Summer for medics is usually the time we get a brief respite from seeing patients with common respiratory viruses. This vital break from infectious diseases that usually peak in the winter months, gives us some much-needed time to focus on patients with other, chronic diseases.
But the COVID-19 pandemic has meant people wearing masks, social distancing, and not really mixing with those outside their households; this has led to a drop in the number of cases of common respiratory viruses such as colds and flu – something that was welcomed by medics on the front line who were busy treating those with COVID. This reduction in cases makes sense, for the flu virus is not as infectious as the virus that causes COVID.
Some of the strictest social distancing measures were put in place as the pandemic started in 2020 when the Northern hemisphere was still in what is normally “flu season”. Healthcare professionals noticed a drop in flu cases – positive tests for the flu virus plummeted by 98 percent in the United States, for example, and cases of common cold, flu, and other respiratory diseases in England were substantially lower than average in the winter of 2020/2021, GP surveillance data showed. After the flu season ended in the North, countries in the Southern hemisphere reported dramatically lower rates of flu, with Australia, Chile and South Africa reporting a grand total of just 51 cases of flu in more than 83,000 tests.
Although social distancing measures likely contributed to these lower numbers, it is unlikely to be the sole reason for this drop in cases. The marked drop in foreign travel, as well as the increase in flu vaccine uptake, spurred on by peoples’ worries of contracting both COVID and flu simultaneously, undoubtedly also played a part. Of course, viral spread is far more complex than this and other factors are likely to have been at play too, but scientists agree that measures to curb the spread of COVID led to fewer cases of flu across the world. And it wasn’t just influenza; researchers also saw lower rates of respiratory syncytial virus (RSV) – a common virus that typically infects young children and can sometimes cause serious conditions such as pneumonia. The virus spreads through droplets – through coughing, sneezing, and on surfaces – so hand hygiene and surface washing are key to keeping it at bay.
Lower rates of respiratory viruses may sound like welcome news – and certainly, when healthcare professionals are firefighting a novel coronavirus, it is – but the worry is whether there may be a surge in cases of these viruses when social distancing measures lift. There is an additional concern around children who have largely not been mixing with one another in the usual way over the last 18 months – they likely have not developed immunity to RSV, having never encountered it, potentially leaving large numbers open to infection. Although it is a mild disease for most children, those under two years old, those with underlying health conditions, or those born prematurely are at risk of becoming seriously sick with RSV.
Adults and children rely on something called “adaptive immunity” for certain infectious diseases – the part of the immune system that relies on previous infection or encounters with bugs to activate a defence system against future attacks. Without exposure, it could mean many of us are that much more susceptible to these bugs.
We have lived with these common respiratory viruses for thousands of years, but this year is different; the winter virus season is starting earlier than ever before and it is on the backdrop of an exhausted medical workforce that has been battling the COVID-19 pandemic for the last 18 months.
As the number of people vaccinated against COVID-19 increases across the developed world, many countries are easing social distancing measures and allowing people to once again meet in places deemed high risk for respiratory viral spread – including schools, nurseries and other indoor spaces. This has led to many countries reporting a surge in respiratory illnesses across all age groups.
A clear example of the explosion in respiratory infections happened in Hong Kong, which closed its schools to in-person learning from late January to late May 2020 – and then again in early July, when more COVID cases were detected. When schools reopened in October 2020, many children got sick with rhinoviruses – one of the most common causes of the common cold. Scientists expect to see similar trends across the globe as schools and economies open up again.
In the UK, prompted by a rise in numbers of children with RSV, health chiefs issued a warning to parents, reminding them to look out for symptoms of severe infection in at-risk children – including a high temperature of 37.8 degrees Celsius (100.04 degrees Fahrenheit) or above, a dry and persistent cough, difficulty feeding, rapid or wheezing breath – and saying the NHS was preparing for a rise in hospital admissions of children with severe RSV infections. The chief executive of the UK Health Security Agency, Dr Jenny Harries, said on a blog that the country had to prepare itself for a triple threat from COVID, flu and RSV in a “worst-case scenario” winter.
Cases of RSV in children have also been rising in the US, with hospitals in Brooklyn and Utah reporting significantly more numbers of children being admitted with severe symptoms of the disease than expected at this time of year. The Centers for Disease Control and Prevention (CDC) was so concerned about increasing numbers of RSV in children this summer that it put out an advisory for healthcare workers, asking them to be alert to adults and children presenting with symptoms and to encourage testing – something highly unusual for this time of year.
We have lived with these common respiratory viruses for thousands of years, but this year is different; the winter virus season is starting earlier than ever before and it is against the backdrop of an exhausted medical workforce that has been battling the COVID pandemic for the last 18 months. At the same time, many countries are seeing rising cases of the coronavirus, mainly due to the emergence of the Delta variant.
The threat of COVID, flu and RSV is a real one for many healthcare systems, so retaining a few social distancing measures such as mask-wearing and hand hygiene seems sensible. Encouraging the uptake of the flu vaccine this year is also vital, and many countries have widened the eligibility criteria because of concerns over this “triple threat”, meaning more people will be able to come forward and get the vaccine.
Many of us have enjoyed not having a cold or catching the flu over the last year; sadly that period of relief may well be coming to an end, so get the tissues ready.
Progress Report: Are the symptoms of COVID-19 changing?
Many of us can recite the classic symptoms of COVID-19 by heart: A new and persistent cough; a high temperature; a loss of sense of smell and taste.
This list has been around for many months and if any of us have any of these symptoms, it should prompt us to book a COVID-19 PCR test.
