Caitlin Whyte (Host): Welcome to Hally HealthCast, the wellness podcast from Hally Health, your partner in helping you live your healthiest life. Every episode on our podcast addresses a new topic important to your health and wellbeing, bringing in expert doctors, therapists, and specialists who offer advice and answer your most pressing questions.

Host: It's October. Fall is upon us with winter to come at its heels. These next few months are often the height of respiratory sicknesses for children and adults alike. You're likely hearing in the news about the flu, RSV and COVID-19, and you might be getting confused about how each one's different and what all you should know and do to keep your family healthy. So, we've brought in an expert to help answer these questions and more.

Here with us is Dr. Brent Reifsteck. He's a pediatrician at Carle Foundation Hospital in Urbana, Illinois, where he's also the medical director of the Children's Service Line and the Physician Coordinator for the Child Abuse Safety Team.

Welcome, Dr. Reifsteck, and thank you so much for being with us today and sharing your knowledge. So, let's begin here, Doctor. Why are the autumn and winter months so key for flu, RSV and COVID-19 awareness? Why should people be so focused on these now in particular?

Brent Reifsteck: Basically because the weather's nice and we're all outside, we don't have to be cooped up together. And in the summer months, our children aren't all crammed into one space every single weekday like they are during the school year. So in the winter months, that's when we see an uptick in these respiratory viruses because they're spread from person to person. And that's the time of year where everybody's cooped up together, so that's when we see the uptick in cases.

Host: That makes sense. Thank you, Dr. Reifsteck. Excellent explanation. Okay. So, let's dig into each one of these three, and let's start with the flu. If you could explain briefly what causes the flu and how does it spread as well as its symptoms.

Brent Reifsteck: Sure. So, influenza is a respiratory virus and it is spread like every other respiratory virus from person to person by coughing, sneezing, touching infected surfaces then touching our faces. And when you aren't paying attention to this, you don't even realize how often we touch our face. So as respiratory virus season comes around, it's important to really pay attention to that, because all of these viruses are spread pretty much the same way. It's just some are more contagious than others. And the symptoms of influenza are pretty specific, but people don't realize. Influenza has nothing to do with stomach. So when people say, "I have the stomach flu," that's not influenza. Influenza is a respiratory virus. So if vomiting and diarrhea are part of the illness, it has nothing to do with influenza. Influenza is cough, congestion, runny nose, difficulty breathing, sneezing, sore throat, headache, usually right behind the eyes and general feeling of body aches and feeling run down and tired, and that's usually accompanied by a fever.

Host: Gotcha. That is some great information and definitely something I didn't know as well, so we're learning all the time. So, moving on to RSV, the virus that causes many respiratory illnesses for adults and kids, including bronchiolitis in infants and younger children. So, can you talk a little bit about RSV, how it spreads and its symptoms?

Brent Reifsteck: Absolutely. So, bronchiolitis is a general disease name that has dozens and dozens of different causes. The easy news is even though it's one disease and it has many causes, all of those causes are generally respiratory viruses. RSV is the one that we pin it on most often, and that's because it's the best studied and the one that we could test for first. Now, we can test for lots of different causes of bronchiolitis, but they all cause pretty much the same set of symptoms. And for most people, it's just a cold, cough, congestion, runny nose, maybe a low grade temp and feeling down. The reason that most people don't worry about it too much is because in adults it really is just a nuisance. But in children, the first times that they get these viruses, it can actually settle into the medium-sized airways and cause a lot of problems. So, that's why we as pediatricians, especially hospital pediatricians and emergency department providers, that's why we worry about it because when it progresses from a nuisance respiratory virus into respiratory distress and then respiratory failure, that's when we get worried and really we need to step in and help.

Host: Gotcha. Well, thank you for that as well. And doctor, let's finally discuss COVID-19. Can you briefly explain its causes, symptoms and how it spreads?

