Latest / Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner / COVID and Flu: Updates, Insights, and Best Practices

Transcript

COVID and Flu: Updates, Insights, and Best Practices · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

• 0:00
  Oh, and have you been on any fun travels recently? I have, because I went to
• 0:03
  my annual Barbie convention that I go to, and I got COVID.
• 0:08
  Again? Again. So Barbie convention is three for three. Oh my gosh.
• 0:13
  Giving me COVID. I just sent my registration for next year's COVIDpalooza.
• 0:20
  Music.
• 0:20
  Welcome to Pediatrics Now, cases, updates, and discussions for the busy practitioner.
• 0:25
  I'm your host, Holly Wayment.
• 0:27
  I work for UT Health San Antonio's Department of Pediatrics.
• 0:30
  In this podcast, we explore how we can provide the best, most cutting-edge,
• 0:35
  compassionate care for children.
• 0:37
  We hope to give you a unique and behind-the-scenes edge from our expert guests.
• 0:42
  After listening, click on the link on this podcast for free credit that may
• 0:46
  include CME, MOC, or ethics credit, depending on the topic.
• 0:54
  Pediatrics now is brought to you by the department of
• 0:57
  pediatrics at the university of texas health science
• 1:00
  center at san antonio and university health's new
• 1:03
  women's and children's hospital back on the show today we have tess barton she
• 1:08
  is an expert in infectious disease and she works at university health and she's
• 1:17
  a faculty member here at the university of texas health Science Center.
• 1:20
  So Tess, thank you so much for being back on the show today.
• 1:23
  Yeah, thanks for having me back. But you did have fun at the Barbie convention?
• 1:27
  Tons of fun at the Barbie convention. I mean, the Barbie convention is always,
• 1:30
  you know, a bunch of, I mean, adults being silly and playing with dolls.
• 1:36
  So yeah, always fun. And then you're, it's three for three, you were saying. Yeah, three for three.
• 1:43
  You know, I, so it's funny because actually I do, I do wear a mask at the Barbie
• 1:47
  convention when we are doing, like, standing in lines and doing things in crowds.
• 1:55
  But because all of the events are meal events, like most of the large events
• 2:04
  are meal events, so you really can't help but sit in a room of 800 people.
• 2:10
  Everybody's laughing and you know screaming because
• 2:13
  they're excited about about bob mackie that
• 2:16
  was our one of our guests was bob mackie you know and excited about their dolls
• 2:22
  and you know there's just a lot of a lot of you know jubilation going on and
• 2:30
  and you know so so when you're in And in a crowded room of that many people,
• 2:35
  you know, invariably it's going to be some kind of super spreader event.
• 2:40
  So I, you know, I did my best, but...
• 2:45
  I kind of expect that those are the kinds of things that I'm going to choose
• 2:49
  to do that put me at risk with COVID.
• 2:52
  And that's kind of where we are now, right?
• 2:54
  We're living with this. We're still talking about it these years later.
• 2:58
  Yeah, yeah. And I guess I got my COVID booster in something like November or
• 3:08
  December last year. So this was in July.
• 3:11
  Actually, it was August 1st was the day I tested positive for COVID.
• 3:14
  So, you know, my immunity had probably waned enough at that point that just
• 3:21
  it's coming around again.
• 3:23
  And how was it? Were you really sick or was it? No, I was very it was very mild.
• 3:28
  In fact, I didn't even have a fever. It was just sore throat and a cold and a cough.
• 3:34
  I decided not to take any kind of treatment because I've weathered it fine in
• 3:40
  the past and didn't really think that I needed, you know, necessarily to do
• 3:45
  any kind of antiviral treatment.
• 3:48
  Although my husband did the antiviral treatment and he felt like he got better quicker than I did.
• 3:55
  What's your assessment? Well, so the reason I didn't is because the one time
• 4:00
  when I did do the Paxlovid treatment, I had a rebound.
• 4:05
  I rebounded afterwards, so I got better really fast. I was doing fine.
• 4:10
  I finished the treatment, and
• 4:11
  a couple of days later, I had symptoms again and tested positive again.
