Avoiding Viral Illness During the Holidays

This flu season arrives against the backdrop of a shortage in primary care physicians, which many folks may notice when they try to get an appointment at their own doctor’s offices, said Dr. Caroline Sloan, a general internist at Duke who focuses on patients with multiple chronic conditions. Still, people should keep the lines of communication open with their doctor’s offices, Sloan said – particularly when they’re feeling ill. 

“If you have a viral illness of some sort, then make sure to at least call the primary care provider's office or send a message through the electronic portal system to ask for advice,” Sloan said. “If your symptoms are severe enough, or if you’re at high enough risk, then most primary care clinics are going to do what’s needed to get you in and seen.”

Wolfe and Sloan discussed these and myriad other seasonal health issues – including caring for the elderly and the effectiveness of the hepatitis B vaccine – in a virtual briefing for journalists Thursday, Dec. 11. Here are excerpts:

Current Virus Trends

Cameron Wolfe

“There is, front and center, clearly an early increase in influenza activity. Many of us have seen that blip, sort of already around Thanksgiving, go up quite noticeably. That’s early for us. You know, typically, our flu seasons … might start increasing late in December, maybe sometimes not even in until January, and peak around January or February, and yet, we’re already on an uptick that really started in the middle of November.”

“Flu is not the only one that appears in the early winter. So far, at least, we have not seen very much at all of the other two major winter viruses, and by that I mean Covid, which actually is in quite a lull nationally, and the third flu-like virus that we commonly see in the winter and causes a lot of trouble is one called RSV, or respiratory syncytial virus, which so far, at least, seems pretty uncommon.”

“So I think really the big difference is an early flu season that typically in the past, has translated to not as many people being fully vaccinated by the time that flu arrives; we’ve seen a little drop off in vaccine rates … but it also often reflects the fact that we’re seeing an early or modified variant of flu, and so that therefore, I hope not, but I would anticipate probably a busier overall season.”

What If I Get the Flu

Caroline Sloan

“There are now over the counter flu and COVID testing kits that you can get at pretty much any pharmacy for relatively low amount of money. I recommend that patients do that test at home before coming in and potentially infecting other people in the clinic who may have chronic illnesses or may have weakened immune systems. And if that flu test is positive, send a message to your primary care provider or call the nurse line at the primary care provider’s office, and find out if you qualify for any sort of treatment.”

“There may be a number of over-the-counter medications that patients are eligible for, but not every patient can take every over-the-counter medication. So, for example, a person who has high blood pressure shouldn’t take a medication to de-congest the nose, like Sudafed, because that can raise blood pressure. A patient with kidney disease shouldn’t take a medication like a non-steroidal anti-inflammatory, something like ibuprofen or aspirin, because that can cause kidney injury or electrolyte abnormalities.”

Should I Get the New Covid Vaccine?

Caroline Sloan

“There are certain chronic conditions that can increase the risk of severe COVID infection, things like heart disease, lung disease, diabetes, (and) any condition that weakens the immune system; people who are older than age 65 are at higher risk of severe COVID infection. And so with my patients, we end up having a discussion about what is their individual risk of having a severe COVID infection. In general,my advice is the COVID vaccine is very safe and effective. But I especially emphasize it for people who are at high risk of severe infection.”

Should I Travel If I’m Sick?

Caroline Sloan

“This is reminiscent of the COVID pandemic years. If you’re sick, especially if you’ve been diagnosed with the flu or RSV or COVID, it can be tempting to want to go visit your family anyway. If you're going to be visiting family members who are at high risk of severe infection, just think twice about whether you should go visit them. And if you do go visit them, make sure you kind of stay separated. You wear a mask and protect them from whatever illness you have.”

Does Basic Prevention Really Work?

Cameron Wolfe

“Many of us will face a winter again this year where someone in the household gets sick. And I do think you can take good heart from the fact that statistically, if you're careful, most other people in the house won’t get sick again.”

“Masks are effective. Hand washings are effective. Separation in space is very effective, if you can do it and have enough room.  All of those things together add to actually this being quite preventable.”

Keeping an Eye on Your Elderly Parents

Caroline Sloan

“A lot of older adults who are on a lot of medications or have multiple chronic conditions are at risk of falling. As we get older, our muscle mass decreases and we become a little weaker, and our balance gets less good, and so people are at higher risk of falls, and people may need assistive devices like canes or walkers. If you’re going to visit a relative or friend who is older, (pay) attention to their balance and (see) whether they seem to have any risk of falling. That might be something to watch out for, and you may be able to talk to them about, hey, might be time to get a cane, at least for certain kind of longer walks, or walking within the house where there are a lot of trip hazards.”

“Also, are there signs of cognitive impairment as people get older? As we all know, our memory may decline, and that’s normal, but for some people, it may decline faster, and some people, as they get older, develop dementia. And a lot of the time, the person who is developing cognitive impairment or dementia doesn't really notice it for themselves, and so it's when you're visiting your relative that you may notice it.”

“There are obviously medications for dementia that have been in the news, but there are also a lot of strategies for coping with cognitive impairment that can help people’s function. It’s really important to catch dementia or cognitive impairment early, so that’s another thing to watch out for. And then finally, what I would say is, as people get older, there is a higher risk of loneliness and isolation, and so just pay attention to you know, who is your older relative hanging out with during the day, when it’s not the holidays. Do they have friends? Do they have activities that they do during the day? And if not, it may be something to talk to them about and see if there are ways that you can help them reduce their isolation or loneliness.”

There Are So Many Vaccines. Which Are Most Important?

Caroline Sloan

“I typically tell my patient to prioritize the illnesses that are seasonal. So right now, I 100% tell people to prioritize the flu, and then once we’ve gotten to the conditions that are seasonal, then we again take an individual risk approach. So there’s the RSV vaccine. There’s the pneumonia vaccine. There’s the shingles vaccine.”

“I have a few patients who are grandparents, and they take care of their grandchildren during the day, while their kids are at work. For those patients, I recommend prioritizing the RSV vaccine. For people who have lung disease or heart disease, I tell them to prioritize the pneumonia vaccine.” 

“The shingles vaccine, I tell everyone to prioritize, because shingles is just such a terrible disease to get and can cause long, lasting pain, even beyond, you know, after the shingles infection is gone.”

The Government Now Says Hepatitis B Vaccine Isn’t Necessary for Most Newborns. What Should I Do?

Cameron Wolfe

“The standard approach for many, many years now has been that we recognize that the safety data of hepatitis B vaccines in young infants and newborns is outstanding. That it is based on multiple randomized control trials and lots of follow up data of every individual in the United States, for example, who’s been vaccinated. And that’s true across the world, and it is wonderfully effective at preventing hepatitis B.”

“It’s a highly contagious virus that spreads through blood, so during the birthing process and in the aftermath of childbirth and newborns, it’s very contagious for newborns to get. Fortunately, Hep B is not common, but it’s here. We do have hep B both in people born overseas, and 40% of cases are in people who were born in the United States. And also that vaccine is really close to 100% effective at blocking hep B transmission to babies. Why that's important has been that if you're infected as an infant, your chance of turning your Hepatitis B into a chronic and lifelong infection that leads to liver cirrhosis and ultimately to early death is way higher if you get exposed to it as an infant.”

“Many, many countries around the world put this as an early intervention point to say we can block hep B transmission and take this illness off our off our streets, literally.” 

 “When I talk to young mums in my clinic … I say, look, here's the data that guided our recommendations up until the early part of 2025 in the United States, where we did not fundamentally see Hep B transmission. Here’s why I think this vaccine is relevant, is safe and is highly effective for your child.”