Brent Reifsteck: Sure. So, COVID-19, most people are well acquainted with it at this point. It's got one cause. It's a respiratory virus called coronavirus, but it's not the only coronavirus. So when I was talking about bronchiolitis, there's literally five other human coronaviruses that we can check for and that caused bronchiolitis. The difference between those and the virus that causes COVID-19 is COVID-19 had a genetic shift where it became a virus that genetically was not well recognized by our human immune systems, and it was able to evade defenses in a way where it was much more serious. Now, the reason that we don't see as many hospitalizations and deaths from it currently is as a virus progresses through its life cycle, meaning over years, months to years, when it is so severe that it kills its host, then it's basically selecting that version of the virus out. So over time, these viruses tend to become a little more mild, but it's a gradual process and our immune systems after many of us catch it once or twice or were immunized, our human immune systems are able to knock it down before it becomes very severe.

So, the current versions of COVID-19 that are going around are much less severe, they cause less severe symptoms, and it mostly just makes you feel really yucky, gives you a fever, you get a sore throat. Some people still lose taste and smell. But otherwise, it's mostly respiratory like the other ones, you know, cough, congestion and runny nose. It's definitely not the monster that it was in the beginning. Now, that doesn't mean it can't because genetic changes in all of these viruses are very dynamic and mostly unpredictable. So, it's important for us to stay vigilant and to continue to take it seriously. But at least we know the most serious time period of this pandemic has passed us now.

Host: Well, that is some key information. Thank you so much, doctor. So now to perhaps the most top of mind question then, what are the differences between the flu, COVID-19 and the illnesses caused by RSV? Is it possible, for example, to tell them apart based on your symptoms or other factors?

Brent Reifsteck: Not usually. Usually, we have to test to tell the difference between them because they all are very similar and even though they cause similar symptoms, they're going to target a different patient populations. So obviously, the immunocompromised are always going to be at high risk for all of these and they can get more severe illness, the very old and the very young. But when you look at coronavirus, the very young could catch COVID-19 even when it was, you know, at its worst and not really care. So, contrast that with RSV, where if one of us as adults gets a virus that causes bronchiolitis like RSV, we're probably not going to care because our bodies have seen it before, the illness isn't going to be very severe. But the very young or the very old, when they catch it, they can be in big trouble. Influenza is universally dangerous. It just depends on the type of influenza that comes around that season and what other things are going on in your body and how severe it becomes. So on the surface, as medical providers trying to tease out which of these you are infected with is really difficult, and that's why we're glad we have good testing.

Host: Absolutely. Those are some helpful details. Thank you. Another important question here, who's most at risk for getting the flu, COVID-19 and RSV-related illnesses, and for whom are they most severe?

Brent Reifsteck: So, anybody that is immunocompromised is going to be at the highest risk, just because their bodies are going to be less equipped to fight this off on their own. The very old, anybody over 65 and the very young are also at risk, partially because their immune response isn't as robust. Or in the case of the very young, their immune system is still learning how to fight off these types of viruses, so they're going to be at risk. And then, anybody that has an underlying condition, specifically a respiratory condition like chronic lung disease, COPD, emphysema, asthma and things like that. So, we definitely worry about those with underlying illness. But we also can't really say that anybody is at low risk for influenza because influenza targets the entire population and really is something that everybody should worry about in the context of, you know, missed work and, you know, developing a secondary pneumonia or things like that or passing it on to somebody who might get more severe illness. So, influenza is a universal risk. The viruses that cause bronchiolitis and COVID-19, they're more population-specific and we worry about the very old, very young, and then those with immune compromise.

Host: Very important. So with this in mind, what treatments are available for these illnesses and are there ways to help prevent getting them in the first place?

Brent Reifsteck: That's a great question. Any infection that causes widespread disease is always going to be something that the scientific and medical communities are targeting for preventative, because it's always better to prevent than to treat once you catch something. It's always preferable to prevent first. So, good hand washing, trying to avoid touching your eyes, staying home when you're sick and good hand washing, I know I said it twice and I did that on purpose. None of us cleans our hands as well as we should or as often as we should. Make sure and wipe down surfaces after you've coughed or sneezed or touched a surface. And then, masking where it's appropriate. And that's something I'm glad that it's much more normalized than it once was. Because if you're in a crowded place and it's respiratory season, you might want to consider wearing a mask, even if you're feeling well, and that's to protect you and to protect anybody that's around you that's immunocompromised.

