Nurse Maureen‘s Health Show

Flu RSV & COVID: Dr. Christine Palmay On Protecting Yourself Against Respiratory Viruses

• Maureen McGrath

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Maureen McGrath RN :

Good evening and welcome to another episode of Nurse Maureen's Health Show podcast. You know it's been a very cold winter, I have to say, in many parts of this country and that makes me think about illness quite honestly influenza, rsv, covid-19. The Government of Canada Respiratory Virus Surveillance Data is showing influenza, rsv and COVID-19 are highly active across our country. Older adults living with compromised immune systems are at increased virus risks. Today I'm speaking with Dr Christine Palmay, a Midtown, toronto family physician and member of the Adult Vaccine Alliance, about the top three respiratory viruses and what you can do to protect yourself and your family. Good evening, Dr. Palmay. Welcome to the podcast.

Dr. Christine Palmay:

Always welcome, Maureen. It's always a delight to speak with you.

Maureen McGrath RN :

Oh, so lovely to speak with you as well. You know we usually associate respiratory viruses with the fall flu season. Why are we seeing spikes in the middle of winter?

Dr. Christine Palmay:

So, to be honest, when I speak about respiratory season, I think about the Canadian winter, and there's certainly two things that are absolutes these days. Number one we don't want any more snow. Toronto has no place to put any extra snow. You know, we don't want these viruses. Post COVID, everybody is, frankly, sick and tired of being sick and tired. I get it, you know.

Dr. Christine Palmay:

The problem is is that respiratory viruses have a heyday during the Canadian winter, for several reasons.

Dr. Christine Palmay:

So, first of all, you know it's generally a time when we are celebrating, right with Christmas, hanukkah, thanksgiving, family Day, vacationing together, spending time on planes, and that is an ideal setting for viruses to spread. I often say that, you know, there's nothing better than having a blessing of a grandchild. The problem is, is those grandchildren often bring germs home to grandparents who are at increased risk of severe diseases, simply based on age and usually because they have other comorbidities? And the second thing is is that because it is cold, from what I would say starts what, end of September, early October and may last until May Another reason why viruses tend to linger? Another reason why viruses tend to linger. So, in my mind, you know, cough and cold season is just simply Canadian winter, and you're absolutely right. We are seeing another spike, which is not surprising, you know, certainly after the holidays during December, for the reasons I mentioned, my clinic was overrun with respiratory illnesses, but it is still being something that I have seen regularly.

Maureen McGrath RN :

And our clinic is certainly overrun with respiratory viruses as well, and I'm hearing so many people saying you know I've been sick for two or three weeks, I've lost my voice. You mentioned bringing these viruses home to older adults, and you know grandparents and also those who might be immunocompromised. How can these viruses affect those individuals?

Dr. Christine Palmay:

So when we think about patients who are most at risk, it somewhat varies according to viruses, but if you're let's call it over 65, which is a huge portion of the Canadian population, we have an aging patient population here In Canada.

Dr. Christine Palmay:

I like to say we have an aging patient population here In Canada. I like to say we are an expensive vintage of wine, but your immune system ages with you, your tissue ages with you. So age itself, which I don't have a solution for, you know, puts people at increased risk and usually, as we age, we gather baggage in the form of diagnoses that may further increase your risks of things like COPD, diabetes, congestive heart failure. And you know, by virtue of having diagnoses, you're also on medications that may further challenge your immune system. So you can see the additive result that patients you know, generally north of I would even say 60, it'd be hard to find a patient who I don't consider at increased risk. And then, of course, you have your patients who are dealing with cancer treatments, struggling with the immune diseases, who are on chemotherapy, immunosuppressive medications, and that represents a huge portion of Canadians at present time.

Maureen McGrath RN :

So government surveillance data is showing that over 20% of the population is impacted by flu. Does this surprise you?

Dr. Christine Palmay:

Absolutely not. So there's a couple of problems. Generally speaking, we're not fantastic with influenza immunizations, but if you're looking at stats for patients over 65, they're generally okay. It's that middle-aged 40 to 65 that unfortunately we have very low uptakes for the influenza vaccine and I have certainly seen an influenza spike in my practice. The tragedy is, as a community physician, there's no point of care testing. I cannot swab a patient who comes in for influenza or RSV If they have a COVID test that may or may not be expired. Potentially you can test for that. So you know, what I'm seeing in my office is kind of a guessing game, point being, I'm just seeing respiratory viruses.

