It’s Sick Season Again, Now What?

Most of the everyday realities of the COVID-19 pandemic – cancellations, extreme home isolation, fear of the unknown – we’re happy to leave in the past.

But the many lessons we learned during the pandemic should stay top-of-mind, say infectious disease experts, particularly as we enter the 2023 cold and flu season. Things like washing our hands, masking when we have symptoms and staying home when we’re sick will help us stay well as we head into winter.

It’s also critical to stay up-to-date on recommended vaccines, three of which – COVID-19, flu and RSV – were just released at the end of September.

“These vaccines are coming at the perfect time,” says Cindy Noyes, MD, an infectious disease specialist at The University of Vermont Medical Center. “We’re all moving indoors, and this is typically when we start seeing a rise in respiratory illness. The new vaccines are all tools we should be using broadly to protect ourselves and our families from illness.”

Dr. Noyes and her colleague, Jessie Leyse, MD, MPH, from UVM Health Network – Central Vermont Medical Center, recently took the time to answer 12 common questions about 2023 vaccines and respiratory illnesses.

1. Which vaccines are recommended for adults?

Flu and COVID-19 vaccines are recommended for all adults, even those who are healthy and don’t have underlying conditions. They’re strongly recommended for people over age 60 and immunocompromised individuals, which can include chemotherapy patients and those taking immunosuppressing medications for conditions such as lupus or rheumatoid arthritis.

Dr. Noyes also strongly encourages the vaccines for health care workers, teachers and others working in exposed professions, even though it’s not a requirement. “That’s really important because we have such an employee shortage right now, especially among health care personnel,” Dr. Noyes points out.

One RSV vaccine is recommended in pregnancy at 32-36 weeks, while a different RSV vaccine is recommended in adults aged 60 and older.

While getting the recommended vaccines may not prevent you from contracting the illnesses entirely, they can help ward off more severe symptoms and make for a shortened course of infection.

2. Which vaccines are recommended for kids?

All children six months and older should get a COVID-19 shot and a flu shot, says Dr. Leyse, who, alongside her specialty in Infectious Disease, is also board-certified in Internal Medicine and Pediatrics. If this is the child’s first vaccination for flu, they will need two doses, administered one month apart.

The RSV shot is generally only recommended for infants younger than 8 months old, unless they have underlying cardiac or respiratory conditions.

3. How is this year’s COVID vaccine different?

The original series of COVID-19 vaccines in 2020 and 2021 were bivalent, meaning they had two different strains in them. This year’s COVID vaccine is monovalent, so there’s only one, tailored to the omicron variants that are circulating now.

Worth noting is that providers aren’t calling the COVID-19 shot a “booster” anymore, as we transition to an annual vaccination strategy similar to the flu. It’s now just one dose, and it’s recommended for anyone who hasn’t received a COVID-19 booster in the last two months. “Most of us haven’t received a booster for a year, so we’re definitely due,” Dr. Noyes says.

If you didn’t get any, or all, of the original series of COVID-19 vaccines, you should get the current monovalent vaccine, Dr. Leyse adds. “The bivalent shots aren’t available anymore, and this will be your best protection,” she says, noting that the CDC has a helpful website that outlines what it means to be “up-to-date” on COVID vaccines, depending on your age group.

Finally, the brand of vaccine is no longer important, and you don’t need to stay with the same brand you’ve had in the past. “They’re interchangeable,” says Dr. Leyse. “Both are equally effective.”

4. I’ve never heard of an RSV vaccine before. Is this new?

While RSV, or respiratory syncytial virus, has been around for a while, the RSV shots (one version for babies, another version for pregnant patients, and a third version for adults age 60+) are new this year.

According to Dr. Noyes, “RSV is a viral infection that can cause significant (and in some cases, life-threatening) illness in infants and very young kids. Over the course of time, we’ve realized that RSV can cause significant illness in adults as well, especially those of advanced age. Similar to the flu, RSV can exacerbate underlying cardiopulmonary problems, and when that happens, patients may require hospitalization.”

The RSV shots for babies and adults are quite different, explains Dr. Leyse. “The RSV shot for children is not a vaccine, but a dose of an actual antibody. A vaccine teaches your body to make its own antibodies, whereas their shot is the antibody itself, which is only protective for about six months – long enough to get them through their first winter.”

On the other hand, the RSV shot for older adults is a true vaccine, and it’s also durable. This means it lasts longer than a year like the vaccines we get for mumps and measles. “You won’t have to get it every year, and it could even be a one-time dose,” says Dr. Leyse. Although subject to further study, a single dose of the vaccine could protect adults for the rest of their lives.

5. What should we know about the flu shot? And can getting a flu shot make you sick?

The flu vaccine is updated every year to cover the most common circulating flu viruses. This year’s vaccine contains snippets from four different types of flu – two influenza A viruses and two influenza B viruses.

