Maggie McKay (Host): When your child has breathing issues, how do you know whether it's the flu, RSV, or COVID-19, or none of them? Today, we'll find out more with Dr. Eddie Lyon, Pediatric Infectious Diseases Physician.

 Welcome to the Parent-ish Podcast, where experts at Children's Mercy Kansas City talk about the little everyday things parents experience with their babies, teens, and in betweens.

I'm your host, Maggie McKay. Thank you so much for being here, Dr. Lyon.

Eddie Lyon, DO: Thank you so much for having me. I'm looking forward to our discussion.

Host: Me too. So let's start with can you explain the difference between the main respiratory diseases like COVID-19, the flu and RSV?

Eddie Lyon, DO: Yeah, so by and large, they're similar and also unalike at the same time. To begin with, they're all viruses. So by and large it means that for all of them, antibiotics won't work to address really any sort of what happens for them. But they're all viruses, and they all seem to have a somewhat seasonal preference, meaning that they tend to come at different times of the year, and for most of the respiratory viruses, it's more so in the wintertime.

So RSV stands for respiratory syncytial virus, and it's a very, very common cause of the common cold in lot's of different children as well as adults. And it can cause really anything from the cough, trouble breathing, runny nose. A lot of nasal congestion is a big feature. And most kids do really well from it, but occasionally, and most importantly, those who are younger, so less than a year and particularly less than six months of age, seem to be a little bit more predisposed to having a tougher time working through or recovering from RSV.

Influenza is a little bit of a different beast. It tends to cause similar symptoms to RSV, but it is a little bit more. One that's associated with higher fevers, can cause a little bit more systemic symptoms, which means more so that it can cause the body aches, can cause vomiting, nausea. So it causes a little bit more whole body involvement as opposed to just like the isolated respiratory stuff that we see. And it can also make you feel really terrible and can last for quite some time, about a week, sometimes a little bit longer. And it also has the same predisposition to the wintertime as when it's the most prevalent.

And then COVID-19, which we all have our wonderful memories of when it first came onto the scene a couple of years ago, is similar to really kind of both of them. And we've learned a lot about COVID-19 as it's come into our psyche over the last couple of years. But it causes fever, cough, fatigue, more systemic stuff. So again, full body stuff than RSV does, similar a little bit more so to the flu, but can cause a whole variety of symptoms. But its hallmark, again, is somewhat more of the difficulty breathing.

So by and large, all three of these viruses cause difficulty breathing at times, and can also be associated with fevers.

Host: Are they all contagious?

Eddie Lyon, DO: Yes, they all are contagious. So they're wonderful things that you can share between everybody in your home. And, I tend to experience it most often with my kids too. If one of my kids comes home from school or daycare and then it just kind of works its way around in the same way in classrooms and all of that.

 They all are contagious, and all basically the same way. So they're all caused by respiratory droplets. So as people cough or sneeze or stuff, the droplets go into the air and then you breathe those in, or you touch somewhere where those have been, and then you touch your face, and then you now have it as well.

So this is a great thing that we all share between ourselves when we're stuck inside while it's cold out there.

Host: I have to say when I'm like at the movies or in the market in line and someone just has a big giant sneeze, I'm like, oh,no, no.

Eddie Lyon, DO: Yeah, you try and hold your breath, like, cover your mouth, like, really subtly, trying to not be that odd man out.

Host: So how severe do we anticipate respiratory virus season being this year?

Eddie Lyon, DO: Yeah, it's an excellent question, and I think one that we ultimately never really know the answer to. We had a pretty good seasonal predictability and kind of knowing when things were going to get worse versus better, and COVID-19 happened, and it kind of messed up our traditional understanding of the typical respiratory season.

But, what I would say at this point in time is that it's ultimately variable, but we saw quite a lot of infections last year from RSV, and so I don't know that I have a great idea of which one is going to be the most severe, but we are starting to see some signs of RSV kind of coming up in frequency in the community, as well as influenza, and in general, for COVID-19, kids by and large have done pretty well with COVID-19. So COVID-19 hasn't been as much of an issue at times for the pediatric population, as opposed to RSV, or influenza, but, you know, I would expect that it's going to be at least a typical year, if not more so. We're seeing a lot of another infection called mycoplasma, which is one of the causes of an atypical pneumonia, at this point.

And so it's one of those where we just have to kind of see how the year shakes out. But by and large, again, kind of coming to that seasonal thought process of the year for infections. The wintertime is what all of us pediatricians know as respiratory viral season, which is when we know that urgent cares, emergency departments, pediatrician offices, all get busier with kids who are snotty, working a little bit harder to breathe, having fevers, all of those things.

And so I think we'll see kind of what the intensity of it is this year, but it certainly is going to become more of a prominent feature in the community over the coming weeks and months.

Host: Do any of these viruses impact children more than others?

Eddie Lyon, DO: Yeah, actually, RSV, is a prominent player in the pediatric population, causing a lot of illnesses, and kind of as I alluded to a little bit earlier in our discussion, is that RSV affects most intensely those who are a little bit younger; so less than one year olds, six month olds, stuff like that. But, it is a very prominent player in causing kids to be sick. But it's again important, I think, to remember, and I'm sure we'll talk a little bit about some prevention strategies coming up, but, it's important that everybody, so any person who's out there, young or old, is able to get sick with these conditions or with these viruses, but RSV, influenza, are really prominent players in pediatrics but they're not necessarily more of an issue.