Dr. Christine Palmay:

And the greatest misfortune, maureen, is if you win the lottery which is not a lottery, you want to win and get co-infected by two or you know even less rare but tragically three viruses. And I certainly have a young patient. I always tell this tale, for when patients come in and kind of say nay to any sort of immunization, she's 40 years, young. Say nay to any sort of immunization. She's 40 years, young, healthy, vibrant, no official risk factors, and she got influenza A and COVID At the same time.

Dr. Christine Palmay:

I only knew about that because she ended up in the hospital and four weeks later she's still in the hospital. So it's you know those cases. Yes, we need to think about the most vulnerable, our oldest of the old and our youngest of the young patients, but you're not zero risk if you are outside those age ranges. And it's important as well to understand that influenza vaccines also prevent transmission, which we come back to the discussion, that it is a joyful time to celebrate with family, travel with family, be with family. But making smart choices preventively, I think, is the way we preserve health.

Maureen McGrath RN :

Absolutely, and there are so many misconceptions about the flu vaccine. But what are some of the common flu symptoms?

Dr. Christine Palmay:

So when I talk about flu-like symptoms, I just say respiratory symptoms in general, because it's really impossible from a clinical exam to delineate whether a patient has COVID or influenza or RSV. You know they generally come in saying I have a cough, perhaps a runny nose, overwhelming fatigue, joint pain, you know feeling lethargic. Sometimes gastrointestinal issues creep in and there's a whole bunch of GI gastrointestinal viruses that are also spreading around. You know we have some guidance that perhaps a patient with RSV has a bit more wheezing and that's an audible whistle as a patient is breathing out. But you know the reality is is we're horrible at being able to differentiate because symptoms simply overlap and it isn't until a patient tragically ends up in the hospital where you get tested probably. Um, you know we get triple tested for those viruses that we had mentioned, but I'm doing everything to prevent that from happening, right?

Maureen McGrath RN :

right, absolutely. Um. So how can we protect ourselves from the flu? I I mean, you mentioned the gatherings and I have to say, since COVID, I'm not 100% comfortable in a gathering or in an indoor restaurant, to be honest with you. But how can we protect ourselves from the flu?

Dr. Christine Palmay:

So let's start with basics. If you're sick, stay home until you feel well. Even you know a patient who has a COVID test that's negative if they're still symptomatic. Even you know a patient who has a COVID test that's negative they're still symptomatic. I say, you know, be smart, stay home.

Dr. Christine Palmay:

Hand washing is not a public health measure strictly for COVID. It's a good idea in general. Wash your hands right, mind your P's and Q's, make sure you're well hydrated, you're eating your vegetables, you're getting sleep, everything that your mama or your papa told you to do. And then you know taking that one step further in terms of prevention. You know making sure that you get every vaccine that you are eligible for, based on your age and or risk factors, and thankfully we have vaccines that are available against influenza, now newly against RSV and as well as COVID. And unfortunately, as I say, wash, rinse, repeat.

Dr. Christine Palmay:

You know our Canadian winter comes annually and that means we're going to have an annual respiratory season. So you vaccinated yourself in 2024. You know, in October, in preparation for the Canadian winter. Well, guess what? It's now 2025, time to think about. You know, protecting yourself. I talk about you know, putting on your preventative medicine, armor, as we go into this Canadian winter and I always I often mention this quote. It really resonates with me that good medicine treats disease. So if you come into my office and you have some sort of respiratory illness, I'm clearly going to offer treatment that I think is best for you. But I'd be doing a better job if I offer guidance as to preventing vaccines. So good medicine treats illness. Excellent medicine tries to prevent it.

Maureen McGrath RN :

That's a great point. Is it too late in the season for people to get the flu vaccine? For those who thought that they were better off not getting it?