• 4:15
  And and so I and then I ended up having to miss work actually for longer because
• 4:21
  I had a rebound case than if I had just sort of let it run its course and so
• 4:26
  because I knew that I had some,
• 4:29
  obligations in the week after I had COVID I didn't want to be rebounding during
• 4:34
  that time and and so I thought I'm just going to let this one run its course
• 4:38
  and then that way the following week when I have some important things to do,
• 4:42
  I should be good to go.
• 4:44
  But I still wore my mask during all of my meetings and other things that I had
• 4:49
  the following week, because that
• 4:50
  still fell within the time period that I potentially might be contagious.
• 4:55
  The CDC recommendations, frankly,
• 4:58
  I think have become, you know, because they've changed so many times over the,
• 5:03
  you know, over the course of the years as they've kind of both adjusted to learning
• 5:10
  new things about the virus.
• 5:13
  Seeing the way that the viral disease has changed as the population has developed some more immunity.
• 5:19
  And then also, I think, being a little bit more accommodating to human schedules and obligations.
• 5:27
  I think they've kind of changed what are the, you know, we no longer have to
• 5:31
  do like three weeks of, you know, isolation after testing positive.
• 5:35
  But there really is still a period of time when you're still shedding the virus
• 5:40
  and can transmit it to others.
• 5:42
  And so, and you can either just do that based on the time or you can do the self-test.
• 5:48
  So I did self-test to see if I was still having some signs of antigen around
• 5:54
  to know whether or not I needed to wear my mask when I was doing all my meetings
• 5:58
  in the week after I had COVID.
• 6:00
  So that's basically, and then did you test at the beginning to be sure you had
• 6:03
  it? And then you tested several days later?
• 6:06
  I did. I did. I actually tested before we went on our trip, which is kind of
• 6:10
  what I normally have been doing, only because I assume that I,
• 6:14
  you know, have potential exposures while I'm at work.
• 6:18
  Then, so three times, basically, just to give yourself knowledge where you knew
• 6:23
  how careful you needed to be. Yeah.
• 6:25
  So this time I had, you know, I had tests before I went on my trip.
• 6:29
  I, my friends had symptoms and I tested that when they developed symptoms and I was negative.
• 6:39
  And then like two days after my friends had symptoms, I developed symptoms and
• 6:45
  that's when I tested positive.
• 6:46
  And then I kind of
• 6:50
  just stuck it out and you know I was on vacation so I was able to be you know
• 6:55
  fairly relaxed and it was the summer so if we you know if I had to go eat somewhere
• 7:01
  I was able to be outside and didn't have to you know go inside to expose other
• 7:05
  people and then and then at the the end of that,
• 7:09
  the day before my meetings were starting, I felt fine.
• 7:16
  My symptoms were totally gone, but I did a test to see and it was still positive.
• 7:21
  So then I knew that I needed to continue wearing a mask when I was in all of
• 7:24
  my meetings, even though I felt better and didn't have symptoms,
• 7:27
  which is actually not, you know, this current CDC guidelines are a little bit
• 7:33
  vague because they're like, if you...
• 7:37
  You know, once you're 48 hours after your symptoms are better,
• 7:40
  after your fever has resolved, that you can go back to work,
• 7:43
  go back to school, do your normal activities.
• 7:47
  And then there's kind of a little footnote that says you should consider wearing
• 7:50
  a mask for 10 days, but it's not very prominent in the recommendations.
• 7:56
  But those are basically the recommendations, or is there anything else about
• 8:00
  the recommendations that you want to mention?
• 8:02
  No, I think it's just that. I mean, I think just not, you know,
• 8:05
  You know, just because the recommendations are a little bit more relaxed or
• 8:10
  a little bit more permissive of getting back to our regular activities,
• 8:13
  it doesn't mean that the nature of the virus has actually changed and we can
• 8:17
  still be shedding the virus after we feel better.
• 8:20
  And I think if we have the capability of doing a self-test to kind of determine
• 8:28
  when it is that you're truly safe to be indoors and up close with other people,
• 8:35
  that is, I think, the right thing to do.
