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Flu season is hitting New York and the country as a whole especially hard this year. Stock photo

By Daniel Dunaief

The flu season has hit with a vengeance in February, as a seasonal virus that can be deadly has  become the dominant cause of illness in the area.

Suffolk County hospitals reported 337 residents with influenza in the week ending Feb. 1, according to New York State Department of Health data.

Dr. Sharon Nachman

Just last year, for the 2023-2024 flu season, Suffolk County hospitalizations peaked on Dec. 30 at 52. Even in the year before, when people were starting to wear masks much less frequently than during the peak covid years, flu hospitalizations in the county peaked at 50 on Dec. 17.

“We are definitely seeing more people sick” with flu, said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. The emergency room is “wildly full, and even urgent care walk in is full.”

The number of positive cases of flu A at Stony Brook University Hospital in January was 800. That compares with 400 cases for the same strain last year, according to Nachman.

While the flu is cyclical and can cause different levels of infections from year to year, local doctors suggested that the overall flu vaccination rate was lower this year, which may have increased vulnerability to the virus and extended the time people exhibited symptoms.

The number of people vaccinated is “incredibly lower compared to past years,” said Nachman. On top of that, people may not have been exposed to the flu for several years amid measures to reduce the spread of Covid-19.

Residents’ immune systems may have “no good memory response” if the last exposure to the virus occurred some time before 2020, Dr. Nachman added.

The dominant strain of the flu this year is the A strain, which accounts for about 80 percent of the cases.

Nachman suggested that people who were vaccinated in early September may not have as much resistance to the flu this month, as their peak resistance, which typically lasts about three months, has wained.

Health care professionals added that people who haven’t been vaccinated could still receive the shot, as the flu season could continue to last for a month or more.

Dr. Adrian Popp

“It is not too late to get the flu shot,” Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services, explained in an email.

Dr. Adrian Popp, chair of Infection Control at Huntington Hospital, said the staff has been offering flu shots for residents who have were not already immunized.

“I don’t know how much longer this will last,” said Popp. “It’s still cold and it’ll be cold in March.”

Typically, it takes two weeks for the body to receive full protection from the shot. The shot does provide some incremental benefit immediately.

“You start building immunity from the moment you get” the shot, said Popp.

So far this year, there have been two deaths at Huntington Hospital, which is not unusual for the flu.

Mortality from the flu is “turning into what it used to be,” said Popp, with deaths at about pre pandemic levels.

High risk patients

High risk patients are typically older or have preexisting conditions.

People who have an inability to fight infections can get “much sicker from the flu,” said Dr. Alan Bulbin, St. Francis Hospital and Heart Center Director of Infectious Disease.

Dr. Gregson Pigott

Health care workers urged those who are in higher risk groups either to see their doctors if they start developing symptoms or to use some of the at home tests, including a recent one that can test for flu A and B, as well as Covid.

“If you are immunocompromised, you should have a low threshold,” said Bulbin. “You should speak with a doctor, go to urgent care, and do a swab. That may differentiate influenza” from other infections such as respiratory syncytial virus, or RSV, and Covid.

The antiviral treatment Tamiflu can be effective if people start taking it within 48 hours of developing symptoms. Paxlovid, meanwhile, can also help within a few days of developing covid.

“We urge residents, especially those at risk for severe illness, to contact their medical providers at the onset of symptoms,” Pigott explained in an email.

Lower Covid and RSV levels

While the flu has infected a larger number of people than in previous years, the incidence of RSV and Covid has declined.

In Suffolk County, 90 residents are hospitalized with Covid, while the number of deaths from the virus is 29 since the start of the year, according to the New York State Department of Health.

That compares with 190 residents hospitalized last year and 96 deaths from Covid from Jan. 1 through Feb. 14.

“The virus that causes Covid-19 is still circulating and causing disease, although not as aggressively as in previous years,” Pigott explained.

RSV, meanwhile, rose in the fall, peaked in late December and has been falling since then.

RSV accounted for 0.2 percent of emergency department visits on Feb. 1, Pigott added.

Future ID doctors

Specialists in infectious disease were unsure how the pandemic affected the interest among doctors in training and residents in their field.