So as far as treatments go, we do have antivirals for influenza and for COVID-19. The antivirals are okay. They're not great and their efficacy can be better in certain seasons. So, I would definitely not suggest that folks rely upon the antivirals. What's better, since we have immunizations for influenza and for coronavirus, is to just make sure you've got your immunizations, because that doesn't just protect you, it also protects those around you. And it's very safe, very effective and that's going to be our first line as prevention.

We do have a preventative treatment that's given to very premature babies with underlying conditions for the first two years of their lives, but the criteria to qualify for that are very specific and it's not something that's used very often. So, making sure that we're protecting each other by getting immunized and practicing good hand hygiene are the best ways.

Host: Some great advice, doctor. Onto our final and very important question though here, what should you do if you think you have the flu, COVID-19 or an RSV-related illness? And particularly, is there any specific advice for parents and guardians if they think their kids have these?

Brent Reifsteck: Great question. And it really does depend on the sick person in front of you. So, looking at them, listening to them, seeing how they feel, because that should determine your next steps. For most patients, it's a lot of TLC and stay home.

Any kid that's got a snotty nose and a cough and congestion and runny nose, they're probably technically contagious. But, you know, not all those kids stay home. So, making sure you teach kids good hand hygiene and, you know, make it okay for everybody to stay home when they're sick. And then as far as what to do next once a kid is sick or once a patient is sick, is treat their symptoms, make them feel better. If they're running a temp or they have a fever and they don't feel good, treat that fever. Even if they don't have a measured temp, like even if they have a normal temperature but they don't feel good, treat them. Go ahead and give them Tylenol or ibuprofen to help them to feel better.

As far as the respiratory symptoms go, most of the time there isn't really anything good to treat those respiratory symptoms except like suction, blowing your nose, saline nose drops, or nose sprays are good. But the cough is usually the symptom that gives people the most distress, or it sounds really dramatic. But there's not great medications out there for cough. There's lots of bottles on the shelf that say cough and cold. Most of them don't actually do what they say they do. The same studies that tell us that honey is a natural cough suppressant and it works better than the cough and cold medicines, it's only allowed to be given over the age of one. But it's, you know, just a spoon full of honey, easy to get ahold of, or VapoRub on the chest or on the feet. We have no idea why it works on the feet, we just know that it does, one of those grandma remedies that works for sure. But most of the symptoms just have to pass in time and they will. It'll just take some time, and that's the frustrating part most parents have an issue with.

But if there's ever a moment when you're looking at your kid and you're like, "Gosh, I'm not comfortable with how they're breathing," or "I'm not comfortable with the symptoms that are happening in front of me," "I'm not comfortable with the fact that they're not eating or drinking right, always, always, always, when that feeling gets into a parent's mind, bring them in. Don't hesitate, don't wait, just bring them in. Because if you're uncomfortable with what's going on in front of you as a parent, it's our job to help you be comfortable or tell you, "Yep. Your instincts were right. It's time for that kid to be in the hospital for a day or two." Because even when they're in the hospital, we're not going to be able to do a whole lot for them, but we'll be able to do more than at home and those kids are going to get better because that's one thing they're really good at. But some of them just need some support while that happens.

Host: Well, again, such great information, Dr. Reifsteck. You've simply been a pleasure to have on our podcast. Thank you so much for joining us and for all that you do every day at Carle for so many families.

That concludes today's Hally HealthCast. Tune in next time as we tackle yet another topic important for your health and wellbeing. And remember, Hally Health is your partner in helping you live your healthiest life. Visit hally.com, that's H-A-L-L-Y.com, for resources, information, tips and much more. Let us help keep you and your family healthy and well. Thanks for listening. We hope you tune in again.