A pediatrician answers your COVID, RSV questions

CATHY WURZER: How about you? Are you doing OK? 12:15 here on Minnesota Now. From NPR News, I'm Cathy Wurzer. My gosh, but a lot of people are sick right now. There's a surge in the number of COVID cases, and the number of flu outbreaks is on the rise too, more than 700 outbreaks in schools so far this year.

The good news, the number of hospitalizations because of flu is dropping from previous weeks but still north of 500. Cases of RSV are also down, but there are still nearly 60 babies under the age of one in the hospital with the respiratory illness. We asked if you had questions about COVID, flu, and RSV, and you do, a lot of you do.

Dr. Angela Mattke is here to help. She's a pediatrician at Mayo Clinic. Dr. Mattke is the medical editor of Mayo Clinic Guide to Raising a Healthy Child and co-medical director of the Parenting channel on the Mayo Clinic press website. Doctor, welcome to the program.

ANGELA MATTKE: Thank you so much for having me, Cathy. I'm really excited to be here.

CATHY WURZER: I'm glad you're here. Let's talk about some news. The FDA has approved the bivalent vaccine for kids under the age of five. Is that a game changer? What do you think of that?

ANGELA MATTKE: I mean, it's a game changer for me. I'm pretty excited about being able to offer this to my youngest patients. It's a little-- the eligibility gets a little bit confusing for parents. But if your child has started either the Pfizer or the Moderna vaccine series, it's good to start thinking about whether they would either be eligible for a booster shot if they received the Moderna or if they started the Pfizer three-dose series and they haven't completed it yet, they would be eligible to receive it as their third dose.

There is some news, though, that we're not giving these children yet a technical booster shot if they've completed that three-dose regimen. But the FDA anticipates that this may be approved in January or later this year.

CATHY WURZER: What are we seeing in terms of COVID among little kids?

ANGELA MATTKE: Like all cases across the United States, we're seeing COVID rates starting to increase again. And thankfully, in children, they have overall done better than some of the older adult populations. But children are still at risk for severe complications of COVID infection and even death. So it is something that we have a vaccine that can offer protection, that can decrease severity and even death, so it's really, I think, meaningful that parents think about considering this vaccination.

As a parent myself, my kids have it. They've gotten their boosters as soon as they could get them, actually. And there's so many things in life we can't control, and this is one thing that we can offer a little bit more protection for our children as they go about their daily lives.

CATHY WURZER: Of course, RSV has been such a problem for kids. My goodness. What are you seeing at Mayo? What are you hearing?

ANGELA MATTKE: Yeah, I mean, Mayo is no different than what we're seeing across the state in metro and non-metro areas. We're seeing high rates of RSV. Thankfully, it is coming down a little bit, according to the Minnesota Department of Health estimates.

But we're seeing just lots of viruses, RSV being one of them. Influenza cases being very high over the past couple of weeks. I feel like if it hasn't been RSV, it's either been influenza or potentially COVID in the patients that I'm seeing in my clinics.

CATHY WURZER: Say, we have a lot of questions. Here's a question from a listener. Carlita wants to know, "How long after being exposed to RSV should we isolate?"

ANGELA MATTKE: Oh, that's a really good question and one that has been debated. We have seen daycares across the state request that children receive RSV testing before coming back. But we really strongly discourage that because that little RSV vaccine, particles can be detected even long after they have infection. So children can return to daycare just like they could have with other viral infections, upper respiratory tract infections, when their fever has gone away for more than 24 hours, they're eating, they're drinking well, and they're not coughing so much that they're having difficulty breathing.

If we ask parents to completely keep their children home until all their symptoms were better, I think parents would never be allowed to go to work. But I also think we want parents to really think before they send their child to daycare when they're sick, and especially they're febrile, because that does decrease transmission to the other kids in that daycare setting.

CATHY WURZER: And "how contagious is RSV," Anne wants to know. She said, "I had a close contact with a six-month-old with RSV, then I coughed nonstop for 10 days, and it felt horrible."

ANGELA MATTKE: Yeah, she's probably been exposed to RSV in the past. RSV is contagious, like many upper respiratory viruses that are transmitted through particles. It's not as contagious as COVID. COVID is one of our more contagious viruses.

But it's definitely one that we see circulating in the communities every year. Adults can get it too. And many people get it multiple different times throughout their life.

CATHY WURZER: Joe wants to know, "When it comes to flu or RSV, is going to the ER necessary? Are there symptoms that should bring concern?"

ANGELA MATTKE: Oh, I'm so glad he asked this question because the ER waits are long and so many of the concerns that people are having with their children can be addressed by your primary care provider, like myself. Call us. We want to talk to you about your child's symptoms, or your symptoms if you're an adult, to help figure out where is the right place for you to be seen because I know you don't want to go sit and wait in the ER for a long period of time as well.