For some, the appeal of reacting to fluid circumstances and to gathering insights about a developing disease that could and did affect billions of lives could be appealing. For others, however, the demands, the hours, and increasing politicization of medicine as well as the divided response to vaccines could have pushed them in other directions.

“Am I concerned that not enough people are going into the specialty?” Nachman asked. “Yes.”

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METRO photo

By Dylan Friedman

Recent Centers for Disease Control and Prevention data indicates a significant increase in illness across the United States, with roughly 40 states reporting high illness activity levels in the past week.

So, what illnesses are hitting the hardest at the moment?

According to Carrie Reed, epidemiologist with the CDC Influenza Division, as reported in a recent NBC News Chicago article, “There is a lot of flu out there.”

Reed further emphasized that the current flu surge is being driven by multiple strains, a fact supported by the latest CDC hospitalization data.

According to the CDC, “flu symptoms usually come on suddenly.”

Some of the most common symptoms include fever or feeling feverish/chills, cough, sore throat, runny or stuffy nose, muscle or body aches, headaches and fatigue (tiredness). Some people may have vomiting and diarrhea, though this is more common in children than in adults.

According to the CDC, antiviral medications may be a treatment option if you contract the flu. These medications can potentially lessen the severity of illness and shorten the duration of sickness. They may also help prevent certain flu complications, such as pneumonia.

For optimal effectiveness, antiviral medications should be initiated promptly, ideally within the first two days of the onset of flu symptoms.

While the flu is prevalent at the start of 2025, it is essential to note that several pathogens, including COVID-19 and respiratory syncytial virus, can present with similar symptoms, such as fever, cough and sore throat. While RSV typically causes cold-like symptoms, it can pose significant health risks for infants and the elderly.

According to the CDC, people infected with RSV usually exhibit symptoms within four to six days after getting infected. The most common symptoms are runny nose, congestion, decrease in appetite, coughing, sneezing and fever.

It is also important to note that symptoms often appear in stages rather than simultaneously. While adults may experience more pronounced symptoms, they can be less noticeable in young infants. Although RSV typically causes mild cold-like illness, it can lead to severe conditions such as bronchiolitis and pneumonia.

Preventive and protective measures against RSV infection vary depending on the age group. For adults, RSV vaccination is recommended for individuals aged 75 and older as well as those aged 60-74, who are considered at increased risk for severe RSV. In infants, two primary approaches are utilized to mitigate the risk of severe RSV infection. First, a maternal RSV vaccine can be administered to pregnant women, providing some level of protection to the developing fetus. Alternatively, an RSV antibody can be administered to infants after birth to enhance their immunity against the virus.

Additionally, the common cold can present with symptoms similar to both RSV and the flu, including a runny nose, sore throat and cough. While the common cold is generally considered a mild illness, it can cause significant discomfort and may lead to more serious complications in individuals with weakened immune systems, such as the elderly or those with chronic health conditions.

According to the CDC, the manifestation of cold symptoms usually reaches a peak within two to three days of infection and may include runny nose or nasal congestion, cough, sneezing, sore throat, headache, mild body aches and fever (usually low grade in older children and adults).

The common cold is a self-limiting viral infection that typically resolves without the need for specific medical intervention. It is crucial to understand that antibiotics are ineffective against viruses and, therefore, will not alleviate cold symptoms. 

Additionally, individuals experiencing cold-like symptoms who suspect a possible COVID-19 or flu infection, particularly those at elevated risk for severe illness, are strongly encouraged to undergo testing. 

Antiviral treatments are available for both COVID-19 and flu, and their efficacy is significantly enhanced when administered promptly following the onset of symptoms.

More information can be found on the CDC website: www.cdc.gov.

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METRO photo
Lowering inflammation and expanding lung capacity are keys

By David Dunaief, M.D.

Welcome to autumn! It’s the time of year when we revel in the beauty of changing foliage, the joy of Halloween decorations and costumes, and the prevalence “pumpkin spice” everything.

Unfortunately, it’s also the time of year when we are most alert to influenza (the flu), respiratory syncytial virus (RSV), and COVID-19 variants circulating in our communities.

If you have a lung disease, such as chronic obstructive pulmonary disease (COPD) or asthma, or if you smoke or vape, the consequences of these viruses are especially concerning.

