Every breath you take

Have you had a bad cough lately? The past few weeks have been particularly difficult with almost everyone coming down with some form of respiratory illness. To fall ill is enough to make one miserable but it takes on horrific proportions when you are the most likely source. Crowding, increased mobility, waning immunity from vaccination, and less of an obsessive-compulsive adherence to basic hygiene measures enable a smooth uninterrupted journey for respiratory viruses. Though anyone can be an easy target, individuals at the book ends of the age spectrum, immunocompromised, or with underlying conditions, are at greatest risk for severe complications which may lead to hospitalization or even death.

To answer queries floating around as to the possible culprits, with limited data from personal exchanges on cases handled, individual hospital census, and public documents available, there have been reports of respiratory syncytial virus (RSV), influenza virus, and yes, COVID-19. While they may act as single proprietors, they may, at times, decide to go into partnerships, so co-infection is not an impossibility but also not a common occurrence. If you have become more than familiar with influenza or COVID-19, allow yourself to be acquainted with RSV as well.

Data gathered from the country report to the FluNet of the World Health Organization, from the months of March through September of this year, have documented Influenza A (H1N1) pdm09, Influenza A (H3), Influenza B (Victoria) as the subtypes involved in causing illness. Aside from its importance from an epidemiological standpoint, it has a bearing on the protection afforded by vaccination. To reduce the risk of contracting the disease, strains in circulation should match those that are contained in the vaccine and ideally must be given prior to the influenza season. These along with other factors such as age, prior flu illness or vaccination, and the presence of comorbidities influence vaccine effectiveness. Waning immunity and the capacity of the virus to undergo mutations necessitate careful monitoring of circulating strains and receipt of the vaccine on an annual basis.

Overall, there has been a general decrease in the number of cases as reflected in the COVID-19 tracker of the Department of Health. Even though it is no longer classified as a public health emergency, it still remains a threat. In the past couple of weeks, we have seen a small number of COVID-19 cases being admitted to our pediatric institution.

How about the respiratory syncytial virus or RSV? This virus can affect all ages and can be an important cause of mortality for infants and young children. In a systematic review by Shi T, et al. in 2015, “Globally, RSV is estimated to cause as many as 2.3 percent of deaths among neonates 0 to 27 days of age, 6.7 percent of deaths among infants 28 to 364 days of age and 1.6 percent of deaths among children one through four years of age.” Available studies have also shown that amongst the older age groups, it is an important but unrecognized cause of lower respiratory tract infection and can be detrimental for individuals with compromised immune systems. In May 2023, the United States Food and Drug Administration licensed an RSV vaccine for adults 60 years old and above, and as of Aug. 21, approved its use for pregnant individuals starting at their 32nd through their 36th week of pregnancy to prevent infants from birth to six months of age from lower and severe lower respiratory tract disease from the virus.

For these respiratory pathogens, clinical manifestations alone will fail to differentiate one from the other. Though diagnostics may be available which may be of help to direct subsequent management, most of these are not within reach or are affordable to everyone.

As no one can live in a plastic bubble, the best way that we can do our own share in curbing the spread of disease is to revert to observing practices that were part of our survival kit during the pandemic. Catch up on essential vaccinations, observe strict hand hygiene, ensure that your homes and workspaces have adequate ventilation, mask when necessary, refrain from going to work or to school or closely interacting with your family members if you are sick or still with symptoms to prevent transmission.

Not to be missed is the importance of monitoring. If you or your child’s condition does not improve, do not hesitate to seek a medical consultation. Do not self-medicate especially with an antibiotic which may be unnecessary and ineffective against the aforementioned viruses. If you have lingering questions, consult the one with professional expertise. On that note, may I suggest those of the living and breathing kind.

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