What to know about the rise in respiratory illnesses

This article originally in NewYork-Presbyterian Health Matters.

An infectious disease expert explains the surge in flu, COVID-19, and RSV and whether it’s a cause for concern.

By Dorothy Cucci 

Manhattan Voice 

November 3, 2024

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NEW YORK - It’s common for cases of respiratory illnesses to spike during the winter months, but ever since COVID-19 hit, the potential of a “tripledemic” — COVID-19, Respiratory Syncytial Virus (RSV), and influenza peaking at the same time — is always looming. This fall, there was also an uptick of Mycoplasma pneumonia (known colloquially as “white lung syndrome”) among children in Ohio, adding to the concern.

According to the Centers for Disease Control and Prevention (CDC), the amount of respiratory illness activity continues to  be “high” or “very high” in the majority of the United States as of January 19. “We tend to see an increase in respiratory illnesses in late October and November leading into December and January,” says Dr. Candace L. Johnson, a pediatric infectious disease specialist at NewYork-Presbyterian Morgan Stanley Children’s Hospital. “This is also the season when we start seeing spikes in the flu. Right now, we’re simultaneously seeing a rise in COVID infections, influenza infections, and RSV infections, which are all viral, but there are ways to decrease your risk for acquiring any of them.”

Health Matters spoke with Dr. Johnson about the types of respiratory illnesses circulating this winter, including symptoms and treatments.

What is a respiratory illness?

A respiratory tract infection is a broad term for any type of illness that primarily affects the area of our body involved in breathing, which extends from our nasal passages to our lungs. Often in medicine, we make the distinction between infections of the upper respiratory tract, which is the area from the nasal passages and sinuses to your larynx (or voice box), and the lower respiratory tract, which is the tract below your larynx, including your lungs.

Young children, older adults, and people with underlying medical conditions tend to be at highest risk of getting seriously ill from respiratory infections. Influenza, RSV, and COVID-19 are the big three that can cause both upper and lower respiratory disease and account for many hospitalizations.

What are symptoms for RSV, flu, and COVID? How can you tell the difference?

The symptoms for these respiratory viruses can be very similar and can include fever, body aches, cough, congestion, runny nose, and fatigue, or decreased energy. Some symptoms, like sore throat and loss of taste or smell, are more common in COVID, but generally speaking, it can be difficult to distinguish between these viruses on the basis of symptoms alone. We diagnose by testing for these specific viruses.

When these infections become severe, they can cause symptoms such as difficulty breathing, noisy breathing, faster breathing than normal, or long pauses in breathing. If you experience those symptoms or see them in a loved one, seek medical attention.

Why do we see an increase in respiratory infections during this time of year?

There are a variety of theories about why we see more respiratory viruses in the winter, including the fact that people tend to spend more time indoors during the winter — that closer contact allows viruses to spread more easily. Another thought is that the drier air in the wintertime can also make us more susceptible to viral infections. Last year, a study was published in the Journal of Allergy and Clinical Immunology that described how exposure to the cold can impair some of our immune defenses in the nose which may lead to increased susceptibility to infections.

What’s made the season different for the past couple of years is COVID. Last year, we saw a rise in non-COVID respiratory infections compared to what we saw during the first year of the pandemic; this is thought to be in part because we were coming out of a period when people were wearing masks and isolating because of the pandemic — particularly in young children who hadn’t been exposed to these viruses before.

What is Mycoplasma pneumonia, or “white lung syndrome?”

Unlike COVID, RSV, and flu, Mycoplasma pneumonia is not viral; it’s caused by a type of bacteria called Mycoplasma pneumoniae. This type of infection is not new on the scene — in the past it’s also been called “walking pneumonia,” and we do tend to see it rise this time of year. Especially in a post-pandemic era, it makes sense that we’re weary or nervous when we hear about a spike in any type of respiratory infection. But it’s not a new organism or new phenomenon.

Pneumonia, in general, is essentially an infection of the lung, which can be caused by bacteria or a virus. The body’s response to these organisms can cause inflammation, which contributes to the symptoms that you experience, such as coughing, shortness of breath, or chest pain.

While there are reports of increased cases of Mycoplasma infection in certain geographic areas, it’s too early to say that it’s significantly more than prior years or that it’s more widespread than prior years. As far as treatment, there is an antibiotic called azithromycin that is very effective; but the thing about Mycoplasma is that we don’t have a vaccine to prevent it.

What should people know about RSV treatment and the RSV vaccine?

For most people, RSV infections are typically treated with supportive care. At home the focus should be on keeping the sick individual well hydrated and providing symptom relief, such as using fever reducers to help with fever or nasal saline spray and suctioning to help with congestion and nasal secretions.

We now have immunizations against RSV that provide protection for our most vulnerable populations. There’s a vaccine that provides protection for older adults (aged 60 years and older). To protect infants, there is the option to either vaccinate the pregnant person, who then passes on protective antibodies to the infant before birth or giving a monoclonal antibody (Nirsevimab) to infants after birth, which provides protection during the highest risk periods, when infants are very young and more vulnerable to developing severe illness that could result in a hospital stay.

How can RSV impact young children?

RSV can be especially dangerous for young infants, especially those who were born prematurely or who have other underlying medical conditions like lung disease or congenital heart disease. Because their immune systems aren’t as mature as older children’s or adults’, they’re not able to fight the virus as effectively. That’s where the monoclonal antibody helps; it provides an infant with protective antibodies to fight against RSV. Additionally, young infants have narrower airways which means that they may have more trouble dealing with secretions that can occur in inflamed airways during a viral infection.

As adults, we’ve had a lifetime of exposure, so our immune systems can better handle these viruses.

What are ways people can protect themselves and their families from respiratory illnesses?

It may seem obvious, but the best ways to protect yourself are by practicing the hygiene basics that we’ve all gotten very familiar with over the past few years: Wash hands and use hand sanitizer frequently, cover coughs and sneezes with your elbow or a tissue that you throw away immediately and wash hands afterwards, and keep frequently touched surfaces clean. Masking also helps mitigates the spreading of the disease. Another key is staying up-to-date on immunizations for influenza, RSV, and COVID-19.

Try to avoid close contact with people who are sick, and if you are sick, stay at home and avoid contact with others. It’s important to remember that the rise in respiratory illnesses isn’t a cause for panic. There are strategies we can use to prevent these infections from affecting ourselves or our loved ones.