Scott Webb (Host): It's hard to believe that we still need to talk about COVID-19, but we do, especially in light of new variants and, of course, cold and flu season being on the way. And here today to help us understand the new variants, evolving symptoms and current treatment options, is Dr. Erica Kaufman-West. She's an infectious disease specialist with Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, so nice to have you on. I wish we weren't still talking about COVID, but we are. And we want to find out what we can expect this fall and winter, and what we can do to stay healthy. And I know you're on the front lines battling COVID there at Franciscan Health Hospitals in Northern Indiana. So, let's just start here, what are you experiencing today when caring for patients that's different from last year?

Dr. Erica Kaufman-West: I think the first thing is that thankfully the number of hospitalized patients with COVID is down dramatically, both from the beginning of the pandemic in 2020 and then that really awful sort of 2021 to 2022, you know, winter season. So, things have been much better now. The hospitalized patients are much fewer. And we're not seeing those severe respiratory infections, typically as we were in the beginning.

Host: Yeah. And that's where I wanted to go next, is ask you this new strains or variants of COVID, are the signs and symptoms any different than they were even a year ago or three years ago? It seems, you know, as viruses will do, they adapt, they overcome, they find new ways to infect us and attack us. So, where are we at when we think of the signs and symptoms compared to previous versions of COVID?

Dr. Erica Kaufman-West: Yes. So, the main difference is that when COVID first came out, we were looking at more of what we would call lower respiratory tract illness. And that was the cough that sort of lingered, people that got very short of breath either with sitting down or with standing up and walking around. And we don't see that much anymore. The new variants have more of what we would call an upper respiratory tract infection. So, that's more like sinuses and throat as opposed to the lungs that are down lower in the chest. So, we see, you know, head congestion or sinus pressure, headaches, sore throat or scratchy throat, and then fatigue has been a constant, but the movement from the chest up to sort of the head and sinuses. We also see a lot less of that complaint of loss of taste and smell. If you remember in the beginning, that was how a lot of people knew, yes, that they had COVID before we even had testing. But we don't really see that as much anymore, that that loss of taste and smell is not the predominant complaint.

Host: Yeah. Viruses really are amazing in their ability to try to stay ahead of us and we're trying to stay ahead of them and thinking about this new variant. Are there any new treatment strategies? As you're saying, it's the signs and symptoms and where it's landing on folks seems to be moving around. So, I'm assuming that then sort of dictates the treatment options.

Dr. Erica Kaufman-West: It can. I think that the sort of over-the-counter chicken soup hydration that grandma taught us is always good, right? Grandmas always know best. But for people that are at high risk for severe disease, so this is going to be folks that are, you know, in the upper stages of life, people that have comorbidities like diabetes, high blood pressure, kidney disease or liver disease, those are folks that are going to want to contact their physician because now, unlike before, we have medications that we can give for COVID. We have the IV medication for hospitalized patients, and that's been there for a long time, but now we have pills that we can give, and there's two different oral antiviral medications that are out there for patients with COVID. So, those are good. There's, you know, pros and cons to both of them, and they both seem to still be effective against these new variants, maybe a little bit less effective, but still very good for preventing mortality and death. So, that endpoint still remains an effective endpoint. So, for folks that are, like I said, at those high risk for severe illness and death, those are the folks that should call their doctor when they get that first COVID test positive and see if those medications are right for them.

Host: Yeah, for sure. And is it still the same recommended preventative measures? Stay home if you're sick; wear a mask in public, whether you're sick or you don't want to get sick from someone else; wash our hands. Is it still basically the same thing that we've been kind of preaching for the last, whatever it is, three, four years?

Dr. Erica Kaufman-West: Yes, I think so. I think that the biggest things are when you are ill to not go to work. And I think that there's been a big shift from, you know, sort of demonizing people who take time off because they're sick to actually saying, "You know what, that is the right way to do this." If you do feel sick, stay home. Whether it's COVID or not, nobody wants to get what you have. And keeping those germs away from other people is the best prevention that anybody could offer. Hand hygiene and washing your hands regularly is also very important. We touch our faces much more often than we think we do.