• 8:39
  Because we don't know who we'll be talking to or around who has compromised
• 8:43
  immune system. Sure, exactly. Exactly.
• 8:47
  Music.
• 8:51
  So a recent New York Times article talks about how we now know it's rare when
• 8:57
  kids get really sick after having COVID,
• 9:01
  the MIS-C, but there's a major study that directly links that to getting the
• 9:08
  full-blown COVID virus. Yeah.
• 9:10
  So this is something that was actually recognized fairly early on in the COVID
• 9:16
  pandemic, that there were children who were being hospitalized with what I'll
• 9:23
  call a hyperinflammatory syndrome.
• 9:25
  So basically where they have an illness where there's just massive amounts of
• 9:29
  inflammation going on in the body.
• 9:31
  And we we there are several there
• 9:35
  are several syndromes like this that pediatricians
• 9:39
  are used to seeing but these particular children were
• 9:42
  like they were a little bit older than
• 9:46
  what you would normally see for something like kawasaki they were just a little
• 9:50
  bit different and they and the timing was that it seemed to follow a few weeks
• 9:55
  after their covid infection and and so So that's when this new disease was described.
• 10:04
  And there are similar diseases that have kind of a similar background,
• 10:13
  which is that you get an infection, and then your immune system reacts to that infection,
• 10:18
  and then your immune system goes nuts and starts doing all sorts of crazy reactions
• 10:23
  that leads to damage to other parts of your body.
• 10:27
  So in the setting of MIS-C, you have things like damage to your heart.
• 10:34
  So you can get a myocarditis or other cardiac manifestations.
• 10:39
  You get blood clots, which is something that's been very well documented for
• 10:44
  adults with COVID infections, that one of the consequences of COVID infections are blood clots.
• 10:49
  You get multiple organs become inflamed. And that's what MIS-C is.
• 10:55
  And so we saw a little flurry of that early in the COVID pandemic.
• 11:00
  And then we've actually haven't seen as many cases of MIS-C subsequently.
• 11:06
  And I guess we'll ultimately figure out why that is,
• 11:10
  but likely it's because people now have some pre-existing, you know,
• 11:15
  immunity or antibodies from their,
• 11:17
  either their vaccines or their previous COVID infections that's giving them
• 11:22
  some degree of immune system knowledge so that it doesn't create these like crazy,
• 11:31
  overreaction, you know, inflammation cascades in response to COVID.
• 11:37
  So it's good. It's good to be, you know, to have that kind of confirmed.
• 11:42
  It is becoming more and more challenging to diagnose MIS-C because,
• 11:45
  you know, in the early part of the pandemic when nobody had COVID,
• 11:49
  we actually diagnosed it by having a child that had all the symptoms and we
• 11:55
  could test their COVID antibodies, and if they were positive,
• 11:57
  you'd be like, okay, this is likely MIS-C.
• 12:01
  But now everybody has COVID antibodies, so it's not a useful test anymore.
• 12:06
  And so you really do have to kind of hunt down the timing of did they have a
• 12:10
  known COVID exposure or a documented COVID infection in the weeks prior to presenting
• 12:16
  with this syndrome. Mm-hmm.
• 12:19
  And this syndrome, it's the child recovers, it could be a mild case of COVID.
• 12:25
  And then it's a week or two later, they get very ill.
• 12:28
  That's right. So so typically, you they have they have whatever version of COVID
• 12:32
  a child will have, which is usually just a mild fever and upper respiratory infection.
• 12:38
  And then they recover. And then about two weeks later,
• 12:43
  on average, they develop this massive release of inflammatory proteins that
• 12:51
  gives a whole myriad symptoms,
• 12:54
  including fever and multi-organ damage and abnormal coagulation.
• 13:00
  We will see long COVID patients. I will see them.
• 13:03
  The cardiologists are also interested in them because that's one of the That's
• 13:08
  one of the kind of long-term manifestations of COVID is,
• 13:12
  you know, did you have a silent myocarditis or heart muscle infection due to the virus?
• 13:21
  And now you have your heart muscle not working properly.