The good news is that you can do a lot to improve your lung function by exercising, eating a plant-based diet with a focus on fruits and vegetables, expanding your lung capacity with an incentive spirometer, and quitting smoking or vaping (1). 

Does diet improve lung function?

It’s no surprise that your dietary choices can help or hinder your health. What is surprising is diet’s impact on your lung health. Let’s review some of the studies.

In a randomized controlled trial (RCT), results show that asthma patients who ate a high-antioxidant diet had greater lung function after 14 days than those who ate a low-antioxidant diet (2). They also had lower inflammation at 14 weeks, which was measured using a c-reactive protein (CRP) biomarker. Participants in the low-antioxidant group were over two times more likely to have an asthma exacerbation.

The high-antioxidant group had a modest five servings of vegetables and two servings of fruit daily, while the low-antioxidant group ate no more than two servings of vegetables and one serving of fruit daily. Using carotenoid supplementation in place of antioxidant foods did not affect inflammation. The authors concluded that an increase in carotenoids from diet has a clinically significant impact on asthma in a very short period.

In a longer-term analysis of the Coronary Artery Risk Development in Young Adults (CARDIA) Study, researchers assessed and stratified diets into three tiers to identify the impacts of diet quality on long-term lung health (3). Researchers found that a nutritionally-rich plant-centered diet was associated with significantly less decline in lung function over 20 years, even after adjusting for demographic and lifestyle factors influencing lung health.

What is the impact of fiber on COPD risk?

Several studies demonstrate that higher consumption of fiber from plants decreases the risk of COPD in smokers and ex-smokers.

In one study of men, results showed that higher fiber intake was associated with significant 48 percent reductions in COPD incidence in smokers and 38 percent incidence reductions in ex-smokers (4). The high-fiber group ate at least 36.8 grams per day, compared to the low-fiber group, which ate less than 23.7 grams per day. Fiber sources were fruits, vegetables and whole grain. The “high-fiber” group was still below the American Dietetic Association’s recommended intake of 14 grams per 1,000 calories each day.

In another study, this time with women, participants who consumed at least 2.5 serving of fruit per day, compared to those who consumed less than 0.8 servings per day, experienced a highly significant 37 percent decreased risk of COPD (5).

Both studies used apples, bananas, and pears to reduce COPD risk.

What exercise helps improve lung function?

In a study involving healthy women aged 65 years and older, results showed that 20 minutes of high-intensity exercise three times a day improved FEV1 and FVC, both indicators of lung function, in just 12 weeks (7). Participants began with a 15-minute warm-up, then 20 minutes of high-intensity exercise on a treadmill, followed by 15 minutes of stretching.

You do not need special equipment. You can walk up steps or hills in your neighborhood, do jumping jacks, or even dance around your home. It’s most important to increase your heart rate and expand your lungs. If this is new for you, consult a physician and start slowly. Your stamina will improve quickly when you do it consistently.

What is incentive spirometry?

An incentive spirometer (IS) is a device that helps expand the lungs when you inhale through a tube and cause one or more balls to rise. This inhalation expands the lung’s alveoli.

Incentive spirometry has been used for patients with pneumonia, those who have had chest or abdominal surgery and those with asthma or COPD, but it has also been useful for healthy participants (8). A small study showed that those who trained with an incentive spirometer for two weeks increased their lung function and respiratory motion. Participants were 10 non-smoking healthy adults who took five sets of five deep breaths twice a day, totaling 50 deep breaths per day. 

In recent years, some small studies examined the impact of IS on patient COVID-19 outcomes. One study of 48 patients in an outpatient setting found that study participants using an IS three times a day experienced a 16 percent increase in maximal inspiratory volume over a span of 30 days (9).

Another pilot study followed 10 patients diagnosed with moderate COVID-19 to determine whether IS use prevented development of Acute Respiratory Distress Syndrome (ARDS) (10). IS users had improved PaO2/FiO2 ratio, improved chest X-ray findings, shorter hospital stays, and sooner improvement of symptoms than non-users.

We all should be working to strengthen our lungs. Using a three-pronged approach including diet, aerobic exercise, and incentive spirometer can make a tremendous difference.