Dr. Christine Palmay:

No, I don't think it's too late. I mean it certainly depends on your risk factors. For high-risk patients, absolutely, and as we mentioned, we have a spike in influenza lately. For other vaccines COVID vaccine follow public health guidance no-transcript about older patients, I tend to time that right before the season starts. We definitely have two years worth of data coverage for the two vaccines that are available. That's what I provide guidance to my patients about. So I mean, if you're going to maximize the coverage, you're probably getting that vaccine. October-ish makes more sense. But if you are high risk and you're going to maximize the coverage, you're probably getting that vaccine October-ish makes more sense. But if you are high risk and you're heading somewhere and you're worried about it, timing really is inconsequential. Just get a vaccine.

Maureen McGrath RN :

Absolutely Great advice. You mentioned RSV and we're hearing a lot about RSV. This was typically common in newborns and infants and potentially devastating to them as well, but why are we seeing it more now in older adults?

Dr. Christine Palmay:

So we're actually really not seeing it more. The problem was is that we didn't have much to do in terms of preventing RSV, right? So you're absolutely right RSV once again, it affects the youngest of the young, so typically patients under two years young and then older patients. We did have, and we have had for quite a long time, treatment for those infants at risk, significantly at risk, for RSV. Things have changed since we have new vaccines and new monoclonal antibodies on the market. But now, because we have vaccines, you know it's not that all of a sudden we have more RSV, we just have an ability to try to prevent it. So it has been top of mind, top of news, because we have a new tool in our toolbox.

Dr. Christine Palmay:

I'm going to focus on older adults. We have two vaccines, relatively available, one that is coming down the pipeline and really, when you're thinking about burden of disease, rsv in its severe form is horrible. People end up with super infections, other complications, deterioration of their other health diagnoses and a stat that has always stayed with me if a patient ends up in hospital so has severe RSV disease, 8% of those patients don't necessarily leave in the state that they come in. So they leave the hospital but they leave, requiring, you know, supplemental care. They leave, you know leave requiring nursing home care. They lose their independence and in a society where we place so much emphasis on wellness as we should, when we place so much emphasis on aging with dignity and the ability to be active and enjoy life, we often forget that part of that reassurance policy to maximize the chance that you will be well later on in life is preventing, vaccine preventable diseases, and the best way to do that is immunizations.

Maureen McGrath RN :

Absolutely. Now we're seeing the number trending down of RSV across the country, but the incidence of RSV is higher this year as compared to last. Are we going to see that as an emerging trend, rsv continuing to increase across Canada?

Dr. Christine Palmay:

We don't know fully, right. I mean you have to understand the public health measures that were very much in place during COVID have somewhat lingered. You mentioned you are a little bit hesitant to go to restaurants and gatherings. I think many patients are. So that in itself is semi-protective. We don't really know. But we certainly know that RSV is seasonal. It differs where you are in the world. In Canada we generally say October maybe to late March, with a bit of variance here and there. But I'd like to make a point about the contagious nature of RSV. So during COVID most respiratory illnesses certainly influenza, pneumococcal, which is a bacteria another discussion for another day they were barely detectable because we were staying at home wearing masks, not congregating. The clinical trials that took place to approve the RSV vaccine took place during COVID. So even during a time when people were, you know, so strict about public health measures, we were still able to find enough RSV to power the studies and I think that's a pretty striking point.

Maureen McGrath RN :

That is very significant. I did not realize that at all. You mentioned that whistling. I did not realize that at all. You mentioned that whistling, the upper respiratory symptoms that are RSV, but that differentiation was that whistling, which is very interesting. How can you protect yourself against RSV?

Dr. Christine Palmay:

So all of the measures, you know it's not a difficult discussion because when I talk to patients, you know you feel like you're having a shopping list of vaccine, preventable diseases, but they share a lot of commonalities. So the preventative measures six-day home, wash your hands, et cetera, but RSV for adults, we have two readily available and, as I mentioned, one down the pipeline vaccine that is effective, with officially two-year data for the ones that we have available, which is very exciting. And you know that the combination of common sense, public health measures that are lifestyle-based and vaccination, you know that will optimize your chance of avoiding getting RSV not a hundred percent right. And oftentimes when people have taken a vaccine and they come and I think it's probably RSV, they sort of say, oh, my goodness, I even took the vaccine and I got it. And I say, yes, but perhaps you have an attenuated, a mild version of RSV.