• 13:24
  That's usually one of the first things that we start looking at when somebody
• 13:27
  has long COVID to make sure that that's not why.
• 13:30
  So you're still seeing patients who have long COVID. Every now and then.
• 13:35
  Yeah. Yeah. We continue to get them.
• 13:37
  So having said all of this, where are we in the pediatric setting?
• 13:43
  When should we all as adults working in pediatrics be getting our COVID shots?
• 13:50
  And then what is the recommendation we should be saying to families?
• 13:54
  Well, I mean, I don't think there's anything new or earth shattering here is
• 13:59
  that, you know, we have a virus that circulates that sometimes is mild and sometimes is serious.
• 14:06
  And we can't always predict who's going to get the mild case and who's going to get the severe case.
• 14:13
  And so we have the ability to prevent that virus to some degree, right?
• 14:21
  It's not 100% protective to get a vaccine, but you cut your risk of getting
• 14:28
  the infection in half, and you definitely cut the risk of getting a severe case of that infection.
• 14:35
  So now we know that we can prevent this virus infection to some degree with a vaccine.
• 14:42
  So we should take the opportunity to protect ourselves from whatever contagious
• 14:48
  things are coming around. Every year the flu comes around, and every year we
• 14:53
  have an opportunity to protect ourselves against the flu.
• 14:56
  Every year, and it seems like maybe twice a year, COVID comes around.
• 15:01
  So we're just recovering from a big July COVID surge.
• 15:06
  Surge so nationwide and in
• 15:09
  Texas we peaked in early to
• 15:12
  mid-July and the number of COVID cases have been
• 15:15
  declining and that seems to be the pattern that
• 15:18
  we're falling into is that we get a summer surge and a winter surge and so we
• 15:25
  we know that we you know it will be coming it's currently waning and and getting
• 15:31
  lower but it will likely be coming back in the winter just like it has for the past two years.
• 15:36
  And so there is an updated COVID vaccine.
• 15:41
  So again, similar to the flu vaccine, the flu vaccine every year gets...
• 15:48
  Tweaked or updated the COVID vaccine because that virus also mutates and changes.
• 15:55
  The companies that make the vaccine may tweak the vaccine a little bit so that
• 16:01
  it is a closer match to the circulating viruses.
• 16:05
  So when those updated versions of vaccines come out, we should get them.
• 16:11
  That will offer us some protection for ourselves, as well as,
• 16:17
  you know, helping to protect those of us around us, right?
• 16:22
  The fewer people that are circulating the virus, the less lower the chances
• 16:26
  that you're going to get sick or that your family member is going to get sick with that virus.
• 16:31
  So the updated COVID vaccine is out and ready. The flu shot is out and ready
• 16:36
  and is being given. So now is the the time.
• 16:39
  So the ideal time to get vaccinated against one of these respiratory viruses
• 16:44
  is before the respiratory viruses hit the community, because it always takes
• 16:50
  your immune system a couple of weeks to mount the best response.
• 16:53
  And so if you wait until everybody around you is sick to go get your shot,
• 16:59
  you very likely have already been exposed and you might get sick,
• 17:02
  which is one of the things that often happens with the flu and people like,
• 17:05
  oh, well, I got my flu shot and then I got sick.
• 17:08
  Sometimes that's because you went to go get your flu shot because you saw all
• 17:12
  the people around you were getting sick and you thought, oh,
• 17:14
  I better go protect myself.
• 17:16
  But you were already exposed and your immune system didn't have enough time
• 17:20
  to give you good protection until the time that you got exposed.
• 17:24
  So it's better to sort of prepare ahead, get your vaccine ahead,
• 17:28
  and that way when it comes to the winter virus season, And you already have
• 17:32
  a little bit of a head start in keeping yourself away from those viruses.
• 17:38
  So if you got the COVID booster shot in the summer, or if you got COVID itself
• 17:46
  in the summer, should we be getting the booster?
• 17:48
  You should. So we recommend we're usually waiting 90 days from whatever your
• 17:53
  last COVID exposure, your last COVID infection or vaccine was before you get the next one.