References:

(1) Public Health Rep. 2011 Mar-Apr; 126(2): 158-159. (2) Am J Clin Nutr. 2012 Sep;96(3):534-43. (3) Res Sq  [Preprint]. 2023 Apr 26:rs.3.rs-2845326. [Version 1] (4) Epidemiology Mar 2018;29(2):254-260. (5) Int J Epidemiol Dec 1 2018;47(6);1897-1909. (6) J Phys Ther Sci. Aug 2017;29(8):1454-1457. (8) Ann Rehabil Med. Jun 2015;39(3):360-365. (9) Cureus. 2021 Oct 4;13(10):e18483. (10) Eur Resp J 2022 60: 268.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. For further information, visit www.medicalcompassmd.com or consult your personal physician.

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Photo courtesy Metro Creative Graphics

By Daniel Dunaief

While the fall provides a break from the summer heat and a respite for exhausted parents who coordinate and carpool for recreational activities, it also can trigger a return to more concentrated time indoors.

Dr. Sharon Nachman, Chief of the Division of Pediiatric Infectious Diseases at Stony Brook Children’s Hospital.
File photo

That can trigger the beginning of the flu season, as students and their families share much more than the lessons of the day and stories about teachers and classmates.

Timing shots can be a delicate balance, as the antibody coverage from these shots is typically about three months.

With the peak flu season often occurring during December and January and even into February, Dr. Sharon Nachman, Chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, suggested that residents receive their vaccines in a few weeks.

“Getting a vaccine in October is probably the right time,” Nachman said.

Dr. Gregson Pigott, Commissioner of the Suffolk County Department of Health Services, added that the timing for Covid vaccinations is somewhat trickier.

“Because the evolution of new variants remains unpredictable, SARS-CoV2 [the virus that causes the disease] is not a typical ‘winter’ respiratory virus,” Pigott explained in an email.

The county health department recommends that residents stay up to date with their vaccinations.

“Individuals should speak with their healthcare providers for advice that is specific to them,” Pigott added.

Simultaneous shots

Doctors generally recommend receiving both shots at the same time, if people are eligible and the timing for each vaccine is right. Residents who are unsure about their eligibility should speak with their healthcare providers, Pigott explained.

Dr. Gregson Pigott, Suffolk County Health Services commissioner. File photo

The flu and Covid are viruses that change over time, creating a battle between the pharmaceutical companies that manufacture vaccinations and the viruses that attempt to evade them.

Each year, the vaccines attempt to provide the best match against the dominant or most likely strains.

The Centers for Disease Control and Prevention “determines if the vaccine will protect against a circulating virus by conducting laboratory studies on circulating flu viruses,” Pigott explained in an email. “Updated 2024-2025 flu vaccines will be trivalent” and will protect against H1N1, H3N2 and a B/ Victoria lineage virus.

Vaccine manufacturers create immunizations based on the flu strain circulating in the southern hemisphere during the recent season.

“We expect that those are what’s going to hit us in our winter,” Nachman said. “The science is there. We know generally what types will be rolling around. We could hit or miss it by a subtype.”

Nachman added that the flu vaccines represent educated guesses about the type of microbe that might cause illnesses.

“The educated guesses are still better than no vaccine, which will, for sure, not cover you at all,” Nachman said

As for the Covid immunization, doctors added that it is also likely to change as the virus that caused the pandemic mutates.

Nachman said people should plan to get the Covid shot around once a year.

“I don’t think we’re going to go to more often” than that, Nachman said.

During the summer, when an infectious strain of Covid surged across the county, state and country, Nachman said the data is not available to determine how much protection a vaccine provided.

“Only on TV do computer models work instantly,” Nachman said.

She suspects that the Covid shot offered some protection for residents, who may not have been as sick for as long as some of those who dealt with a range of symptoms.

Concussion awareness

With the start of a new school year and the beginning of contact sports like football, school districts are continuing to ensure that coaches and athletes follow concussion protocols.

“Schools have done a nice job thinking and talking about it,” said Nachman. “Coaches know you can’t throw [student athletes] out and say, ‘You’ll do fine,’” after a head injury.

Nachman suggested that area athletes may engage in activities that are not connected to the schools and that may involve head injuries that people ignore.

“We know what’s happening with school-regulated” sport, but not with those that are outside the academic umbrella, she added.