As far as possible reactions, some patients report a sore arm, some slight fatigue, and even a low-grade fever. “These are signs of your immune system revving up in response to the vaccine,” Dr. Leyse notes. But if you come down with symptoms that are more in line with actual illness – such as a high fever or respiratory symptoms – you were probably exposed to a virus, whether the flu or something else, before you got your flu shot. “The shot is not the live virus, and it can’t give you the flu,” Dr. Leyse stresses.

6. When should I get these vaccines?

High-risk individuals should get the shots as soon as they can. For everyone else, it’s okay to wait until mid-October. But don’t wait too long; it takes your body about two weeks to build up immunity after getting a vaccine.

It’s okay to get the COVID-19 and flu shots at the same visit, says Dr. Noyes. They won’t interfere with each other or overwhelm your immune system. “You’re only getting a fraction of the antigens that you would get if you were actually infected,” she says. “Plus, our immune system is used to multitasking.”

Both Drs. Noyes and Leyse suggest that the RSV vaccine be given in a separate visit. “We don’t have any data yet on whether the RSV vaccine could interfere with the other two. So we recommend that people get the RSV vaccine one to two weeks before or after COVID-19 and flu vaccinations,” says Dr. Noyes.

7. Are the vaccines safe during pregnancy?

“Everything I’ve seen has suggested that COVID and flu vaccines are safe,” says Dr. Noyes. “Expecting parents are at a much greater risk of developing severe illness from COVID-19 and flu. Plus, there’s also the highly beneficial transfer of antibodies that happens with delivery, which is very protective for infants in their first few months. Weighing risks and benefits is important, but I absolutely would advocate for these vaccines,” she says.

And, as noted earlier, there is an RSV vaccine formulated for use in pregnancy, which is recommended to be administered during RSV season for those people 32-36 weeks pregnant.

8. If I get sick, how do I know if I have flu, COVID-19 or RSV?

Because all the symptoms are similar, it’s nearly impossible to tell the difference among respiratory viruses without testing. But there’s not usually a reason to test unless it will affect treatment – and usually, that’s the case only for older or immunocompromised people. “For higher-risk people, doctors might want to test for COVID-19 or flu, so they know which antiviral to prescribe,” says Dr. Noyes.

For everyone else, the best treatment is plenty of rest, good hydration, and over-the-counter pain relievers for symptoms like headache, body aches or fever.

“Allow your body the time it needs to use the tools it has to recover,” says Dr. Noyes.

9. Is home COVID-19 testing still important?

While it may not affect treatment if you’re otherwise healthy, determining early on whether you have COVID-19 is still important because it can prevent transmission to others who are at higher risk. Every household can now order up to four COVID home test kits for this season, free of charge, at COVIDTests.gov.

10. If I have COVID, do I still need to stay home and isolate?

The short answer: Yes.

”People are most infectious early in their symptoms, when they’re feeling their worst,” says Dr. Noyes. “For COVID, the cough is one of the easiest ways to transmit the virus to others. We’re still recommending that people stay home for the first five days, and then wear a mask through day 10 if they go back to work or school. That guidance from the CDC hasn’t changed.”

As far as isolating within your house, that depends. If you have young kids, or if you have pregnant, older or immunocompromised people in your household, you should still try to isolate. That doesn’t mean you have to move out of your house, says Dr. Noyes, but try to sleep in a different room. You may also want to wear a mask in common areas and clean high-touch surfaces frequently.

11. What’s the typical course for these illnesses, and are there complications I should watch out for?

For any upper respiratory virus you may catch this season, you’ll probably feel crummy for seven to 10 days, then start to improve. For people who have underlying conditions such as asthma, the cough may linger.

If you’re just starting to feel better, then experience a relapse, it’s worth a call to your provider, Dr. Noyes adds. That may be a sign that you’ve developed a bacterial pneumonia on top of the viral infection, which would be a reason to prescribe an antibiotic. She’s seen this happen with all of the respiratory viruses this season – COVID-19, flu, RSV, and the common cold.

Other situations to worry about would be extreme vomiting or diarrhea, where you can’t keep anything in your system, says Dr. Noyes. In those cases, dehydration could be a concern, especially along with fever. In that case, you should contact your doctor for advice. And if you have any shortness of breath, difficulty breathing, or confusion, that calls for a visit to the nearest emergency department.

12. What’s your most important advice to get through “sick season?"

“We should use all the tools that helped us though the COVID-19 pandemic before we had vaccines,” says Dr. Noyes. “Stay home when sick, practice good hand hygiene, and mask when symptomatic.”

Last but not least: Don’t go back to the old ways of trying to push through because you don’t want to burden your coworkers. “A return to those practices is not good medicine,” stresses Dr. Noyes. “When you’re sick, the last thing you should do is be at work or at school.”