It's just that with kids being physically smaller, it means their lungs are smaller, their airways are smaller, so all of the mucus that goes down in there, is harder for them to mobilize, harder for them to get out, and causes a little bit more of an issue, so sometimes you can have a little bit more substantial infection at times with some of these viruses. It again is important to remember that everybody can get these things, overall.

Host: What are some of the best ways to prevent these viruses? That's the big question.

Eddie Lyon, DO: The best ways to prevent a lot of infections, in general, come down to some of the basics that, you know, we all learned way back when in the day is washing hands, is super important. Really any time of the year, but certainly when we're all stuck inside with it being cold outdoors, staying home if people are sick, keeping kids out of daycare if they're sick, all of those things.

But another really, really crucial and important portion of keeping kids healthy and really everybody healthy, and preventing these infections comes in the realm of immunizations and vaccinations. So RSV actually has some really exciting new stuff coming out, which hasn't really been available outside of the last two years.

And that's a product called nirsevimab, the brand name is Beyfortus. But it's actually an antibody, so it's basically a protein that goes into the child's body and it's typically for kids who are less than 8 months of age entering their first RSV season. And it's given pretty much right after birth or it can be given right after birth.

And what it does is it binds to this virus to prevent it from causing as significant of illness as we've seen previously. So it does a really good job at preventing kids from having to come into the hospital, with this particular infection. And so that's one way is for the brand new babies coming out into the world in this time of year, is to get that nirsevimab product or that antibody to help protect them from the severe complications of RSV.

But another exciting part about RSV, again kind of thinking that these viruses are able to cause illness in everybody, is that if we're able to create a community of protection around our children, that makes it easier for them to stay healthy as their immune systems are learning how to fight all of these different viruses and infections; in protecting them by protecting ourselves. And so moms, or pregnant persons who are in their pregnancy, in between 32 to 36 weeks of their pregnancy, from September to January, are able to get an RS vaccine, if they're interested, that actually generates an immune response in the mom, and then the antibodies are then shared with the baby through the placenta and protects them for the first six months of their life. And so it really works very similarly to that nirsevimab product or that antibody that we then give babies, once they're already born. And so if somebody gets the RSV vaccine, their child wouldn't really need the injection after birth.

And then for older adults, so 75 or older, or if you're 60 years of older with some different features that could put you at risk of RSV disease or severe RSV disease, can also get vaccinated against RSV, which is a relatively new vaccine on the market to offer some substantial protection. So again, creating this kind of community of protection around our children as they're growing and developing.

There's of course the yearly influenza vaccine that's available and does a good job at preventing certainly the most significant complications from influenza, which are hospitalization and then even up and to and including death. And so it does a really good job of preventing those really severe outcomes, and is available kind of broadly in the community at this point.

And then lastly, COVID-19 also has a vaccine, and it's been updated to include the variants that are commonly circulating this year. So there's a 24-25 updated COVID-19 vaccine that's available and licensed and approved for everybody six months of age and older to get to again, kind of protect them from the most significant outcomes associated with getting COVID-19.

Maggie McKay (Host): Lot of prevention options. What are the options to treat these viruses if you are unlucky enough to get them in your family?

Eddie Lyon, DO: Yeah, so as we kind of spoke just briefly, since these are viruses, antibiotics won't work to actually treat the virus itself. Occasionally you can get a bacterial infection following a virus, and that's kind of a little bit of a different story, but when you're acutely sick, or meaning sick right now, with these viruses, there's by and large, not a ton of things that we're able to do in terms of specifically treating the virus.

What we do most importantly is symptomatically treat. So we help kids, you know, if they're having a fever, we can give them fever medications. A lot of times when you're breathing harder or breathing faster, you're at a little bit higher risk to get dehydrated. So making sure that people are hydrated, lots of rest, all of those things.

So managing symptoms is super important. And then, of course, if there are any signs of difficulty breathing, all of the really more severe things, we're able to support those children whenever they come into the urgent care, pediatrician office, emergency department, or hospital, to support them through this particular illnesses overall. And so that could be a whole range of symptomatic management to support them. So for RSV, there's really not a whole lot aside from that symptomatic management that we're able to do to kind of shorten the duration of illness or really help it go by faster.

For influenza, if patients or families do present to care, typically within the first 48 to 72 hours of illness, and they're diagnosed with influenza; there are several medications that are available, and licensed even for down to really young, up until adults to help shorten how long you're sick with these viruses. And so those are also tamivir or Tamiflu, or baloxivir or Xofluza, which are two antiviral medications that then would shorten your total duration of illness by a little bit of time and can hopefully help you feel better a little bit faster.

For COVID-19, again, it's really that symptom management by and large. For kids, there's not really a whole lot that's available to help quickly resolve the infection. If a child is over 12 years of age and over 40 kilos, so about 80 pounds or so, they're able to swallow pills and then they have certain features that would put them at high risk for severe disease associated with COVID-19, there is an over the counter medication called Paxlovid, that they would potentially be a candidate for.

That's more geared toward the adult population, but then, you know, if a patient was to be hospitalized with a COVID-19 infection, there's things that we can do at that point, to try and help slow down how fast the virus is able to make more copies of itself and cause issues, but that's typically only available if somebody's meeting the level of care that's provided inside of a hospital setting.

Host: Well, this is all such useful information. Thank you so much for sharing your expertise, Dr. Lyon.

Eddie Lyon, DO: Yeah, absolutely. Thank you so much for having me.

Host: Of course. Again, that's Dr. Eddie Lyon. And to find out more, please visit childrensmercy.org/parentish. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

That concludes this episode of the Parent-ish Podcast. Again, for more parenting tips and tricks, visit us at parentish.org, where we help you celebrate the craziness and challenges of parenthood.