How Do I Avoid Getting Sick This Winter? with Dr. Harjot Singh

Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Faith Salie.

It’s that time of year again — cold season. And we’re not just talking about the weather. Why is it that every year when the temperature drops everyone starts coming down with colds or more serious viruses like COVID-19, RSV, and the flu?

This week, infectious disease expert Dr. Harjot Singh joined me to talk about what we can do to prevent getting sick and how to care for ourselves if we do come down with something. 

Faith: Dr. Harjot Singh, thank you for joining us.

Dr. Singh: Thank you for having me.

Faith: OK, Dr. Singh, I hardly need to tell you. It feels like everyone is getting sick, has just gotten sick, or is about to be sick. So are you seeing this at work right now? Is there an uptick?

Dr. Singh: We at the hospital are definitely seeing very high activity in respiratory viruses. It is mirrored in the city, the state, and actually nationally as well. I’m going to talk about all three respiratory viruses. So, we all know about COVID-19. We’re all very familiar with influenza or flu. But less people know about the third virus, which is also very active this year, respiratory syncytial virus, also known as RSV.

Faith: And I think this little trio is also known as the tripledemic. Is that right?

Dr. Singh: That is correct. It is a new word in our language.

Faith: Ugh, we didn’t really ask for this word, but it’s upon us. So all of these things are happening at once. Why is it that we are more likely to get sick in the winter?

Dr. Singh: So, Faith, that’s a great question. Researchers have been trying to figure that out for a really long time. They have some understanding of why this happens. It has a lot to do with the humidity and the temperature. When the weather is cold and the air is dry, like it is in the winter season, that combination facilitates viral transmission and viral entry.

Faith: OK, so basically what’s good for our hair, which is low humidity, is not good for our respiratory systems, sadly.

Dr. Singh: One hundred percent.

Faith: Dr. Singh, why should we worry about these three illnesses in particular?

Dr. Singh: Well, Faith, that’s a good question. A lot of people when they get these infections will have just a mild illness. They might miss a day or two of work and have some mild symptoms, but some people can become severely ill and require hospitalization and a small portion can even die from these infections. So it is really important for us to be talking about them today and for us to be aware of the symptoms and thinking about how to test and treat and protect others around us.

Faith: I mean, I remember when my kids were really little, RSV seemed very, very scary.

Dr. Singh: RSV is a very significant virus for infants. So, RSV is a virus that really affects the airway in, in all people, but particularly in infants, because they have very small airways. We know for RSV that it’s the youngest and the oldest that are the most susceptible. So let’s start with the older crowd. Anyone older than the age of 65 is eligible for RSV vaccination.

That’s a new vaccine this year and it is approved and recommended by both the CDC and the um, ACIP, which is the CDC group to recommend vaccines, for anyone older than the age of 65. For the younger infants, it’s not actually a vaccine that is recommended to help prevent development of RSV disease. It’s actually antibodies, so a slightly different approach.

So, you know, we all make antibodies. When we, when our bodies see something foreign, we make an antibody to it. It’s a Y shaped molecule that runs around the body, recognizing it and sets into motion a cascade of protection. But infants at that young age aren’t really able to make antibodies fast enough or in enough quantity.

And so what we do for infants is we actually give them the antibody. So were they to see RSV infection or be exposed to RSV infection, they have the protection that we give them so that they don’t develop severe disease.

Faith: OK,  is this also new? Monoclonal antibodies for infants?

Dr. Singh: This is also new. Yes.

Faith: Wow, this is big news!

Dr. Singh: This is big news. It’s an exciting year to be able to have a new tool in our toolkit to protect our most vulnerable from RSV.

Faith: Pregnant women are kind of a special case, right?

Dr. Singh: Oh yes, they are a special case because pregnant women have an opportunity to not only protect themselves, but to pass on those antibodies to their unborn infant. So they are also a group that is eligible for vaccination this year.

Faith: I feel like I first heard of monoclonal antibodies, um, in the earlier days of COVID. Is that still a COVID treatment?

Dr. Singh: That is a good memory, Faith. That is actually where our understanding in the lay press began of monoclonal antibodies. And it’s the same concept. Initially, people who developed COVID would then develop their own antibodies of protection and those antibodies were collected by blood banks and then given to patients who had COVID to help them, uh, resolve their infection.

Faith: How much are COVID variants changing? And, and by that, I guess I mean, should we all be getting COVID boosters this winter?

Dr. Singh: So, yes as we’ve been following along, COVID likes to change its spike proteins. And so every few weeks, every few months, there’s a new variant. So the current variant as of today, January 17 is the JN1 variant.

It actually resembles a prior Omicron variant. It is infective, but it doesn’t really cause a lot of severe disease in most patients. But the older vaccines don’t really cover the new COVID-19 variant. So the recommendation is if you did not get a booster since September, you should. Because the newly FDA approved COVID vaccine has coverage for the new Omicron variant. So absolutely recommend that if you haven’t had your COVID-19 vaccine, it’s not too late.

Faith: And what about the flu? It’s, you know, we’re talking to you in the middle of winter. Is it never too late to get your flu vaccine?

Dr. Singh: It is never too late to get your flu vaccine, Faith.

Faith: You look so happy saying that. You are living in your purpose, Dr. Singh.

Dr. Singh: One hundred percent. You are talking to an infectious disease physician who wants to prevent infection. So, as I mentioned, COVID-19, RSV, and flu are still very highly active in New York City and, although they are nearing their peak, respiratory season goes through February and March. So there’s still a lot of opportunities for us to get exposed and for us to get sick.