• 18:01
  So, for instance, I had I had COVID on August 1st myself.
• 18:08
  Right. Thanks, Barbie Convention. So I had COVID myself.
• 18:12
  And so I'm, you know, on November 1st, I will be the first person in line at
• 18:17
  the at, you know, the the university clinic to go to go get my COVID vaccine.
• 18:23
  But I'm waiting until then.
• 18:25
  I get asked by pediatric practitioners, where should kids get the vaccine?
• 18:31
  Is it okay to go to their neighborhood drugstore?
• 18:34
  Is it better to have them in their off shift to their pediatric clinic or go
• 18:39
  to a hospital in your city?
• 18:43
  I mean, it doesn't matter, right? Like whatever works the best for a pediatrician,
• 18:48
  whatever works the best for your practice.
• 18:50
  If it works well for your practice to order that vaccine and to have it in stock
• 18:53
  because you know, you're going to use it, and you're not going to have to be
• 18:57
  throwing away a supply at the at the end of the season, then absolutely go ahead and do that.
• 19:03
  Because we know that the fewer stops that somebody has to make in their healthcare,
• 19:08
  you know, access points, the higher the likelihood is that they're going to
• 19:13
  actually complete their things, right?
• 19:15
  So if they have to go multiple different places to get different shots,
• 19:18
  they're probably not going to end up getting all of those shots.
• 19:20
  Whereas if they can do a one-stop shop to get all the things that they need,
• 19:25
  they're more likely to get them all.
• 19:27
  But of course, there are logistics in your supply and your ordering and things like that.
• 19:31
  And so it's perfectly fine for children to go to the local, you know,
• 19:37
  retail pharmacy to get their vaccine.
• 19:41
  That's fine. It's perfectly fine for them to go to the, you know,
• 19:46
  a university health center or, you know, a community health clinic or someplace that has the vaccine.
• 19:53
  It honestly doesn't matter. The vaccine is going to be the same in all of the places.
• 19:57
  One practitioner was saying they may not, would the dosage be right if it's
• 20:02
  at the local drugstore? How do they know for kids what they need?
• 20:06
  Well, so the dosage should be correct at the local drugstore because those vaccines
• 20:11
  are being given by pharmacists.
• 20:13
  And pharmacists are very vigilant about things like dosing and products and
• 20:18
  lot numbers and things like that. That's what they do professionally.
• 20:22
  Frankly, they're better than we are as physicians at paying attention to all of those things.
• 20:26
  And COVID vaccine is confusing because it's for children, it's like three doses
• 20:32
  of the Pfizer product or two doses of the Moderna product.
• 20:36
  And if you want to use the Novavax product, it's H12 and up and it's just one
• 20:39
  dose. And so it is a little bit confusing to keep straight.
• 20:43
  So certainly, I would assume that most pediatricians, if they're going to have
• 20:49
  that COVID vaccine in their practice, they're probably going to stick with one product.
• 20:53
  And that way they don't have to remember three different dosing schedules because
• 21:00
  they have enough to remember as it is.
• 21:02
  And do you still recommend that it's It's totally fine to get the flu shot and
• 21:07
  the COVID booster at the same time. Absolutely, yes. For kids, too. Absolutely, yes.
• 21:12
  Okay. Our community pediatricians, they're on the front lines.
• 21:18
  One pediatrician I was talking to the other day, she sees 40 patients in a day.
• 21:22
  Any advice on what to say to patients? It seems like there's still such vaccine
• 21:27
  hesitancy, especially with the COVID vaccine.
• 21:30
  And I mean, even I remember this summer being at the beach and one of the dads
• 21:35
  I was talking to was talking about like still believing that MIS-C is caused.
• 21:41
  Only by the vaccine, which it's much more common, even though it's all still
• 21:46
  rare, it's much more common, the actual virus, what we were just talking about caused by, right?
• 21:50
  Yeah, actually. Actually, and the vaccine does not cause MIS-C.
