Healthy for the Holidays with Dr. Marci Drees

'Tis the season... to be sick. And as we say goodbye to 2024, we want to avoid saying hello to respiratory illness.

On this episode of For the Love of Health, ChristianaCare Chief Infection Prevention Officer Dr. Marci Drees gives us tips on how to keep the uninvited germs away from your holiday gatherings.

Marci Drees, M.D., MS, is the Chief Infection Prevention Officer and hospital epidemiologist for ChristianaCare. Dr. Drees serves as a councilor on the Board of Trustees of the Society for Healthcare Epidemiology of America (SHEA), and previously served as SHEA's liaison to the CDC's Advisory Committee on Immunization Practices (ACIP). She is board certified in internal medicine and infectious diseases.

Links

• Make a Plan to Get Your Flu Show
• COVID-19 - Details, Prevention and Treatment
• Delaware.gov - Current Delaware Flu Infection Rates
• Delaware.gov - Current Delaware COVID Infection Rates

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Transcript

Speaker 1 0:02

Even if you already had the flu, I would still get vaccinated because you might get a different strain of the flu.

Speaker 2 0:09

You're listening to For the Love of Health, a podcast about delivering care and creating health, brought to you by Christiana Care. And now here are your hosts.

Speaker 3 0:19

Hello everyone, I'm Megan McGerman.

Speaker 2 0:21

And I'm Jason Tokarski. Welcome to another episode of For the Love of Health brought to you by Christiana Care.

Speaker 3 0:26

Tis the season to be sick and as we say goodbye to 2024, we want to avoid saying hello to respiratory illness.

Speaker 2 0:34

So we've brought in Dr Marci Dries, Christiana Care's Chief Infection Prevention Officer, to help us stay healthy for the holidays.

Speaker 3 0:41

Marci, thank you so much for being here today. Thanks very much for having me. Over the years, we've talked about the tripledemic flu, COVID, RSV. Now there's whooping cough in the headlines, walking pneumonia in the headlines. Where are we with all of these infectious diseases going into 2025?

Speaker 1 0:58

We're clearly in respiratory season now, right Going. You know, usually things start to ramp up October, november-ish. If you remember, during COVID, when everything was locked down, everyone was masking. There was almost no other respiratory disease out there. And then once we started to open things back up, we had very early seasons for flu and RSV. We've really started to shift now back to more the normal seasonality. The good thing is they don't tend to all peak at the same time. So we really are seeing. The first one is RSV is definitely on its way up I don't think it's peaked yet, but it's kind of sooner than the other ones. And then COVID would be our next most common infection that we see, followed by flu. So they're all on the rise, just at different rates. At this point. What we're also seeing an increase now is bacteria. The same thing happened with those that we saw very little of them during COVID when everything was shut down, and they're really resurging with a vengeance, so to speak.

Speaker 1 1:50

So when we think about walking pneumonia. So first of all, pneumonia is obviously a lung infection deep in the body, compared to most cases of flu, and COVID will mostly affect your upper respiratory tract. So pneumonia, of course, is typically more severe, usually caused by bacteria, though not always, and often lands people in the hospital to get IV antibiotics and other things. When we talk about walking pneumonia, it's just a less severe type of pneumonia. People normally are walking around, right. They're not usually hospitalized, although it can happen, and it's a number of different organisms that can cause walking pneumonia it's kind of a generic term, but the one that we're most worried about now is mycoplasma pneumoniae. So we've seen a large increase this year compared to last, and what's really new about this year is that it's being seen in that two to four year old range which normally it affects older children and adults. And how do you tell the difference? Well, typically you know, it comes on very gradually and lasts for weeks at a time. So you know, whereas a typical flu or COVID or just common cold will usually kind of peak within a week or so, you may, you know, may last a little bit longer, but you're clearly on the mend, whereas this will continue to get worse over a couple weeks. The good thing is there are antibiotics for it, but it's not necessarily the same antibiotic that you would give for your average ear infection. So there needs to be some suspicion that this is more than just kind of your one-of-a-mill ear infection.

Speaker 1 3:15

There is testing for it. It's not readily available in the outpatient setting. Certainly we test for it if people are sick enough to be hospitalized. It's a little bit less available outside just because it's a pretty expensive test.