As for the emotional or psychological impacts of a divided and bitter electorate during an election year, Nachman said people are under considerable emotional stress.

“The social media echo chamber is making it worse,” she said. The abundance of misinformation on both sides is causing mental anguish.

“Election times are very stressful and I think, in particular, this election may be even more stressful,” Nachman said.

Nachman urges people to minimize their time on social media and to create down time from electronics during meals.

As students move up a grade and into new places, they also can endure stressors, peer pressure and bullying. She suggests that parents understand what their children are seeing online.

Newborn RSV protection

Children born in March or later are eligible to receive an approved shot called Beyfortus, which, in 80 percent of cases during clinical trials, prevents the development of respiratory syncytial virus, or RSV.

The Beyfortus monoclonal antibody will make a “huge difference” for newborns and their parents, Nachman said. Last year, Stony Brook had numerous hospitalizations in children under one year of age.

“We’re not going to have those children coming into the hospital,” Nachman said. “That’s amazing and is a huge step forward.”

When newborns get RSV, doctors don’t have an effective treatment for the virus and typically treat the symptoms.

The mortality rate from RSV is low, but the morbidity is high. Newborns who contract RSV can end up developing chronic asthma.

As with any shot, Beyfortus can have side effects, with the most common including rash and pain, swelling, or hardness at the site of the injection, according to AstraZeneca and Sanofi, which manufacture the antibody.

Beyfortus is covered by insurance and is under the vaccine for children program and numerous private health insurance plans. Parents can opt out of the shot. Nachman suggested they should understand what they are opting out of when they make that decision.

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Photo by Annie Spratt on Unsplash

News Flash: Generated by ChatGPT, edited by our staff

• FDA approves RSV vaccines for the first time. These vaccines target the respiratory syncytial virus, a seasonal lung-related illness, with recommendations for adults over 60 and pregnant women in specific gestational weeks.

• Infants under eight months born to mothers without the RSV vaccination can receive monoclonal antibody treatment, providing immunological protection against severe RSV symptoms.

• There are challenges in accessing RSV shots, including delayed processing by insurance companies and pharmacy shortages. Health officials urge residents to advocate for themselves, emphasizing the importance of timely vaccinations given the approaching RSV season.

For the first time, vaccines against the respiratory syncytial virus, or RSV — a lung-related illness that crops up during the fall and winter — have been approved by the U.S. Food and Drug Administration.

The FDA recommends that adults ages 60 and older receive a dose of the vaccine, either Pfizer’s Abrysvo or GSK’s Arexvy, within the next few weeks.

Women in their 32nd to 36th week of pregnancy at some point during September through January are also urged to receive Abrysvo.

For babies born to mothers who didn’t receive a dose of the RSV vaccine, the FDA has approved a monoclonal antibody treatment for infants eight months old and younger that will offer immunological protection against a common and prevalent respiratory condition that can lead to severe symptoms and hospitalizations.

Additionally, the Centers for Disease Control and Prevention recommend a dose of RSV antibody for children between eight and 19 months entering their second RSV season if they have chronic lung disease, are severely immunocompromised, have a severe form of cystic fibrosis or are American Indian or Alaska Natives.

Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. File photo from Stony Brook Medicine

While local doctors welcomed the opportunity to inoculate residents, they said finding these treatments has been difficult.

“People are having a hard time getting” the vaccine, said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital.

Some pharmacies have told patients to come back, which decreases the likelihood that they will return for vaccinations in time, Nachman said.

Additionally, insurance companies have not immediately processed requests for vaccinations, which also slows the process, she said.

Nachman recommended that residents “continue to go back and advocate for yourself” because that is “the only way you’ll get what you need.”

RSV season starts around November, which means residents qualified to receive the vaccine or parents with infants need to reach out to their health care providers now to receive some protection against the virus.

Childhood illness

According to recent data, RSV caused 2,800 hospitalizations per 100,000 children in the first year of life, Nachman said. The range can go as low as 1,500 per 100,000.

However, that only captures the number of hospitalized people and doesn’t include all the times anxious parents bring their sick children to doctor’s offices or walk-in clinics.

“Hospitalizations are the worst of the group, [but] it’s a much bigger pyramid” of people who develop RSV illnesses, Nachman said.