• 21:53
  So that's just totally false. That was a... Yeah, there have been a literally
• 22:00
  handful of cases that were,
• 22:04
  you know, speculatively, perhaps caused by, you know, following there was somebody
• 22:10
  developed an MIS-C like illness following the vaccine.
• 22:14
  So I can't say like, no, it never ever happens, But it is exceedingly rare.
• 22:19
  The thing that can look like that from COVID vaccine is myocarditis, right?
• 22:24
  That's sort of the worst possible side effect that we see in pediatrics for COVID vaccine.
• 22:32
  Also very rare, right? So the highest risk person for getting myocarditis from
• 22:40
  their COVID vaccine is the adolescent male,
• 22:44
  and their risk is like 1 in 15,000 to 30,000 doses.
• 22:52
  Right? So that means that the vast, vast, vast, vast majority of boys who get
• 22:59
  COVID vaccine are going to be just fine after their COVID vaccine.
• 23:03
  There will be the rare few that get inflammation of the heart and and the vast majority of those.
• 23:12
  What we've experienced has been that they are mild and they get through it and
• 23:17
  they don't have a long-lasting side effect and then so what would you say to
• 23:21
  the the parent who says well i i don't want to take that chance i know it's
• 23:26
  extremely rare sure so i think that there are two there are two.
• 23:31
  Reasons why, why I see parents really hesitating to get COVID or,
• 23:38
  or other vaccines, but particularly the COVID vaccine.
• 23:40
  So one is they're worried that it's not safe, right? So that goes back to the myocarditis issue.
• 23:47
  So, and so usually what I, my answers to those are at this point in time,
• 23:54
  hundreds of millions of children in the U.S.
• 23:59
  And around the world have received this vaccine without any side effect.
• 24:04
  So no vaccine, no medication, nothing that we do like that is 100% safe.
• 24:14
  Everything has a potential for a side effect. The side effects for COVID vaccine,
• 24:19
  serious side effects for COVID vaccines is exceedingly rare.
• 24:24
  So, and the side effects that you have, the most severe one is really myocarditis,
• 24:30
  which is also a consequence of COVID infection.
• 24:33
  And actually the odds of getting myocarditis from the actual COVID virus is
• 24:40
  much, much, much higher than the odds of getting myocarditis from the vaccine.
• 24:44
  So, again, really getting the vaccine for most children actually will help to
• 24:50
  prevent them from getting myocarditis, right, by preventing them from getting
• 24:54
  the virus in the first place.
• 24:56
  So having the vaccine is safer than having the virus.
• 25:00
  Much safer. Yes, much safer. And so that's one of the takeaways, right?
• 25:05
  So similarly, like, well, if COVID disease is mild for kids,
• 25:11
  so why would I bother getting them the vaccine?
• 25:13
  Because COVID vaccine is also mild for kids, right? In that same sense.
• 25:18
  So then the other reason why I see parents not wanting to give COVID vaccine
• 25:25
  is they say, well, it doesn't work, right?
• 25:27
  Vaccines don't work. work and and so i think that we as health care workers
• 25:32
  have to acknowledge that this vaccine,
• 25:34
  is about 50 protective right so and that you know that means not that you're
• 25:44
  you know 50 of you are going to still get covet anyway that's not what that
• 25:48
  means that means that you have cut the risk of getting COVID in half.
• 25:53
  Not 100%, right? Not 90%. So there, yeah, there is a chance that you will get
• 25:58
  vaccine and you will still get the virus, but you're at least cutting your risk in half.
• 26:04
  And, and so that's something. That's something.
• 26:08
  And I know our, our colleague, Dr.
• 26:13
  J.B. Canty, when he was on the show where he was saying, cause he hears parents
• 26:17
  saying, well, I don't want to put COVID into my child.
• 26:21
  And it's not that it's, and if you decide not to get the vaccine,
• 26:25
  your, your child is going to get the COVID and flu, but it's the full blown virus.
• 26:31
  It's not, what do you want to say about that? Yeah, no, that's, that's exactly.
• 26:34
  You're right. So, you know, all vaccines are all a little bit different,
• 26:41
  but the COVID vaccine is not giving,
• 26:45
  and the flu vaccine are not giving your child COVID or the flu.