Dr. Christine Palmay:

And even you know, for patients who aren't in hospital, maureen, rsv is a pain, like you really aren't. Well, it is not a pleasant experience. And the other huge learning point during COVID was understanding and appreciating the precious nature of time and the ability to spend time traveling, not having to cancel your travel plans. You know, even with Air Canada's and our Pearson international crisis, making sure that you're able to join family that concept really resonates with patients. So maximizing your protection against RSV in the form of vaccine provides you the best insurance policy that we have at present.

Maureen McGrath RN :

And helps those that you love as well. Now COVID-19 is shockingly to maybe to a lot of people, or surprisingly, is still with us. And what do we need to know about COVID-19 aside from that? It's still here.

Dr. Christine Palmay:

It's still here, unfortunately, and it doesn't care. It's not going to go away, it doesn't care that you missed your trip to Punta Cana or you couldn't celebrate with family. The virus's goal is to propagate its DNA right, and it's going to continue to do so. So public health guidance has changed. I briefly mentioned that. I really encourage you to speak to your or the viewers to and listeners, just speak, make to their primary care providers. We're changing the way. We recommend a vaccination based on risk factors, and that's new as of this year, a little bit different Next year, who knows. But you know it's a moving target and we obviously try to create vaccines that are the most up to date, based on the variants that are circulating. So we know what's happening now. We don't necessarily know what's happening in September. So ears open and certainly it's not going away. And, yes, you still need a vaccine.

Maureen McGrath RN :

You know I love that. You said if you're sick, stay home. You know basic information. You know I'm seeing some health care providers coming into the office sick, thinking well, I'll just wear a mask, which is also uncomfortable, I think. You know, during COVID-19, people knew if they were sick, stay away. But now people are a little bit easier about that. But should people still be testing for COVID-19? Or should they assume they have it with certain symptoms? And you mentioned earlier that some of the kits are expired. Do they actually work if they're expired?

Dr. Christine Palmay:

We don't know. I mean, generally speaking, I say a positive is a positive. So if you do a test that's positive, pretty sure it's positive. The question is is whether a negative test is negative, and you know guidance varies. But if you get three tests that are done in 24 hours apart and they're all negative, you're probably negative. Probably. We don't know fully.

Dr. Christine Palmay:

The other reality is in terms of you know how to deal with COVID and whether it matters whether you test positive. It does because it will delineate in general when you are next most eligible for the vaccine. You know, after a natural COVID infection your immune system is naturally primed. So it's almost like a lost opportunity If you vaccinate. At that time you're already at maximum level and you have to wait in general the guidance is still six months for your natural immunity to wane and you get the vaccine to boost yourself up again.

Dr. Christine Palmay:

The other question is in terms of treatment. So we have treatments for patients who are at high risk. You know those treatments are important for patients who have severe potential outcomes from COVID, but you don't want to give them willy nilly. So I would never say you know, scratch my head. I think possibly you have COVID, maybe, maybe not. Here's an intense medication to take, it's better to know fully. This is sort of the gray zone of medicine. As a primary care doctor, I live in the gray zone. Primary care doctor, I live in the gray zone. And those are, you know, really important intimate discussions to have with your primary care doctor, not necessarily what public health is mentioning in general, but what my personal risk factors are, based on my age, my comorbidities, my medications, my lifestyle choices, whether I'm traveling, whether I'm not, whether I have grandkids, whether I have not. And that is the art of medicine and that's what we call individualized care and, in my opinion, excellent medicine.

Maureen McGrath RN :

Dr Palmay, how can you tell the difference between COVID, RSV and influenza?

Dr. Christine Palmay:

Well, my crystal ball marine is in the repair shop for the next bit. That's a short answer. I mean, it's certainly not meant to be snarky, but we really can't. I think I mentioned that RSV may present, with more wheezing, an audible whistle when a patient is breathing out. You know, aside from a test that's positive, we can't really, once again, without diagnostic abilities in the community. You know, certainly, when a patient ends up in the hospital they get triple tested whether they have COVID, influenza or RSV. But I'm really hoping my patients don't end up in the hospital and actually get that test. So it's once again, you know, looking at a patient and just saying I'm going to treat you conservatively, treat your symptoms if I can. But the best way to even prevent a visit to my office is, you know, vaccinating yourself and being smart. That Canadian winter is long, it's harsh, there is a heck of a lot of snow, no more snow and, you know, hopefully no more sickness to the same extent that we've seen, and certainly during COVID, which was a very dark time.

