With holiday gatherings around the corner and viral illnesses including flu and COVID-19 on the rise again, this Northwestern Medicine doctor offers tips to managing symptoms, identifying what you have, and mitigating transmission risk.
Dr. Jeremy Silver, medical director for Northwestern Medicine Kishwaukee Hospital’s emergency department in DeKalb, said said it’s not dramatic to think of the current illness trends as a “tripledemic,” a term used to highlight the severity of ongoing seasonal illnesses. And another tricky aspect: How to tell the often respiratory-riddled symptoms apart.
“It’s probably the equivalent to the peak of omicron, which hit us a bit later [in 2021],” Silver said. “So I think just generally speaking, when it’s cold, the viruses tend to transmit more readily. People are inside congregating and also viruses do better in the cold than they do in the heat.”
A year ago, as then-new coronavirus variant omicron hit the country, a post-holiday surge swept the region, rendering already overburdened hospitals overflowed. Doctors then asked patients to stay away from the ER unless absolutely necessary.
Now space remains an issue, and while numbers haven’t quite reached crisis levels, Silver said area residents seeking treatment should prepare themselves for longer than usual wait times.
“The current situation in the region is challenging, that many hospitals including our own are holding admitted patients in the ER for extended periods of time because the burden of illnesses,” Silver said. “So if you have a condition that could potentially be treated at an urgent care or primary care that might be advisable given the current situation.”
In 2021, DeKalb County reported 78 flu-like illnesses at Kishwaukee Hospital’s emergency department from Oct, 31 through Nov. 13, according to the DeKalb County Health Department. This year, that’s more than doubled so far, with 181 reports during that same time frame in DeKalb. High rates of flu are also reported in DuPage and Kane counties, according to the respective county health departments.
As of late Thursday, Illinois had 1,704 COVID-19 patients in the hospital, the most since Feb. 14. Of those, 223 were in intensive care units, the most since Feb. 23, and 60 were on ventilators.
The IDPH recommends indoor masking for all regardless of vaccination status in counties reporting high community transmission rates. Self-testing before socializing with a person who’s immunocompromised, staying up-to-date on vaccinations and boosters, maintaining good ventilation and using precautionary measures such as discretion when in large crowds, hand-washing and staying away from others if you feel ill is also recommended.
“I think what you’re starting to see now with COVID is flareups, with surges regionally as opposed to these broad based, national or continental sweeps of disease,” Silver said. “You may have a COVID surge in the Midwest, but the South is seeing flu, as an example.”
It’s been only months since a “massive influx of RSV,” as Silver called it, swept through the region. With it came more strain on the already strained healthcare systems, as pediatric nurse shortages or shortages of patient space in hospitals meant a bottleneck of cases. Kishwaukee Hospital, for example, doesn’t often admit pediatric patients, Silver said.
Pediatrician Dr. Blair Wright sets up an examination room for a patient visit Friday, Nov. 4, 2022, at Northwestern Medicine Valley West Hospital in Sandwich. (Mark Busch – mbusch@shawmedia.com/Mark Busch – mbusch@shawmedia.co)
How to tell the difference between viruses
Flu, COVID-19 and RSV are all contagious respiratory viruses, with many of the same symptoms that can be hard to distinguish.
According to the CDC, COVID-19 spreads more easily than flu.
Distinguishing between the two must be a matter of testing, as symptoms such as fever, cough, fatigue, sore throat, runny or stuffy nose and headache can be found in both infections. And with omicron and its subvariants still the primary strain in the country, COVID-19 might not often show up with a loss of taste or smell, the CDC reports.
“Flu tends to be rapid onset, high fever, you were fine when you woke up, by 3 p.m. it’s over,” Silver said. “COVID tends to be slow, subtle flu-like with cough or sore throat versus sometimes diarrhea or nausea.”
COVID-19 tests can be found in pharmacies and retail stores throughout the area. Healthcare professionals can provide a flu test.
Of the three, most people can recover from RSV in a week or two, though infections in infants and older adults can be especially serious. RSV also is the most common cause of bronchiolitis, inflammation of the small airways in the lung, and pneumonia, or lung infections, in children younger than 1, the CDC reports.
“RSV is more of an illness of very young children, fewer than 2 years, with wheezing, difficulty breathing, ow grade fevers and clear runny nose,” Silver said.
According to the CDC, RSV upticks are still reported in several regions throughout the country, with some nearing seasonal peak levels.
“We’re seeing a lot of flu or flu-adjacent illnesses,” Silver said. “In my opinion, the nature of the viruses is dominance so the idea of a tripledemic as an onslaught of all three viruses at once is not reality. I think what’s more realistic, which is what we’ve seen, is this scenario: COVID surges, then dips. Then the RSV epidemic, and that kind of wains, and then flu comes to the foreground.”
Those who seem to suffer are often the ones who do annually, Silver said. In children especially, Silver says he’s noted leapfrogging from one illness to the next.
“The very young and the very old, so the extremes of age,” Silver said. “And vulnerable populations who can’t really, they require society to help lift them up in order to make it through times like this.”
Though it’s possible to be infected with both COVID-19 and flu at the same time, it’s uncommon, says the CDC.