But according to new research, focusing on just these three symptoms might mean we are missing a large number of people who have the virus and are displaying “non-classic” symptoms. According to ZOE – the world’s largest ongoing study into the coronavirus, which logs information on symptoms, testing and vaccines – these may no longer be the most commonly reported symptoms by those who test positive.
Rather than the ‘classic triad’ of cough, fever and anosmia, the three most common symptoms in unvaccinated people today are headache, sore throat and runny nose, followed by fever and coughing.
According to Professor Tim Spector of King’s College London, co-founder of the ZOE study, we now know that there are more than 20 COVID symptoms, and their relative importance has changed over time. He added that the data included people who had received either one or both COVID vaccines and tested positive for the coronavirus. It is important to remember the vaccines protect against developing serious symptoms but do not make those vaccinated immune to the virus. “Rather than the ‘classic triad’ of cough, fever and anosmia, the three most common symptoms in unvaccinated people today are headache, sore throat and runny nose, followed by fever and coughing,” Spector said.
As more and more people get vaccinated and data coming in about COVID-19 symptoms changes, it is important that countries update their guidance around getting tested for the virus. It is important to track the numbers of those infected with COVID-19, and that those numbers are reliable and based on the latest research. If people only get tested when they have the classic triad of symptoms, we may be missing many people who have the virus and are not advised to isolate, spreading the disease to those who may not be vaccinated and could end up seriously ill.
Professor Spector’s message is clear: “If you feel unwell, it could be COVID-19 – stay at home and get tested to help keep yourself and those around you safe.”
Some good news: Let’s prioritise our mental health over pleasing others
The Tokyo Olympics are under way and while those winning medals are making headlines, the decision by four-time Olympic gold medallist Simone Biles to withdraw from many of her events also made waves across the world. It later emerged that Biles was guarding her mental health. A press statement released after she pulled out of the team final said: “I have to focus on my mental health. I just think mental health is more prevalent in sports right now. We have to protect our minds and our bodies and not just go out and do what the world wants us to do.”
Biles is not the only athlete to drop out of a sporting event to focus on their mental health. In May, Japanese tennis player Naomi Osaka withdrew from the French Open for the same reason, and England cricketer Ben Stokes has taken an “indefinite” break from cricket to prioritise his mental health.
While I understand many people were disappointed by this news, as a doctor I welcome these athletes’ openness in dealing with the very personal issues of mental health. I can only imagine what it is like to have the pressure of your country’s expectations on you when it comes to sports, but I have seen many patients who try to press on with unrealistic workloads when it is causing very real harm to their mental health.
My advice is to stop and re-evaluate the situation. If your work is causing persistent sleepless nights, affecting your relationships with loved ones and making you unhappy for long periods of time, it may be time to think about asking for help.
Mental health is often the poorer cousin of physical health and gets pushed by the wayside much to the detriment of those who it can adversely affect. These star athletes may have the finances to allow themselves breaks from their job, but asking for help does not mean you will lose your job, it just means you are human and have reached your limit. So whether it is an extension on a deadline, a break, or for someone to help lighten your workload – if you are really struggling with work don’t just shut those feelings of being overwhelmed away, speak to someone.
I may not know your individual circumstances, but I have seen enough patients with mental health issues to know that those who ask for support earlier tend to be those who end up happier.
In the Doctor’s Surgery: Reeling from anti-vaxxer protests
Police in the UK are investigating a former nurse who was struck off the nursing register for spreading misinformation and comparing people delivering coronavirus vaccines to Nazi doctors who were hung. Kate Shemirani was one of several conspiracy theorists at a protest in Trafalgar Square, London on July 24, 2021. In her speech, she encouraged those who were attending to get the names of any doctors or nurses who were administering vaccines and send them to her, where she went on to say they would face prosecution.
When she suggested doctors and nurses administering life-saving vaccines to the population should share the same fate as Nazi doctors who were hung for war crimes, the crowd cheered. The video was widely shared on social media and watching it sent a shiver down my spine. Never in my life did I think I would be threatened with hanging for doing my job as a doctor and acting in the best interests of my patients.
This rubs salt into the wounds of healthcare professionals who have risked their own lives caring for those people sick with the virus, as well as those who have lost loved ones because of it.
The protests themselves fill me with a sense of dismay; the people who attend them seem to think the coronavirus is, at best, part of some plan for the world’s billionaires to gain control over large numbers of the population or, at worst, a hoax. This rubs salt in the wounds of healthcare professionals who have risked their lives caring for those people sick with the virus, as well as those who have lost loved ones to it.
Not only this, it makes me worry for my own personal safety. It only takes one unstable individual to take misinformation these people spread seriously enough to act out their suggestions. We have seen similar things happen before when people were brainwashed enough by what they see online to commit very serious violent crimes.
I really hope the police prosecute this woman for inciting violence against healthcare workers; this group of people need to know their words have consequences and they can no longer get away with the nonsense they spew.
Reader’s Question: Could my runny nose be allergies or COVID-19?
We are learning that people with COVID-19 can present with a much wider range of symptoms than originally thought.
Whereas a new persistent cough, high fever, and loss of sense of smell and taste remain important indicators of infection, and anyone with these symptoms should get tested, new research now shows that runny nose, headaches, sore throat and sneezing can also indicate COVID-19 – especially in those vaccinated who may have contracted the Delta variant.
The problem is that these symptoms overlap with common hay fever or allergy symptoms. People with longstanding allergies will be well versed in their symptoms and will be able to recognise what is normal and what is unusual for them, in which case I would encourage those with unusual symptoms to get tested.
Given this new research into COVID-19 symptoms, if you feel unwell or develop any new symptoms and are unsure about what it may be, my advice would be to get tested – it is the safest thing to do.