In addition to recommending monoclonal treatment for children under eight months old, the CDC urges parents to get this treatment for vulnerable children who are under two years old.

Dr. Gregson Pigott, commissioner of the Suffolk County Department of Health Services. File photo

Like other vaccinations, the RSV vaccine won’t prevent people from getting sick. It will, however, likely reduce the symptoms and duration of the illness.

“In trials, RSV vaccines significantly reduced lower respiratory tract lung infections serious enough to require medical care,” Dr. Gregson Pigott, Suffolk County Health Commissioner, explained in an email.

At its worst, the symptoms of RSV — such as fever, cough and serious respiratory illness — are problematic enough that it’s worth putting out extra effort to receive some immune protection.

“If you’re a little kid or an elderly patient, this is a disease you don’t want to get,” Nachman said.

Pigott said that data analysis shows that RSV vaccines are 85% effective against severe symptoms of the virus.

While people can receive the COVID-19 and flu vaccines simultaneously, doctors recommend getting the RSV vaccine two weeks later.

According to preliminary data, eligible residents may benefit from the RSV vaccine for two seasons, which means they would likely need to receive the shot every other year, according to Pigott.

With two vaccines approved for adults, Pigott recommended that people receive whichever shot is available.

“Both reduce a person’s chances of getting very serious lung infections,” Pigott explained, adding that several measures can help people protect themselves from the flu, RSV and COVID.

Getting a vaccine, washing hands, avoiding touching your eyes, nose or mouth, avoiding close contact with people who are sick with respiratory symptoms and wearing a mask in places where respiratory viruses are circulating can all help.

Those who are symptomatic should stay home when they are sick and wear masks when they are around other people.

Suffolk County Department of Health Services officials indicated they are aware of the challenges of getting shots and monoclonal antibodies and “ask people to be patient.”

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Stock photo

After a November and December in which realities like a “tridemic” of viral threats sickened residents throughout Suffolk County, the new year has started off with fewer illnesses and cautious optimism among health care professionals.

“The numbers are coming down now,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. The overall threat is “less” and “we’re in the take-a-deep-breath phase.”

Indeed, the frequency of cases of several viruses is lower.

“Flu and RSV (respiratory syncytial virus) are down,” Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health and associate professor of medicine at Hofstra School of Medicine, explained in an email.

At the Catholic Health hospitals, including Port Jefferson-based St. Charles and Smithtown-based St. Catherine of Siena Hospital, the emergency room visits are down around 10% from a few weeks ago, said Dr. Jeffrey Wheeler, medical director of the Emergency Department at St. Charles.

In between too busy and too quiet, the hospital is in the “sweet spot” where health care providers have enough to do without frantically racing from one emergency to another, Wheeler said.

Among those visiting St. Charles, Wheeler added that health care providers are seeing a smattering of illnesses.

At the same time, the vaccine for the flu has proven to be a “good match” for the current strain, Nachman said. “Amongst those who did the flu shot, they have tended to not get sick enough to go to the doctor.”

According to New York State Department of Health figures, the overall numbers across the state have been declining for the flu. For the week ending Jan. 14, the number of infections was cut in half.

Suffolk County saw a slightly larger drop, falling 59% for the same week, to 571.

This year, people who were going to get the flu vaccine may have helped themselves and their families by getting the shot earlier, rather than dragging out the process of boosting their immune systems over the course of months. Nachman said.

Cases of monkeypox continue to be on the lower side, in part because of the number of vaccines people in the area have received.

To be sure, health care workers are still helping people overcome a range of infections circulating in the county.

“We are still seeing a smorgasbord of flu, COVID and RSV,” said Nachman. Of the people admitted to Stony Brook Hospital, most of them have a comorbidity.

At Huntington Hospital, admissions are “high,” and the hospital census remains high, Popp added.

Health care workers are diagnosing viruses like the flu and COVID-19 and have used available treatments to reduce the symptoms and the spread of these viruses.

New COVID vaccine approach

Earlier this week, the Food and Drug Administration posted documents online that reflected a possible future change in its approach to COVID-19 vaccinations.

Instead of recommending bivalent boosters or a range of ongoing vaccinations to provide protection against circulating strains, the FDA plans to approach COVID-19 vaccinations in the same way as the flu.

