 We begin tonight by talking about your health. Joining us is Dr. Greg Schrank, Associate Hospital Epidemiologist at the University of Maryland Medical Center and Assistant Professor of Medicine at the University of Maryland School of Medicine. Doctor, it's good to see you here in person again. You were one of the very last in-person people before the pandemic Zoom era started. You're doing well, I see. I am, and it's great to see you as well in person. Again, Jeff, thank you for having me. How would you explain the setup that we have now heading into this winter in terms of respiratory viruses? So we still have COVID, we got the flu, and we have RSV. Yeah, well, I think how I think I can describe the current situation is we had, on the baseline level, a fair amount of COVID circulating. And then what we've been confronted with earlier than a usual respiratory viral season is a whole host of other respiratory viruses, namely RSV and influenza at the top of that list that are adding a whole additional burden of disease to the community, some of which is then also spilling over into hospitalizations as well. RSV is something I knew very little about, primarily focused or more serious for very little kids. That's right, it stands for respiratory syncytial virus, at least prior to the COVID-19 pandemic, almost every child would be infected with the virus before the age of two. We had a couple of years going back to 2019 with almost none circulating, with very little influenza as well. So in our communities, we just really haven't seen much of these viruses. So with some weaning immunity and the onset of winter, we're just seeing them explode. Let's talk about what's happening with the flu because we had a couple of years when everybody was being really careful about viruses and so forth. Well, we didn't have much of a flu season. The map from the CDC that they update every week that shows with like a color heat map, how severe the flu is, you can see on this picture. I mean, the Southern states and creeping up the Eastern seaboard and including Maryland, it's a very high level at the moment. Are you seeing that? We are in fact, and the geographic distribution that you're seeing on the map is not unusual for the early part of flu season starting in the Southeast and moving up the coast. What I think is unusual about 2022 is that not only have we not seen much influenza for the past couple of years, so this is really a stark change for us, but we're also seeing the wave, the epidemic wave as it's called of influenza beginning almost two months earlier than we typically see, at least here in Maryland. And it's coming, as I said, along with a whole host of other respiratory viruses that is really all returning with a vengeance. I saw that map, a version of it from a couple of weeks ago was a little less advanced. Saw it a couple of weeks ago and ran out and got a flu shot. Is that the appropriate response? Absolutely, and even though we're seeing flu cases rising right now, it is without a doubt not too late to get your flu shot. Particularly for those who are over the age of 65 or who have medical conditions that put them at greater risk, many of those medical conditions are the same ones that we've been hearing for the last two years that place you at higher risk for complications from COVID-19. So go out and get your flu shot and make sure you get your COVID booster along with it. You can do it at the same time. That's right. I was reluctant. Yeah. I did them sequentially like a week apart. And that's okay as well. Whatever you feel comfortable with, both may lead to some side effects, a little bit of fatigue, especially with the COVID boosters. We know that sometimes there can be some fever or some soreness, but it is safe to receive them both at the same time. And I think as we're seeing influenza really starting to take off right now, I would absolutely recommend not waiting on either one. Let me remind our viewers, if you have a question for the doctor about any of these respiratory viruses running rampant, give us a call at the number on the screen or you can email a question to livequestionsatmpt.org. You mentioned age 65 for the flu shot. What changes at age 65? Well, I think the risk for complications from influenza is increased in that older age group. And with regards to the vaccine, what I think is really important for our older neighbors to remember is when you're getting your vaccine, make sure that your provider, your pharmacist, knows to give you the vaccine that's specifically designed for older adults. There's a couple of different versions, one of which is a higher dose to make sure you're really maximizing your immune response. The other formulation comes with another component that helps boost the immune system as well. Either one is perfectly fine, but they are specifically targeted to older adults to make sure that they are protected during influenza season as best as possible. How do we know? Like if, especially a big family get-togethers, office get-togethers, it's gonna be a lot of mingling, people are gonna get sick. I mean, it's how we spread stuff. But how is somebody gonna know what they have this year when it's not just COVID that's floating around? That's right. I think we've become accustomed to any cough or any fever as COVID until proven otherwise. And it's going to be much different this season. There's a lot of overlap between the symptoms that all of the different respiratory viruses circulating cause many of them will lead to fever, many will lead to cough or sore throat. The best way to find out is by getting tested. Though the tests that could differentiate between RSV, flu, COVID, most of those are only available at a medical provider or like an urgent care or an emergency department or your primary care doctor. If you were a question, if you were once to know, would you recommend continuing to wear masks or returning to wear masks to prevent flu, COVID and other illnesses? Where do you stand on masks? Yeah, and I think there's a few things that masks over the course of the pandemic haven't changed at all. One is that we know that they contain infection when the person who's infected is wearing one. The second thing is we know that especially a well-fitting mask, one that's multiple layers, protects somebody who's well and is wearing it and is exposed to a virus. And the last thing is that masks don't care what virus they encounter. They really don't. If you're wearing a well-fitting, high quality mask, it doesn't matter whether it's flu, RSV or COVID, it will help protect the wearer. And so for me personally, especially knowing what's going on out there if I'm going into a very public crowded setting, I put on a mask. If I'm taking my girls to the aquarium downtown at