?
• 43:46
  She managed to unzip her container. I had her on a leash and the leash was tied to the container.
• 43:53
  So she didn't get far, but yeah, she busted out, but not until the very end of the flight.
• 44:00
  Oh my goodness. They're so smart.
• 44:04
  Well, thank you so much. Dr. Tess Barton, Pediatric Infectious Disease with
• 44:09
  the University of Texas Health Science Center and University Hospital.
• 44:13
  We're really so grateful that you were able to do this interview today.
• 44:18
  Great. Thanks for having me. Have a good day. Okay. See you soon. All right. Bye.