[COLUMN] Tripledemic

YES, three different viruses, not only the Three Kings, are expected to visit us this coming Christmas season. This is predicted to be a winter of tripledemic.

The three viruses include our old annual nemesis, influenza, the current COVID-19, and the returning visitor, RSV (Respiratory Syncytial Virus).

All these 3 are high contagious and it is possible for people to get infected with these three viruses at the same time.

The flu virus spreads rapidly during the winter months as individuals gather closer together indoors. The same is true with the SARS-CoV2 virus of COVID-19 and the RSV. In general, respiratory tract infections are common the year round, but greater number of cases are noted during the fall-winter season. The flu virus can be of different variety each year, the very reason why one should get a flu vaccine each year. Vaccines are tailored to target the “viruses of the year.”

RSV is caused by the virus with that name, respiratory syncytial virus, which infects adults and more especially children, with milder symptoms for adults and older children but more severe symptoms for infants and seniors.

RSV, for emphasis, is more dangerous to infants and old people, where symptoms, including fever and wheezing, shortness of breath, are more severe. Hospitalization may be required, though most RSV infections run their usual course of 1-2 weeks. Babies with RSV must be watched and monitor closely for hypoxemia (low blood oxygen level), which could kill. Signs of this are rapid breathing, bluish fingernail or lips, abdomen is sucking in, trying to breathe for air hunger. When any of these are noted, call 911. Rapid emergency hospitalization is required.

There is now a COVID-19, Flu, RSV combined test, to determine which viral infection is affecting the individual, and is available through physicians and hospitals. One could be exposed to COVID-19, still without symptoms, but could already be infectious to others. That’s why persons exposed to a known infected individual should test themselves with the rapid antigen home kit. This test has a 50 percent false negative yield but when positive (showing two lines on the Test Card) it is 100 percent accurate. If in doubt, a PCR test is recommended for confirmation.

The symptoms of the flu and COVID-19 could be very similar, sometimes hard to distinguish one from the other. But one unique symptom of COVID-19 is the loss of taste or smell. Also, it takes longer for people infected with COVID-19 to show symptoms (between 2 days to 5-6 days incubation period) and the infection lingering longer for COVID-19 compared to the flu.

Why do persons, who are fully vaccinated, even with booster #3 (5th shot) still get infected? The reason is vaccines do not confer 100 percent protection (more like 98 percent) and the level of immunity provided by the vaccines also depend on the person’s general health and the integrity of his/her immune system. Also, these COVID-19 vaccines wane in potency in 4 to 6 months, which is the reason for the boosters. In the future, since COVID-19 appears to linger, we might have to have COVID-19 shots every 6 months or so, like the seasonal flu shot.

Natural immunity from infection also confers some protection but not as potent, stable and reliable as immunity from the vaccines. And waiting to get infected in order to have natural immunity is dangerous.

The give radio talk show hosts in the U.S. who were advising people against the vaccines, got infected themselves, and all five died. Before their death, they were remorseful, admitting they were wrong and strongly recommending for people to get vaccinated. In their cases, they never benefited from the natural immunity from the infection they were hoping for. While their original stand might have killed people, their reversal surely saved countless lives.

The latest boosters are the bivalent vaccines by Pfizer or Moderna, both equal in safety and efficacy, both reformulated to target Omicron’s subvariants, including the latest (BA.46, BQ.1, BQ.1.1, BF.7). The boosters could also be mix-and-match, P or M, safely.

COVID-19 patients could be infectious from 2 days up to 10 days, but the severe cases could be for as long as 20 days. Those who are immunocompromised should be isolated for at least 20 days.

Paxlovid, an anti-viral pill, is effective if taken within 5 days of the onset of symptoms. Statin drugs and blood thinners must be stopped during this treatment. The pills are taken 2 tablets two times a day. The other alternative treatment is intravenous infusion of Monoclonal Antibody at a clinic or hospital, as early as possible after the first symptom starts and the patient testing positive for COVID-19. It is not recommended for severe COVID-19.

From about 5 to 14 days after exposure to COVID-19, the body releases cytokines to fight the infection and the first symptoms start to manifest: fever of 100.5 F (38 C) or higher, dry cough (the first sign in many cases), sore throat, fatigue, headache, runny nose, muscle aches, diarrhea, and in some people, loss of taste or smell, which is not typical in cases of flu or RSV. An oximeter is helpful. The normal SPO2 (blood oxygen level) is 95-100, and below 90 is too low. If shortness of breath occurs, go to the nearest emergency room. If using an inhaler, use it as you leave for the ER. This could be pneumonia developing.

COVID-19 update:  As of November 1, 2022, 12:38 PM (CST), worldwide –635,843,256 cases, 6,595,100 deaths; U.S. – 99,374,721 cases, 1,095,315 deaths; and the Philippines – 4,005,157 cases, 64,109 deaths. In the U.S., the daily averages for the past week was 37,665 cases per day, and 348 deaths per day. COVID-19 is not done with us yet. Maybe never.

Let us face these three winter invisible enemies with wisdom and humility, not recklessness and arrogance.

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The main objective of this column is to educate and inspire people live a healthier lifestyle to prevent illnesses and disabilities and achieve a happier and more productive life. Any diagnosis, recommendation or treatment in our article are general medical information and not intended to be applicable or appropriate for anyone. This column is not a substitute for your physician, who knows your condition well and who is your best ally when it comes to your health.

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Philip S. Chua, MD, FACS, FPCS, a Cardiac Surgeon Emeritus based in Northwest Indiana and Las Vegas, Nevada, is an international medical lecturer/author, a Health Advocate, and Chairman of the Filipino United Network-USA, a 501(c)3 humanitarian foundation in the United States. Websites: FUN8888.com and philipSchua.com; Email: [email protected].


Dr. Philip S. Chua

Philip S. Chua, MD, FACS, FPCS, Cardiac Surgeon Emeritus in Northwest Indiana and chairman of cardiac surgery from 1997 to 2010 at Cebu Doctors University Hospital, where he holds the title of Physician Emeritus in Surgery, is based in Las Vegas, Nevada. He is a Fellow of the American College of Surgeons, the Philippine College of Surgeons, and the Denton A. Cooley Cardiovascular Surgical Society. He is the chairman of the Filipino United Network – USA, a 501(c)(3) humanitarian foundation in the United States.

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