Silvers said flu cases he’s seeing now are fairly severe.
How to mitigate risk
Does vaccination seem to be playing a role in those who are getting this year’s strain of flu, like the bivalent COVID-19 booster?
Yes, said Silver.
Similar to the COVID-19 vaccine’s primary function, the role of vaccination against both flu and the coronavirus is meant to stave off severity: Severe symptoms, infections, risk of hospitalization and death.
“Vaccines work, the risks of vaccines are far outweighed than getting sick and having long complications such as baring fog, loss of function, loss of job, chronic fatigue, blood clots, strokes and heart attacks,” Silver said. “Don’t forget the flu was the big boogie man just a few years ago prior to COVID. You can’t take your eye off the ball there. Vaccination not only protects you but protects the grandbaby next door. There’s a safety net component there that maybe gets lost.”
That also means additional steps exist to mitigate viral control, Silver said. As has been preached by healthcare professionals since the beginning of the pandemic nearly three years ago, behavioral risk mitigation is paramount, especially as indoor gatherings are likely to abound this holiday.
For all illnesses, he recommends taking the we-before-me approach, using masks, isolation and testing as a way to keep yourself and those around you healthy. Even if at first it feels like just a cold.
“Early [upper respiratory infection] symptoms – ear ache, headache, sinus congestion, runny nose, post nasal drip, dry cough, sore through, body aches, nausea, fatigue – should prompt mask wearing at minimum,” Silver said.
Those with confirmed COVID-19 should isolate until symptom are gone, Silvers said. Those with flu or RSV are likely to experience infectiousness for about 10 to 14 days, Silver said.
“Because of overlap of symptoms, if you feel bad, get tested at home, frequently,” Silver said.
That goes especially for those with who are older or have chronic disease like high blood pressure, kidney problems, heart or lung disease such as asthma or COPD, cancer or autoimmune disease, Silver said.
Masking up is about protecting those around you, too, Silver said.
“If you don’t feel well please wear a mask so that you don’t make the person next to you sick,” Silver said. “If you have a fever or you’re very symptomatic, I’d strongly advice not going to work and spreading it around. I’d advise people that are managers in workspaces be sensitive to this. You want your employees to come to work but not be sick at the same time.”
One of the surgical recovery areas set for renovation at Northwestern Medicine Kishwaukee Hospital in DeKalb. (Mark Busch – mbusch@shawmedia.com/Mark Busch – mbusch@shawmedia.co)
At a glance – symptom checks and treatment
RSV
No vaccine available
Recommended treatment includes fever and pain management medicine, drinking fluids and consulting a doctor
Symptoms generally show up four to six days post-exposure, according to the CDC.
Symptoms include runny nose, decreased appetite, coughing, sneezing, a fever or wheezing. Often appear in stages, not all at once
Young infants might also experience irritability, decreased activity or trouble breathing
Nearly all children will have had an RSV infection by their second birthday, according to CDC
Most infections clear within a week or two
Seek medical care if patient experiences difficult breathing, loss of fluid intake, or worsening symptoms
Symptoms for flu and COVID-19 can be very similar, according to the CDC. Northwestern Medicine emergency department doctor Jeremy Silver recommends testing to determine what you may have. Here are ways to help you distinguish symptoms, according to the US Centers for Disease Control and Prevention. (US Centers for Disease Control and Prevention)
Flu
Vaccine is available, can be received as most pharmacies, doctor’s offices, etc.
Symptoms start to appear between one to four days post-exposure, usually come on suddenly
Symptoms: fever (though not always), chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue, vomiting and diarrhea (latter is more common in children)
Recovery often within a few days or less than two weeks
moderate complications could include sinus or ear infections. Severe could include heart, brain or muscle tissue inflammation, sepsis
Treatment can include antiviral drugs, recommended to start early
Contagious from a day prior to showing symptoms to about three to four days after, according to CDC
COVID-19
Vaccine still available, can be received as most pharmacies, doctor’s offices, etc. Latest vaccine will be the bivalent booster, specifically made to target omicron strains of coronavirus
Symptoms might not show up for between two to five days post-exposure, and can last up to 14 days after infection or longer if complications arise, according to the CDC.
Symptoms: Fever, chills, cough, shortness of breath, fatigue, muscle or body aches, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea
Test to determine diagnosis
Isolate until symptoms disappear once positive
Treatment can also include antiviral drugs, including Paxlovid, available through healthcare provider
Can often remain contagious longer than those with the flu.
Can begin spreading virus two to three days prior to symptoms onset, and remain contagious on average for about eight days after symptoms began, the CDC reports.
MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.
There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.
The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.
Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.
Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.
Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.
“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.
Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.
But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.
That includes his own teenage daughter.
“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.
It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.
“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”
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AP data journalist Kasturi Pananjady contributed to this report.
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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.
How a sperm and egg fuse together has long been a mystery.
New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.
“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.
The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.
Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.
It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.
Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.
Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.
The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.
The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.
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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.
Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.
The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.
The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.
The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.
“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.
When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.
“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.
“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.
The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.
Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.
The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.
“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.
They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.
“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”
This report by The Canadian Press was first published Oct. 17, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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