• 26:50
  You are giving them bits and pieces of those viruses so that their immune system
• 26:57
  will later recognize what those bits and pieces look like when the virus comes around.
• 27:05
  When you get the actual virus, yes, you get exposed to all the different components of that virus,
• 27:14
  which means that your immune system will react to all those different components,
• 27:21
  and that's good and bad, right?
• 27:24
  That means you get a very well-rounded immunity with antibodies against lots
• 27:28
  of different parts of that virus, But it also means that you get the,
• 27:33
  sometimes those antibodies are antibodies that misbehave and act against our
• 27:38
  own body and create actually more illness.
• 27:41
  And so, yeah, you do run the risk of having these other effects of having had the whole virus.
• 27:49
  I was curious to, before we move on to the flu,
• 27:53
  and I know we talked a little bit about it just now, but do you want to say
• 27:57
  anything about what most of us saw this summer with the Olympic runner who won
• 28:03
  the medal and then announced that he had COVID?
• 28:08
  Any thoughts on that?
• 28:11
  No. I mean, I think that everybody weathers their COVID illness differently.
• 28:16
  And, you know, some people get laid up for a week and don't want to do anything.
• 28:24
  Some people perform in the Olympics. Some people end up in the ICU.
• 28:29
  Like, everybody's a little bit different. And like you were saying,
• 28:32
  we can't predict how it will hit someone.
• 28:34
  Even an otherwise healthy person could get really sick and have terrible outcome
• 28:41
  from COVID. Absolutely.
• 28:45
  Okay, are we ready to move on to the flu? Sure.
• 28:50
  So, Tess, can you tell us what is the flu season going to look like this year?
• 28:53
  I mean, I... That's a hard question, isn't it?
• 28:58
  Yeah, you know what? Maybe if I knew the answer to that, I would have some like,
• 29:02
  yeah, I would be... Crystal ball.
• 29:03
  Yeah, I would be super, super wealthy if I knew the answer to what flu would
• 29:08
  look like each year. I don't know.
• 29:11
  No one does, right? Nobody knows. So what I know is that flu is coming because
• 29:16
  flu pretty much always comes.
• 29:18
  Like literally the only time that we didn't have a flu outbreak is when every
• 29:22
  single one of us was wearing a mask because we were trying to avoid getting COVID.
• 29:27
  That's the only time that we haven't had a flu outbreak. So flu season will
• 29:32
  be arriving in the next few months, which there are always a combination of
• 29:38
  different strains of flu virus that circulate.
• 29:41
  What those strains are going to be. We don't yet know.
• 29:45
  We do try to predict those because that's part of how they make the vaccine
• 29:50
  is they actually have to try to predict which are going to be the circulating
• 29:54
  flu viruses and make the vaccine with those strains.
• 29:59
  The vaccine will contain an H5 avian flu strain.
• 30:06
  So it will be a vaccine that will provide some protection against the The bird flew.
• 30:13
  So that's all I know.
• 30:15
  Should we be worried about the bird flu? I mean, I think that we should be as
• 30:18
  worried about the bird flu as we always are worried about new flu strains.
• 30:22
  So influenza is an incredibly crafty virus, and it changes and changes and changes and changes.
• 30:34
  There are flu viruses for all sorts of different animals.
• 30:38
  And what we see is that when one virus mixes with another virus inside an animal or a human's body,
• 30:48
  you sometimes end up with a virus that has the capability to spread more widely.
• 30:54
  So the bird flu that has gotten a lot of press this year, there have been a
• 30:59
  few human cases and they've been serious cases.
• 31:03
  And most of those have been cases that a human acquired from an animal.
• 31:08
  So the key always with influenza is, is it going to do human-to-human transmission?
• 31:15
  Because not all of them do.
• 31:17
  And so I think there's been this one case in Missouri that they suspect may
• 31:23
  have been a human-to-human transmission. mission.
• 31:26
  And so, yeah, everybody's going to be watching to see, is this going to be a
• 31:32
  change in that strain that allows it then to spread through a human population?