Faith: What about antiviral medications? So, we’ve established that vaccines are great. We should all be getting them, depending on our age. What are the antiviral medications? Which of these illnesses can be treated with them?

Dr. Singh: So let’s stay with flu, since we were talking about flu. Influenza is a respiratory virus. It can cause upper respiratory symptoms, but it can also cause fever and sometimes can cause some lower respiratory symptoms, like cough or mucus production. If you have symptoms of a cold, you should start by testing for COVID.

Those tests are still available for free through the government, but all pharmacies still carry those. If your COVID test is negative and you continue to have symptoms, especially if you develop a fever, you should definitely get yourself tested for influenza. Now, influenza home testing isn’t as accessible as COVID home testing, but all of the urgent cares are able to test for it. Some primary care doctors are able to test for it. Some pediatricians. So, if you find that you have a fever and you have cold symptoms, and you’re testing negative for COVID, absolutely get a test for flu.

The reason to get tested is because there are treatments available. So for influenza, there’s an antiviral treatment called Tamiflu, and it does help abate the symptoms and shorten the infection periods, which in turn can shorten your transmission to others as well. So it has lots of benefits, in helping you feel better and keeping those around you safer.

Faith: If, if someone in your family has tested positive for flu and they start Tamiflu, can you also start it thinking, oh, I might be infected and this will prevent it?

Dr. Singh: If someone in your family has been diagnosed with influenza and you have symptoms, then you should definitely call your provider, whether it’s your internist or your family practice doctor and let them know that a family member has been diagnosed with influenza and you have symptoms, then you should also get tested and treated.

If you don’t have symptoms and you’re in close proximity to the family member, let’s say you’re a parent and your child has it and you’re taking care of them, so you can’t  really separate yourself, there is a role for influenza prophylaxis. But it depends a little bit on the time frame and it depends a little bit on your risk factors of getting severe infection. So if you’re taking care of a child and they’ve had symptoms for three or four days, then you’ve probably been exposed. And if you’re a healthy person, then taking prophylaxis may not really help. But if you’re someone who has underlying medical problems or it’s within two days of your child being diagnosed, there is a role for influenza prophylaxis. It’s the same drug, Tamiflu, but it’s just taken in different dosing.

Faith: And then what about our, you know, our old friend who never goes away, COVID? What about treating that nowadays?

Dr. Singh: Uh, so again, some people with COVID will get very mild symptoms and not even know they have it, and it’s gone before they’ve had a chance to, um, get treatment. But if someone gets COVID and has either persistent symptoms, or has underlying medical problems, uh, they should seek help in the emergency room or with their primary care doctor.

If they have low oxygen levels, then they should be hospitalized to get not only oxygen, but steroid treatment as well as antiviral treatment. If they’re well enough to not be hospitalized, then just antiviral treatment is sufficient for someone who has symptoms. It helps shorten the course of the infection. And again, like flu it may help reduce the chance of transmitting that to other members of the family.

Faith: You’ve given us a lot of clarification on why we get sick in the winter and how to understand these respiratory illnesses but what can we do to try to keep ourselves healthy in addition to getting vaccines. What can we do to prevent getting sick?

Dr. Singh: So Faith, I think it comes down to a lot of our common sense measures in our toolkit. So 20 seconds of washing our hands with soap and water can really reduce the number of viruses on our hands, which reduces our chances of spreading it to others and getting infections from others.

Other things that can help mitigate our chances of being sick is physical distancing and wearing a mask. Since we are in peak respiratory season and everyone is traveling and everyone is in small spaces indoors, this is a really useful way to protect yourself.

So if you know you’re going to be traveling to the airport and be in a crowded room, wear a mask.

Faith: So if you are surrounded by lots and lots of people who are not wearing masks, but you decide you want to wear a mask, is that still meaningfully helpful to keep yourself healthy?

Dr. Singh: Great question, Faith. Yes, there are actually studies that show masks are effective in preventing transmission or acquisition of viruses. Nothing is 100%, but if you wear a well fitted mask, it’s going to protect you from a lot of the respiratory particles and droplets that come out of people’s mouths and nose when they’re speaking to you if they happen to have an illness.

Faith: There seems to be this general understanding that everybody’s getting sicker this winter because, uh, we went through a pandemic. Does that hold true? Is it because we spent a year or two sort of isolated from each other that we all feel like we’re getting sicker now that we’re back together?

Dr. Singh: I think it feels that way because it has been three years and we’ve forgotten what things were like before COVID. All we remember is all of the masking and physical distancing of COVID. And in doing so, those were very effective measures for respiratory season. So all of that masking, hand washing and social distancing actually kept the respiratory season cases very low.

And now that we have stopped doing all of that, it’s really just a resurgence back to our prior levels. So it’s just that we’re not used to it again. We’ve been so lucky to have such low case levels. But now that, you know, we’re coming back out of, of COVID and back to sort of our routine practices that we’re seeing things again. But I think the evidence speaks for itself.

All of these measures really worked and that’s why we didn’t see them. So if we can practice even a few of these mitigating measures, I think we can make it easier for ourselves.

Faith: Yeah. So things aren’t worse than before, and in fact, they’re better than before the pandemic because we have more treatments.

Dr. Singh: Yes.

Faith: Dr. Singh, thank you so much for what you do. I am so glad, you’re like a human monoclonal antibody. I’m so glad you’re out there on the front lines fighting infectious diseases for us.

Dr. Singh: Well, thank you, Faith, for letting me share this with you because together maybe we can make a difference.

Our many thanks to Dr. Harjot Singh. I’m Faith Salie. Health Matters is a production of NewYork-Presbyterian.

The views shared on this podcast solely reflect the expertise and experience of our guests.

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