the Inner Harbor, I'll put on a mask while I'm there with them. And you're in the minority. I mean, I've been on a couple of flights recently, been in Target and big stores. I see, and it was the case on this flight, 100 people on the plane, seven or eight wearing a mask, including me. And I remember sitting there thinking, like, who's the smart one? Because I think I'm well insulated with a good mask. But on the other hand, these people who aren't protected at all are being exposed to everything all the time. And maybe their immune systems are in better shape than mine after all that exposure. Well, I think we don't need to be all or nothing with masking. And I think maybe that's a false decision that's been created for us and with so much debate and discussion over the past couple of years around masking. I think I have very much enjoyed going back and enjoying eating indoors, dining indoors, seeing friends I had not seen for some time. But I also still, I wanna make sure that I stay healthy so I can show up to work every day at the hospital, take care of the patients that I'm there for, make sure that my daughter that's in school stays healthy so she can be with her friends and learn. And we knew that prior to the pandemic, an enormous amount of days lost from work and days lost from school were attributable to respiratory viruses. And so if there's something I can do that's for at least me personally, a low burden for a couple hours around walking around the aquarium, that's fine by me. Yeah, if you're used to breathing through it at this point, which I am, it doesn't really bother you. Let's take a phone call, Washington County, this is Fred, Fred, thanks for the call, go ahead. Okay, yes, about a month ago I got my booster shot and the COVID shot and the flu shot. And I still have pain in my arm from that. And I didn't know like they switched the vaccine on me from Moderna when I originally got this Pfizer initially. And just wondered, is that a problem or is that normal but still have a pain in your arm where they injected the needles? Great question, glad you called, thank you. Yeah, it's a great question. Typically the soreness wears off after a few days, though they're a small percentage of people that can last and there can even be some swelling that lasts for a number of weeks. Not sure anything else about the caller's history but some people that take aspirin regularly or blood thinners, there can be a little bit more swelling and bruising present there as well that may contribute to some discomfort. But most of the symptoms from these vaccines wear off within about two to three days. And they do tend to bother some people a whole lot more than other people. And that could be for a whole host of reasons, younger individuals. We saw in the vaccine trials, tended to have fever a little bit more frequently, maybe slightly higher fevers and fatigue as well that persisted longer than older adults. Not necessarily a sign per se that your response was better and that your immune system is better primed but it's just an underlying sign that your immune system is working hard to train your body that protect it against future exposure to the viruses. Let's take a call from Arlington, Virginia. This is Paul. Paul, thank you for calling. Go ahead. Yes, please. Could you tell us, help us understand what is it that's going around? It's very strong, it's lasting over three weeks. It doesn't feel like flu. It's got persistent coughing, dry coughing and it just hangs on very strong. Is this a new virus? Are these viruses merged together to give us something new like flu RSV together? Wow. Is this so strong this season, this time around, please? Hey Paul, you've got it? Oh yes, I've got it, the family got it, everybody got it. And COVID test is negative? Not COVID, definitely. We've done about seven COVID tests and it's not COVID. It doesn't feel like any influenza. We've had it earlier in life. It's just something that's really strong, respiratory. Wow, sir, thank you very much for calling and feel better, your thoughts? Yeah, Paul, I echo that, please rest up. And there, as I mentioned at the top of the interview, what we're just seeing out there in the community are the myriad of respiratory viruses that typically cause infections in humans. And so it's difficult to know what exactly the caller may be experiencing, but we know that RSV has been extraordinarily prevalent in the mid-Atlantic over the past few weeks. And most adults haven't seen it in a couple of years either. So it can occasionally cause some severe lower respiratory infections in older adults. But we're not seeing anything new per se. These are just all of the typical viruses that we got, we're very used to year in and year out that we just took a couple of years break from. And I don't know if Paul has seen it, a doctor or not, but do medical professionals have better COVID tests? I mean, as the virus is mutated and all that, we're still using the same test. I guess they're still working. That's right. With all of the viruses mutation, we haven't seen any decrease in the performance of the COVID tests. The at-home tests are very much different from what we use in healthcare settings though. And they are better at detecting very low levels of virus. What I have seen as a phenomenon anecdotally and also have seen in data is that individuals with very high levels of immunity to COVID may actually experience much of the symptoms of COVID, especially sore throat and some fatigue without really testing positive by at least the at-home tests. Let's squeeze in one quick phone call, Chris in Montgomery County, a quick question, sir. Yes, thank you. My question is I've had no issues whatsoever. I have all of my shots. I've not had COVID. And I've had no issues with any of my boosters. And it's been, I've heard some people say that that means that because I'm not feeling any discomfort, the boosters are not as strong for me. Great question. I don't believe that. Chris, we will get you an answer. Thank you, ma'am. Yeah, and I started alluding to this earlier when you were asking about side effects. The, certainly we know that the side effects that can occur are as a result of the immune response ongoing in the body, though the absence of symptoms, just because you don't have a fever and you don't feel soreness afterwards doesn't mean that your immune system's not responding. The dose is standardized, it's been tested and we know from data in hundreds of thousands of people around the world that they're effective. Dr. Greg Schrank of the University of Maryland Medical Center. Dr. Schrank, thanks for visiting us in person again. Thanks, Jeff. Your health segments are a co-production of Maryland Public Television and the University of Maryland Medical System.