Host: A hundred times a day, I'm told. a thousand.

Dr. Erica Kaufman-West: Yes. That's exactly right. And so, I now keep in my car hand sanitizer. So after I go to the store, after I go to the gas station, those areas where just multiple people touch multiple things, I always go back in my car and use the hand sanitizer right away. And then I think there are things that we all know, but often we push to the wayside when we are busy, and those are things like good nutrition and sleeping for eight hours a night and spending 20 minutes exercising every day. So, those are things that do build up the immune system and those are ways that we can be a little bit more proactive as opposed to reactive and really taking care of ourselves.

Host: Yeah, for sure. Taking care of ourselves mentally, physically. And I'm assuming that you're still recommending shots, booster shots. You know, at some point, you just feel like, you know, I still have my card, you know, and I have it kind of like in this little laminated pouch thing, I was kind of hoping to never have to take it out and to have someone sign it again. But I feel like that's what's happening here. And I'm assuming that that's the best recommendation in terms of protecting ourselves, building our immunity, just sort of being prepared for the next variant is to get those shots, right?

Dr. Erica Kaufman-West: It is, it is. And the manufacturers have looked at their vaccines against these new variants that are out there and they're still very effective at creating antibodies and those antibodies are active against what's circulating currently. So, just like with the flu vaccine every year, you sort of have to start making it early. So, you are in a little bit of a guessing game. But this fall at least, at least as far as COVID goes, we know that the boosters are a good match. And that should last you a good several months, hopefully get us through the respiratory season. And then, when the warmer weather comes out and we know the COVID numbers typically just drop off because we're able to be outside and have more of a better ventilation that we should be protected again until that point comes.

Host: Yeah. And I know folks have this question, maybe I even have it myself, so if we go and we want to get the COVID booster and we also want to get the flu shot, can we get both at the same time? Should we do one in one arm and one in the other or just bite the bullet and get it all done in one arm? So, you know, what do you recommend when it comes to both and can we have both at the same time?

Dr. Erica Kaufman-West: Yes. The flu and COVID vaccines can be given simultaneously. They do recommend, separate arms. And there is some thought to like, well, if you always get your COVID in your right arm, maybe switch that up and sort of swap sides. I know, it's weird what we find out.

Host: It can't hurt, right? Why not? it up a little bit.

Dr. Erica Kaufman-West: That's exactly right. But I will say that there is a new vaccine out for RSV or respiratory syncytial virus that was just approved for folks that are high risk for severe illness from that virus. And that cannot be given with the COVID vaccine. So, don't go and get all three. You can't do that. The COVID and influenza are fine to get together. If you are someone that does need that RSV vaccine, then you do need to space that out. So, do talk to your doctor about the timeline and how you should do that. But don't get the COVID and the RSV and the flu all together. That's not the recommendation.

Host: That's perfect. Yeah. And of course, you know, when everybody was wearing masks and staying home and using lots of sanitizer, great hand hygiene, the incidence of cold and flu were down. But, you know, that's all by the wayside now. So, what are your expectations? What are you bracing for when you think about cold, flu, COVID, RSV, who knows what else? What do you think we can expect as we head into the winter months?

Dr. Erica Kaufman-West: Oh, yeah, I think that's, you know, anybody's guess. I sort of get heartburn thinking about it. But I think the one thing that we can say is that COVID has disrupted a lot of things. And the one thing that it has especially disrupted is what we have considered the normal rhythms of other viruses. So typically, we would expect, for example, RSV to start rising middle to end of December, influenza to start middle of January, but we're starting to see RSV going up now, which is only the end of September. So, I have braced myself to be ready for anything, I guess, because I don't know that we can say, "You know what? We're probably not going to see flu until the new year." I don't know that we can sort of pin our hats on that like we always could. I think usually October is get-your-flu-shot month, so I would stick with that. I wouldn't push it off longer, because I think that, you know, COVID has just caused a lot of havoc and disruption to what we would think would be a "normal respiratory season."