• 31:39
  Personally, I think it's always wise of us to assume that, yes,
• 31:42
  it's going to do that, right?
• 31:44
  And so if you see the signs that something might be coming and you have an opportunity
• 31:50
  to stay protected against it, then take that opportunity.
• 31:55
  Which is getting the flu vaccine, right? Exactly.
• 31:58
  Is there a bird flu vaccine being developed? There doesn't need to be a bird
• 32:02
  flu vaccine developed because they can, they, right.
• 32:05
  So the, when this bird flu was first being detected.
• 32:11
  One of the first things that I did was like, hey, did the old flu vaccine from
• 32:15
  this last year, would it have provided protection against that bird flu?
• 32:20
  And yes, there was a very similar strain that was in that vaccine.
• 32:24
  So it was supposedly, yes, last year's flu vaccine actually provided protection
• 32:30
  against that bird flu strain.
• 32:32
  And so, I mean, I'm not a vaccine manufacturer, but I would presume that the
• 32:38
  vaccine manufacturers are including something, some H5 strain that will provide
• 32:45
  protection against that bird flu strain.
• 32:47
  And as we know from the flu, people are still dying and children can die from the flu. Every year.
• 32:54
  Every year, thousands of people
• 32:56
  die. Respiratory viruses in general have respiratory symptoms, right?
• 33:00
  So all of those, you know, runny nose, congestion, coughing, those things.
• 33:06
  Influenza typically is a little bit more severe and systemic than just a regular cold.
• 33:13
  So you could add on to that headache, body aches, muscle aches,
• 33:18
  extra tiredness, higher fever, you know, stomach aches, all those things.
• 33:23
  Every person will have maybe a little bit of a different mixture of those things,
• 33:27
  but it's basically, you know, similar to a common cold, but more severe.
• 33:34
  And COVID, the same, right? COVID is often, you know, respiratory symptoms,
• 33:41
  lots of sore throat, high fever, lots of feeling tired and body aches.
• 33:47
  So, and if someone thinks they had the flu or COVID, but they don't know for
• 33:53
  sure, should they go ahead and still get the vaccine as soon as they can if
• 33:57
  they never tested for either one of those? Yeah. Okay.
• 34:00
  When do you worry with the flu symptoms? The things that you worry about are
• 34:04
  really the complications in the acute phase.
• 34:08
  So things like, yeah, so difficulty breathing, severe headaches,
• 34:14
  like high fever with severe headaches, because those are the things that can, you know, really,
• 34:20
  really be pretty life threatening if,
• 34:24
  you know, if somebody has an influenza pneumonia or an influenza encephalitis,
• 34:29
  meningitis something like that they those are really the
• 34:32
  things that can that you can get into trouble with the
• 34:36
  other thing are sometimes you get that infection and
• 34:39
  that allows the bacteria that are living in your body to manage to sneak their
• 34:42
  way into your bloodstream or into places where they don't belong and then they
• 34:45
  begin to cause bacterial infections like a sinus infection or a pneumonia or
• 34:51
  a meningitis or something like that and so so if you have what seems like a
• 34:56
  pretty regular flu or COVID,
• 34:59
  but then it just keeps going, like the fever's just not going away,
• 35:03
  and now you're on day four or five, and you really should have been recovering
• 35:06
  by now, but you're not recovering, those are also the times to go get seen.
• 35:11
  Dr. Tess Barton with University Health and the University of Texas Health Science
• 35:16
  Center at San Antonio, infectious disease expert.
• 35:19
  Thank you so much for being here today again on Pediatrics Now.
• 35:22
  Now it's, you always do such a great job. Great. Thanks. Have a good day.
• 35:27
  We hope you've enjoyed this episode of Pediatrics Now. Click on the link for
• 35:31
  free credit if you're a practitioner.
• 35:33
  You can also email us with questions or episode ideas.
• 35:34
  Music.
• 35:37
  That address is pediatricsnow at U-T-H-S-C-S-A dot E-D-U.
• 35:43
  We release a new episode every Friday.
• 35:46
  I'm Holly Wayment. I hope you can join us for our next episode.