Joey Wahler (Host): It's an annual concern, so we're discussing respiratory illness season. Our guest is Dr. William Chasanov. He's an internal medicine and infectious disease physician as well as Senior Vice President and Chief Health Systems Design Officer for Beebe Healthcare. This is the Beebe Healthcare podcast. Thanks for joining us. I am Joey Wahler. Hi, Doctor. Welcome.

William Chasanov, DO: Hi Joey. How are you?

Host: I'm good. Yourself?

William Chasanov, DO: I'm doing great. Thank you.

Host: Excellent. Well, we want to help as many people as possible to also do great during this cold and flu season. So, to get us started, what exactly does respiratory illness season mean to you, and when does it typically occur?

William Chasanov, DO: Respiratory season is when we start to see an increase in the number of those of us that unfortunately get sick from respiratory illness, especially viruses around where we are right now in January, for instance, this time of the year. Normally, we start to see this in the United States around October and generally runs through April. We really look to see how many people start to get sick from what we all know as the flu or COVID or some other respiratory viruses.

Host: Gotcha. So, let's differentiate with each of the most common such illnesses. Let's start with the flu. What are the common symptoms there?

William Chasanov, DO: Yeah. So, most people with a flu end up having fever. I think it's really important, Joey, to just state that what I'm saying are common symptoms. Not everyone may have these symptoms, even though they may be common. So, fever is one of the most common complaints that people have; body aches, which is what we also call as myalgias. People will generally develop a cough. They can have trouble breathing as well. And then. What we would also expect some nose congestion, stuffiness, sometimes a sore throat. Those are generally the common symptoms that we see with the flu. Sometimes people do end up getting an upset stomach. Sometimes people end up with nausea and, occasionally, throwing up as well.

Host: Then, there's RSV, which if you could first remind us, what does that stand for actually?

William Chasanov, DO: Yeah, thank you. So, it is a mouthful, but it stands for respiratory syncytial virus. And we do acronym that as RSV to make it easier for everyone.

Host: What a great idea by whoever came up with that.

William Chasanov, DO: Very much so.

Host: And so, what are the typical signs of that?

William Chasanov, DO: As you're going to see, there's a theme here, Joey. RSV or respiratory syncytial virus tends to be more of respiratory symptoms. But as we just talked about, those symptoms could match similar to the flu, meaning congestion of the nose, stuffy nose, could be also trouble breathing, cough, could also be fevers as well, which makes it sometimes very difficult to determine in the two viruses we've talked about being the flu or influenza and RSV to determine which is which.

Host: All right. Then, of course, we have COVID-19. How prevalent have you seen it to be so far this year?

William Chasanov, DO: COVID is still around. This year, in particular, we are seeing more of the flu, more of the flu than we are for COVID. We are still seeing some RSV in the area as well.

Host: And so, what are the real distinguishing factors for COVID for those who maybe haven't had to deal with it for a while and have forgotten from back when it was far more common?

William Chasanov, DO: Well, when COVID first hit the scenes, and we were all trying to understand what this new virus is, was, continues to be, Joey, it's interesting because some of the hallmark features of COVID that seemed to not be as prevalent as they were, if you remember, was a loss of sense of taste and smell. With the strains changing through COVID throughout the years and throughout the seasons, that tends to be a symptom that is less common. But if that does occur in the symptoms such as the stuffy nose, the fevers, shortness of breath, that could be a hallmark feature of COVID-19.

Some of the other things that we have identified with COVID and, again, maybe not as common as they used to be, some people did develop rashes with COVID, while you could develop a rash with RSV and also with flu or influenza, it seemed to be at a higher chance of having that happen with COVID, although that's also decreased with time. Headaches could happen in actually all three of those viruses that we've just talked about, but still tend to correlate a little bit more with COVID than the other two.

So, you can see that it's very hard sometimes, even as an infectious disease physician, as a nurse, as someone who is taking care of individuals to know is this flu that I'm dealing with, is this RSV, is this COVID? There are other viruses that are less commonly talked about that could cause some of those similar symptoms as well.

Host: Understood. So speaking of COVID, has it changed the way you and yours think about or even address respiratory illness season? Anything that's changed on your end year to year?

William Chasanov, DO: COVID has changed a few things. COVID has changed a few things for all of us. And Beebe Healthcare is in Sussex County, which is one of the counties in Delaware. I know that you are aware of that, Joey and others. But I would state that beyond just Sussex County, Delaware, I think COVID has changed several things of how we manage respiratory virus. And I'll be very specific around what I mean for that.

One of those things is that COVID, for the right people, it does have some treatment opportunities. For instance, RSV has more limited treatment opportunities for medication, I mean. And we know that the flu virus, if caught early enough and medication is started soon enough, may actually decrease the length of someone having symptoms with the flu.

So, COVID has reminded us that some of these respiratory illnesses we do have treatments for, and that it is important in the right circumstance to Maybe not just wait at home and eat your chicken noodle soup and try to have your hot tea and be in bed. It may be worth reaching out to your healthcare physician or provider to see if there's something else that can be done.