Each year, people who are otherwise healthy and may not have high risks may get a single dose of a vaccine based on the strains the administration anticipates may circulate, particularly during the colder winter months.

Health care professionals welcomed this approach.

Nachman and Popp thought a single shot would be “great” and appreciated how the annual vaccine would simplify the process while reducing inoculation fatigue.

“The simplest messages with the simplest strategy often wins,” Nachman said.

Bivalent booster concern

Addressing concerns raised by the Centers for Disease Control and Prevention about a potential link between the bivalent booster and stroke, Nachman suggested that was one data point among many.

Israel has used the Pfizer bivalent booster exclusively and hasn’t seen any such evidence linking the booster to stroke.

The CDC data is “one of multiple data points that we use to look at safety events,” she said. “Not a single other one has shown any relationship with stroke among the elderly in the first 21 days.”

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People are waiting once again for COVID-19 and other tests at local urgent care centers. File photo by Lina Weingarten

Around this time of year, parking lots are often full.

That’s true of the mall parking lot, as people go out to shop for holiday gifts for their friends and family, but it’s also true, especially this year, for hospitals and urgent care centers.

With the so-called “tridemic,” which is a combination of viruses that typically affect the lungs, including COVID-19, the flu and respiratory syncytial virus (or RSV), infecting people of all ages, the need for health care and medical attention has been high in the weeks leading up to the holidays.

When Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, arrives at work at 7 a.m., she drives past urgent center parking lots that are “full for a reason. It’s because people are sick” and need medical attention at the start of the day.

Indeed, the combination of the three viruses, as well as other viruses and bacteria in the community such as adenovirus and enterovirus, has made it difficult for some children to attend schools and for adults to go to work.

For the week ending Dec. 10, which is the most recent period for which data is available, Suffolk County reported 3,936 cases of the flu, which is up 35% just from the prior week. The week ending Dec. 10 alone represents more than half of all flu cases for the entire 2019-2020 season, according to data from the New York State Department of Health.

At the same time, COVID and RSV numbers have climbed.

“We almost doubled our COVID census over the last three to four weeks,” Dr. Michael Khlat, chief medical officer at St. Catherine of Siena Hospital in Smithtown, explained in an email. St. Catherine currently has almost 60 COVID-positive patients. Nearly a third of those patients are admitted for COVID and are receiving intravenous remdesivir, while the others are incidental findings in the context of other medical needs.

“What is special about this surge is that it is inclusive of COVID, influenza, rhinovirus as well as RSV,” Khlat wrote. “The symptoms are very similar, and treatments are all supportive at this time.”

Family gatherings at Thanksgiving contributed to the increase, adding “extra turbocharging to the current respiratory viruses,” Nachman said.

The most vulnerable patients are the immunocompromised, patients with diabetes, chronic lung and cardiac disease, obese residents and patients with chronic liver and kidney disease, Khlat added.

Demand for beds

The influx of patients has meant that St. Catherine has had to increase its capacity of staffing using nursing agencies to meet the needs of the community for “seamless, high-quality care,” Khlat explained.

St. Catherine has also added more providers on the medical wards to care for patients and has load balanced patients with their Catholic services partner St. Charles Hospital and other Catholic Health facilities.

Nachman urged residents to see their primary care doctor if they have routine viral symptoms. Coming directly to the emergency room slows the process of delivering urgent care.

To be sure, Nachman urged anyone with chest pains or stroke-like symptoms should head directly to the emergency room.

Nachman said Stony Brook Children’s Hospital is transitioning to a model in which they triage patients who walk into the ER to assess the need for services.

As people prepare for family gatherings, Nachman suggested that they evaluate the risks of interacting with others.

People with an immune deficiency might want to wear masks or speak outside with others, particularly if someone in the group had one of the respiratory viruses.

Viruses like RSV are generally contagious for about three to eight days, according to the Centers for Disease Control and Prevention.

RSV spreads through close contact, which means that passing someone in a supermarket won’t likely spread the virus, while sitting and doing homework or eating a meal next to someone could.

As for COVID, Nachman continued to urge people to get the bivalent booster shot.

Every study, she said, shows that the booster drastically reduces the risk of being hospitalized with COVID.

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