Speaker 1 3:26

What about whooping cough? Yeah, so whooping cough, also known as pertussis, it gets its name from the whoop. That can happen as people are trying to catch their breath in between coughs. But you don't have to have that. It's also called the 100-day cough, which kind of gives you a sense that this can last a really long time. I had a friend who actually break a rib from coughing so hard. It's a very severe cough. We're seeing six times as many cases as we did last year. It is a reportable disease. Even that is certainly an underestimate because not everybody with pertussis gets tested. Again, it's not a readily available test that you can just get at the drugstore, even from most primary care offices aren't necessarily going to test for it. They'll just treat empirically.

Speaker 1 4:07

The good thing is there is a vaccine. Unlike for mycoplasma, kids get five doses up to the age of six and then a booster around starting at age 11. And so kids are actually pretty well protected against whooping cough, but it's when that later adolescence, early adulthood, when that immunity has worn off, is when people start to be susceptible again. The vaccine is the combined vaccine between tetanus, diphtheria and pertussis. It's recommended every 10 years for tetanus. The pertussis immunity wears off a little bit quicker than that, unfortunately. So if you haven't had what's called a Tdap in the last 10 years, I definitely would go out and get one. Pregnant women get it every pregnancy again to protect the newborn who can't be vaccinated yet. And if you're a caretaker, a grandparent, a teacher, a daycare worker anyone who's around young kids really should get that Tdap and get it on a fairly regular basis.

Speaker 2 4:59

We've got Christmas, Hanukkah and Kwanzaa all hitting basically at the exact same time, so lots of people getting together for get-togethers and parties and such. Do you have any advice on how people might be able to get through all this so that the only thing they come home with is the gifts and the food that they were supposed to?

Speaker 1 5:15

Well, I mean, it is the perfect time of year to spread viruses and bacteria to each other, right? These are all spread via respiratory means. You know, coughing, sneezing, touching things with your hands that aren't clean, coughing, sneezing, touching things with your hands that aren't clean. So the best you can do with your respiratory etiquette, you know, using a tissue or your elbow, not your hands, washing your hands frequently, wiping down surfaces frequently.

Speaker 1 5:36

A lot of people are traveling, so if you are visiting loved ones, especially if they're elderly or they're young babies, you know you have to be especially careful. Make sure, of course, you're up to date on all your vaccines that you're eligible for. If you're flying, I would certainly consider masking in the airport or in the plane, at least until they get the air running in the plane. If you're sitting at the gate, they're not running the air circulation, so that's a high risk time. Of course, none of that's going to protect you if someone who's sick is right next to you, but if you notice that, then I would probably mask the whole time that you're in the plane.

Speaker 2 6:08

Is it too late at this point for somebody who wants to get one of the vaccinations, be it for flu, COVID, RSV, what have you?

Speaker 1 6:14

Absolutely not. So we will continue vaccinating for flu really up until the end of March, even though usually by then flu has kind of come and gone. But not infrequently we'll see a late surge in flu B. So that's why we continue to do that. Now is really the perfect time. It's not going to protect you tomorrow or the next day. You know it normally takes about two weeks for any of these vaccines to show protection. Even if you've already had the flu, I would still get vaccinated because you might get a different strain of the flu. If you've had COVID recently, I would wait three months to get that vaccine because that will maximize your immunity. But no, it's definitely not too late.

Speaker 2 6:48

But it is as far as covering you with the vaccines for the holidays. If it's a two-week thing like you're talking about there, you kind of already missed that window as far as the holidays are concerned.

Speaker 1 6:58

Well, I mean, I would not wait until after the holidays for sure, because you never know at what point you might get exposed, and if you're going to go somewhere for a week you might start to see some protection by the end of that week, if you were to get vaccinated today and anyone six months or older can get the COVID vaccine and the flu vaccine.

Speaker 3 7:14

But RSV has some specific guidelines.

Speaker 1 7:17

Yeah, so RSV is our newest kid on the block. This will be the second RSV season. It's really intended for older adults and pregnant women. The vaccine so to talk about older adults, it used to be anyone over 60 could kind of consider getting it. They just changed the guidelines this spring to say that everybody over 75 or older should get that RSV vaccine, because they're at very high risk of severe RSV should they get infected. But then if you're between 60 and 74, it really depends on whether you have other conditions. You know diabetes with end organ failure, like kidney disease, or neuropathy, end-stage kidney disease, and there's a whole host of other ones that are on the website.