Host: Yeah. I've heard that expression, new normal. You know, and I sort of get my mind around that, but then it seems to be changing. It keeps moving. What we thought was COVID before, well, now it's in your throat, it's in your nose. And yeah, I don't know what normal means anymore. But I did want to finish up today and just talk to you about, you know, we've talked a lot about the physical part of all of this, but it's been especially difficult on folks mentally, emotionally, whether it was just the isolation or losing family members and friends to COVID and all that that implies, what would be your best advice, doctor? As we head into these months, are we still sort of carrying COVID on our backs here, about how folks can stay well mentally, emotionally and physically?

Dr. Erica Kaufman-West: Yeah. You know what? Very early on in the pandemic, before it really, you know, hit us, I would say mid-March, I lost a dear friend to COVID. And her memory and our friendship sort of comes up and it hits me in waves every once in a while. So, I can definitely empathize with folks and their grief. And I think, you know, first and foremost, honoring that and just sitting with it for a while, remembering those people and not trying to push it off. I think dealing with it and just feeling it is healthy. And it also is a memorial in a way to those people that meant so much to us.

But I also think that you're right, that just the isolation that a lot of people have felt in these last couple years, even if you haven't had deaths or that sort of disruption, I think just knowing that you can't be with people at certain times, and especially folks that have immunocompromised conditions that really make it difficult for them to gather with family, especially in the winter months, I think that that needs to be recognized. Those folks and their loved ones need to make that effort to still have that support and still have that family time. And it might look different, and it might be a phone call. And it might be, you know, bundling up and sitting in the backyard even when it's 20 degrees out just to be there and bring your thermos out and have some soup on the back porch, those things are still important to do. There's a lot to be said about meditation and prayer. There's a lot to be said about the inward reflection that can bring a lot of peace to people.

And then, I always think being active. You know, you don't have to go to a crowded, sweaty gym. There are things that you can do in your home. There are a lot of YouTube channels and apps out there that can help you. Just get moving at your own sort of comfort pace, even in your own home to just stay active and get the blood circulating.

Lastly, I would say, you know, social media can be a really great influence. You can get a lot of good information. You can connect, you can see pictures of your grandkids and your college friends and all of those things. But it can also be the sort of doom and gloom spiral for a lot of people. And I hope that people don't allow that to happen. And if you find yourself sort of with that fear of missing out, or you find yourself saying, "Well, you know, that person has everything and I'm not worth it," like those are the times that you just need to turn it off. And you just need to say, "I'm not going to fall for that. I'm going to remember that I'm worthy. I'm going to remember that I'm loved. I'm going to remember that there are people out there that care about me." And then, reach out to those people and just pick up the phone and say hi and send a quick text or a funny GIF or something and just sort of reconnect with people and remind yourself, you know, how lucky we all are to just be here and to be, you know, living.

Host: Yeah, that's beautifully put. Lucky, for sure. And sorry about your friend. I know most of us have lost somebody to COVID, and it's difficult, you know, and I keep thinking that because you don't hear about it as much, it's not talked about as much. And then, I go to Costco, and I see someone with their mask on, and I go, "Oh, right. It's still here of course." So, I appreciate your time, your expertise, your compassion today. I know we've spoken before. And unfortunately, we're going to speak again, as much as I enjoy speaking with you. I guess what I mean to say is we'll probably end up talking about COVID more as we move on. And as I said, you know, whatever the new normal is, at least we have experts like yourself that we can lean on. So, I appreciate your time and your expertise. Thanks so much. You stay well.

Dr. Erica Kaufman-West: Thank you. Thank you. You too.

Host: And get the latest on COVID-19 by going to franciscanhealth.org and searching COVID. And if you found this podcast helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.