So getting back to your question, when you should seek care is if you're struggling to breathe, if you're having trouble staying hydrated, or, in young children, if there's a-- especially if there's a change in their mental status. Those are the three most important things that I tell parents because there's a lot of other things as a doctor that I'm going to assess, but if you can just remember to look at your kid's hydration levels, are they able to stay hydrated, are they working harder to breathe, or is there a change in the way that they're acting and how alert they are?

Those are definitely times that your child needs to be seen. And if it's less than that and you're wondering if it's something you can just watch at home, give us a call. Most hospital practices have some type of triage line with skilled nursing or providers that can help answer your questions and help direct you to the right place.

CATHY WURZER: Alice wants to know, "Is a vomiting child a symptom of the flu?"

ANGELA MATTKE: That's another great question. Yes, in children with influenza virus, we may see vomiting and diarrhea. It's much more common in children than it is adults. But when people say flu, I think there's kind of a confusion out there.

Sometimes flu to people means-- in the medical profession some type of viral gastroenteritis, which is not caused by influenza virus. But with influenza virus A or B, we may see vomiting and diarrhea in kids, and that's why hydration is important to keep track of to make sure your kid is urinating a couple of times a day, at least, and then maintaining sips of water to keep their hydration levels up.

CATHY WURZER: Stacey asks, "When we start feeling sick, can you clarify what to do to confirm it is flu and get an antiviral?"

ANGELA MATTKE: That's really another great question. So I cannot usually tell when I see someone exactly what virus it is. So the most important thing is to get COVID testing first because COVID can be transmitted longer. It has broader effects in regards to how long you would need to quarantine at home. So getting tested for COVID is very important, and then probably also influenza at the same time, especially given the high levels of circulating influenza A that we're seeing in the community.

So the best way to do that is just to contact your provider. Most of them have very good processes in place where they can expedite testing if they don't feel that you need a visit. And that's where that triage line can be really helpful in determining if a visit is needed or not needed. And if your influenza is positive, then getting you started on appropriate antiviral therapy if you do qualify for that therapy.

CATHY WURZER: Say, several people want to know, Doctor, if wearing masks, as many of us have done over the past two to three years, has affected our immune systems, making mask wearers a little more susceptible to illness?

ANGELA MATTKE: I don't think per se that it's affected our immune system, but it has helped slow the spread of these viruses. So every year, we see, especially during the winter months when we're more in close quarters and inside, spread of many different types of respiratory viruses. And if we haven't-- if we've seen that slow down, like we did especially during 2020 when virtually no influenza cases were seen during that year, your body is just not being exposed to it in that time.

And so as your body's had a little break from some of these viruses, when they come back and hit you again, your body just maybe has a little bit more robust response, a little bit longer to fight it off because it doesn't quite remember it as well. But it doesn't harm your immune system. Masks are so important at helping protect vulnerable people and spread-- or limit the spread of these respiratory viruses. So I can't say enough about how important masking is just to show kindness to those who are maybe immunocompromised and who are at higher risk or susceptibility to infections.

CATHY WURZER: Are you wearing masks even out in public right now?

ANGELA MATTKE: Yeah, I actually am. My children are as well. And so we wear a mask because we do have-- we have family and friends that are high risk for infections. And it's really important, especially if we're going to be around them, that we try and protect them as much as possible.

Our family's been trying to practice that throughout the COVID pandemic. And also just testing for COVID even if we're asymptomatic before we're going to be around those high-risk people is something that we've done, especially when it's high levels of community spread according to the CDC guidelines.

CATHY WURZER: And how are you preparing for the holidays?

ANGELA MATTKE: Socially or for decreasing the spread of viruses?

CATHY WURZER: Decrease the spread of viruses.

ANGELA MATTKE: Yeah, in the weeks leading up to it before we're going to be around our family members that would be at higher risk, we're definitely going to be conscious about making sure that we're wearing our masks. One of the most important things my family has done is make sure we're all up to date on our immunizations, our bivalent COVID vaccines, our influenza vaccines, because that's one thing we can do to decrease us getting sick, and by us getting sick then spreading it to our loved ones.

CATHY WURZER: All right. Doctor, it's been a real pleasure. Thank you so much.

ANGELA MATTKE: Thanks for having me.

CATHY WURZER: Dr. Angela Mattke is a pediatrician at Mayo. We'll be posting all of this advice and more online at mprnews.org. Say, coming up after the news break, we're switching gears to talk about one relatively new holiday celebration that inspired one woman to make a career change.