Speaker 1 7:55

Now for RSV, really the highest risk group are newborns. They far and away are most likely to be hospitalized with severe RSV, be on a ventilator and even die from RSV. So we have two strategies now to protect those newborns. One is that mom can get vaccinated toward the end of her pregnancy and so she has time to develop antibodies that she can pass directly to the baby and also through breastfeeding, if she breastfeeds. And then the second option is to give the baby what's called a monoclonal antibody. It's given as soon as possible after birth, within the first week ideally and that gives them kind of the direct antibodies to protect them.

Speaker 3 8:31

Bit of a personal question. Going past the holidays, I am in full worried about the daycare and preschool germs mode. As a parent of two young little guys, what is your advice to the parents in a similar boat that, no matter what they know, those germs are going to come home?

Speaker 1 8:49

Yeah, it's really hard because you have limited control over what happens in the daycare. Obviously you want to make sure that you talk to your daycare providers that they are cleaning toys regularly. They're maybe not using toys that you can't clean like stuffed animals. Certainly they should have policies around when children need to be excluded from daycare so that other parents aren't bringing their sick kids and dropping them off. You can't exclude a kid every time they have a runny nose, of course. So some of those germs are still going to come home and certainly if you have more than one child at home, then cleaning your toys maybe not having the kids play with the same toys, if that's possible it may not be Putting those stuffed animals away until after, kind of the viruses die down a little bit. Those are things you can try and then you know, just cleaning, cleaning, cleaning. You know you can't get them to cover their cough most of the time, but you know the best you can try.

Speaker 3 9:38

And do you recommend kind of a nightly cleaning of all of the little people, toys and the Paw Patrol figurines and all the things that are kind of in that heavily play rotation?

Speaker 1 9:46

Yeah, if they've been played with, they probably should be cleaned, you know, at least by the end of the day, and maybe, you know, have a rotation of your toys. You're not cleaning every toy every day.

Speaker 3 9:55

You mentioned making sure that the extra little guys, the newborns, the infants, are kind of extra protected, especially with RSV and everything else going around. What if and this is a very personal question you have both at home a toddler with a lot of preschool germs and then a three-month-old?

Speaker 1 10:11

say Again that three-month-old cannot really be vaccinated themselves. But hopefully you know you were vaccinated.

Speaker 3 10:18

Got the RSV yeah.

Speaker 1 10:20

Or they got the monoclonal antibody for RSV and the older child, hopefully, can be vaccinated against those at least. Obviously we don't have a vaccine for every germ that's out there, but staying up to date on the ones we do have will certainly help. And they want to be loving on each other and that's normal. You don't want to necessarily discourage that, of course, but just washing hands before the older one touches the baby. Obviously, if the older one is coughing a lot you might want to not have them cough right on the baby, sort of thing.

Speaker 3 10:50

One of those easier said than done things for sure Exactly.

Speaker 1 10:53

I no longer have young children, so I don't have to worry about it, but I empathize absolutely.

Speaker 3 10:58

Marcy, you and I have had these types of conversations many times over the years. I remember during COVID it was wear your mask, take a test before you go anywhere. What are your recommendations now for the 2024 holiday season?

Speaker 1 11:11

Well, I think people are kind of over masking and I understand like people aren't going to continue to mask when they're around even loved ones that they haven't seen in a while. But certainly if you feel ill, you know it's hard to do, but I would really consider not traveling Right, even if it requires canceling a last minute flight or disappointing your relatives. You will disappoint them even more if you give them COVID or give them flu, so that would be one thing that I would really be conscious of. Obviously, covid tests are readily available over the counter. There are some over-the-counter flu tests that cost a little bit more, but they're affordable and certainly you can go to your doctor and get tested for flu or COVID as well.

Preventive Measures for Healthy Holidays

Speaker 1 11:48

I would just be really conscious about your own health and have a low threshold to test and potentially delay your travel if anyone in your party is ill. Of course you know, as we said before, all the respiratory hygiene, the hand hygiene, and that's for if you don't feel sick. You still need to do all those things. You know, certainly before you prepare any food. But just, you know, whenever you're in close contact with people, just make sure you know things that you're sharing, like phones or you know, any high touch objects get get cleaned off on a regular basis.

Speaker 3 12:17

Marcy, thank you so much for your time. You're very welcome From all of us here at For the Love of Health. We wish you a happy and healthy holiday.

Speaker 2 12:27

We'll be back in two weeks with another great conversation Until then.

Speaker 3 12:28

thanks for joining us for the Love of. Health.