 I think another way that COVID has changed how we look at respiratory illness season is through the surveillance methods that we look to see if "we are in respiratory season." And what I mean by that, have numbers increased of those who are sick with either the flu or COVID or RSV or some of those other unnamed illnesses or viruses that we've mentioned before? We know that as the Centers for Disease Control in state public health agencies continue to survey to say, "There's more flu cases now, there's more COVID cases now." There's also, I will say, unglamorous surveillance called wastewater surveillance that has become more of the standard, not just in Delaware or in Sussex County, but throughout our country, to also tell us if it looks like the incidence of respiratory illness is starting to increase. And if I can be more specific, Joey, and understand that there are listeners that I do not want to have turned off from the podcast, but we're talking about sewage water and surveillance from areas that may not have been a priority surveillance before COVID.

Host: All right. So, that's all part of how this is tracked so that you have an idea of where things stand in terms of where the season begins and ends. And during that particular season, how about the numbers for those that will experience some sort of a respiratory illness, Doctor? And are there any trends this year, be it locally or nationally? What are you seeing so far?

William Chasanov, DO: Yeah. It's a great question. I think it's also important, Joey, if I may, to say that some of these viruses are actually under closer surveillance than others. So, what I mean by that is, while COVID-19, which may seem like an eternity ago, but was really just a few years ago, had its own surveillance tracking through public health agencies, the Center for Disease Control, academic centers were tracking the number of those who were unfortunately infected with COVID-19 or passed away from it. The same thing happens for the flu.

RSV and some of the other viruses, we don't have as much data around. And I think that that's important. So, we basically use the trends of flu or influenza in order to determine when respiratory season starts and when that ends. So, some of the trends that we're seeing, we know that the Center for Disease Control always puts out a map in surveillance data on a weekly basis for the flu. I believe it's actually called FluView, and anyone has access to that information. It is not only infectious disease physicians or epidemiologists, anyone should be able to go on through that site and look at those trends.

We saw that the United States, is having a moderate to severe flu season. It also appears that about two weeks ago, we may have peaked from the incidence of flu for the nation, so for the whole United States. But here in Delaware, we are a bit behind and we are still having a high incidence of flu and other respiratory illnesses as well. So, I think that's an important point that, even though it appears that the United States, the numbers are starting to trend down, different regions and geographies may not be trending down. And right now, as of January 22nd, Delaware is not one of those.

Host: And picking up on that, Doctor, what factors influence whether a season is mild or severe?

William Chasanov, DO: Yeah, I actually think of three main factors, although there are several other factors. The one is the virus itself, what strain of the viruses are in circulation at the time? Certain strains of viruses are more contagious than others. That is just the life of a virus and how it continues to adapt to its environment.

Number two, I would say would be the climate. We know that when it's cold outside and we have a colder season, especially this time of the year, most of us are inside, most of us tend to congregate more inside than in the summertime where we may be out riding the bike or walking and outside more. There's also some literature that supports that respiratory viruses are more stable. They actually are more hearty in the cold environment than in the warmer environments as well.

And then, one of the other important factors are vaccines. And vaccinations are not all equal and they're not foolproof. So for instance, the most common circulating strain of the flu virus right now in this part of our season, which some have quote dubbed super flu, if you have heard that, is a strain that is in the flu vaccine, but it is not specific for that strain. So, the flu vaccine tends to be less effective this year than some of the other years where the flu vaccine is out.

Host: Couple of other things. As an infectious disease physician, what role from your experience do vaccines play in the prevalence of disease spread and the severity of illness? And what role does Beebe play, would you say, in monitoring and responding to that?

William Chasanov, DO: Vaccines are extremely important. They're important for an individual to protect themselves against, for instance, the flu; if appropriate, because not everyone is eligible for an RSV vaccine for RSV, and also for COVID. I also want to state that as an individual, it is important to assess if there's a benefit to receive those vaccines for one, right? So, should I have the flu vaccine this year? Should I have, and do I qualify for an RSV vaccine this year? Same thing for COVID. The more individuals in our community that are able to obtain and qualify for those vaccines or are eligible for those vaccines, there is something called herd immunity. And what I mean by that is.

As an individual, I get a vaccine to protect myself. But as more and more individuals in the community get a vaccine, we protect the entire community. We can potentially stop, in this case, serious respiratory illness from spreading further and from actually developing complications from these illnesses or to stop individuals from getting as ill as they possibly could have if they had not received the vaccine.

Host: And finally, in summary here, what would you say is the most important thing for our audience to know about fighting these illnesses in season? If they had to keep one thing in mind, what should it be?

William Chasanov, DO: So, make sure that you are taking care of yourself and you are seeking the help that you may need. It is also important to realize that no matter what virus we just talked about, Joey, they are all contagious, some more contagious than others, but they are all contagious by coughing and sneezing, which unfortunately the virus and the illness it causes makes people do. So, wash your hands. If need be, try to stay away from others if you're very sick. And if you need to seek attention, please seek healthcare attention by your primary care physician through a walk-in center or an emergency department in order to make sure that you are taken care of and you know all your treatment options.

Host: Great advice indeed. Well, folks, we trust you are now more familiar with respiratory illness season. Dr. Chasanov, keep up all your great work. Stay healthy and thanks so much again.

William Chasanov, DO: Thank you, Joey. It's been a pleasure.

Host: Same here. If you found this podcast helpful, please do share it on your social media. I'm Joey Wahler, and thanks so much again for being part of the Beebe Healthcare Podcast.