Maureen McGrath RN :

And you know, people have been misinformed and they're hearing information from their friends. They're assuming things about their own health. I had a patient who felt that they had actually a burden about a 15% burden of premature ventricular contractions, pvcs and they felt that that burden had increased because of the flu vaccine. And they spoke to their exercise cardiologist about this and the cardiologist said and the patient said you know we're not conspiracy theorists here, but yeah, I wouldn't get the flu vaccine if I were you. And I thought I wasn't really familiar with that. But I did a little research and I found that the flu vaccine can actually decrease your burden of PVCs. What would you say to listeners who are misinformed or on the fence or haven't gotten their vaccine? What golden nugget of information do you have for patients like this?

Dr. Christine Palmay:

Look at the source of your information, right? I love Instagram. I'm, you know, constantly on it. I Google absolutely, you know. The problem is is that it's a double-edged sword. We certainly have unprecedented access to information, which is wonderful. Right, I sort of laughed because I was speaking to a patient who really didn't have any concept of going to a library and taking books off the shelf. But you know, you need to know what the source is.

Dr. Christine Palmay:

I generally recommend going to national guideline bodies. You know organizations, immunize, canada. There's some wonderful sites with hardworking people who authentically care and spend hours and hours, you know, doing research, provide information that's most up to date. You know fear is fear and even I make correlations that don't necessarily make sense when you're anxiety ridden. But you know you need to understand the correlation is not necessarily causation and when people talk about vaccines they're afraid that their condition will worsen, whatever it be PVCs, hyperthyroidism, hypothyroidism the reality is I am much more comfortable dealing with, you know, expected side effects from a vaccine than I am dealing with the wild west. If a patient gets that particular vaccine preventable disease so whether it's RSV, covid or influenza I don't know what that vaccine is going to do to that patient and that may be an epic disaster. So it's all about relative risk, putting things into context and, you know, going to sources that are reliable and up to date.

Maureen McGrath RN :

And I think sometimes patients walk into doctor's offices and you know they have one impression and the doctor, you know, given the limited amount of time that doctors have to educate patients, sit down with them and, you know, allay their fears. You know, I think sometimes you know health care providers I shouldn't just say doctors, who just go along with what the patient says. Maybe they realize they're never going to talk the patient into something, but it's great advice to look at the resources. I recently read that Dr Google is incorrect 65% of the time and then the social media influences are incorrect 75 to 80% of the time. So it's definitely not a place to get your information and I really appreciate the information that you've provided tonight,

Dr. Christine Palmay:

Thank you so much again for having me. It's always a delight.

Maureen McGrath RN :

It's my pleasure. I love having you on because it's such great information.

Dr. Christine Palmay:

And rally on. We have to rally on as a community, and doctors themselves and healthcare providers themselves need to self-rally as well. So point well taken.

Maureen McGrath RN :

Absolutely Well. Thank you so much. My guest was Dr Christine Palmay a Midtown Toronto family physician and member of the Adult Vaccine Alliance, and we were talking about the top three respiratory viruses COVID FLU, RSV and if you know somebody that can benefit from this episode, please feel free to share. Please send it along to them. I'm Maureen McGrath, a registered nurse, nurse, continence advisor and sexual health educator, and you have been listening to Nurse Maureen's Health Show Podcast. Thanks so much for tuning in. I'm Maureen McGrath and you have been listening to the Sunday Night Health Show Podcast. If you want to hear this podcast or any other segment again, feel free to go to iTunes, spotify or Google Play or wherever you listen to your favorite podcasts. You can always email me, nursetalk at hotmailcom or text the show 604-765-9287. That's 604-765-9287. Or head on over to my website for more information, maureenmcgrathcom. It's been my pleasure to spend this time with you.

Maureen McGrath RN :

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