Our representatives are available to schedule your appointment Monday through Friday from 9am to 5pm.
For a Northwell ambulance, call
(833) 259-2367.
Insights
Covid, flu, RSV: Protecting yourself and others from the 2023 tripledemic
Here’s how to keep yourself safe this season
During flu season, there’s a simple way everyone can help keep themselves and their loved ones safe: Get vaccinated. But flu isn’t the only concern this winter — there’s a strong possibility that we could see a tripledemic again; both Covid-19 and respiratory syncytial virus (RSV) are circulating, as well. The good news is that you have options for protection thanks to vaccines and a therapy known as monoclonal antibodies.
Of course, traditional infection prevention routines remain key to preventing the spread of illness both before and after getting your vaccinations, noted Eric Ascher, DO, a family medicine physician with Northwell Lenox Hill Hospital. “You should sanitize surfaces that are commonly used and either wash your hands for at least 15 seconds or use hand sanitizer after touching a shared surface or sneezing or coughing into your hands,” Dr. Ascher said on a recent episode of 20-Minute Health Talk, Northwell’s podcast. “These are all really important things that are worthwhile doing this winter cold/flu/Covid season — and every single day.”
Here’s what you need to know about the various immunization options available to you.
How do vaccines work?
Vaccinations have been protecting people from a variety of infections for decades. Vaccines deliver antigens — foreign substances derived from a virus. These are usually weakened or inactive versions of the virus. Antigens alert your immune system to the potential invader, allowing your body to not only recognize the invader but develop antibodies that can neutralize the infection.
Once your immune system reacts to the vaccine, your body will remember how to produce the relevant antibodies to fight off the virus. This is called active immunity, and it can keep you from getting sick, or at least make sure your illness is mild.
Adverse reactions to vaccines are rare. Recipients of vaccines may, on occasion, develop head or muscle aches and/or fatigue. Some people may also run a low fever. “Before any vaccine is placed into production, it goes through a series of tests by the FDA,” explained Dr. Ascher. “We know that this has been vetted and studied in multiple populations to understand what the potential for side effects and risks would look like.”
It’s important to remember that any symptoms are all signs that the vaccine is working as intended. “Side effects are very manageable and typically do not last more than 24 hours,” Dr. Ascher assured. If the symptoms persist for more than a week, consult your physician.
Flu vaccine
Immunization against flu typically comes in the form of a vaccine. Each year, a new version of this vaccine is produced and offered to the public. The vaccine is made available around flu season, traditionally defined as the three months from December to March.
Flu vaccines are formulated by mixing a “cocktail” of antigens corresponding to the strains immunologists expect to be the most problematic each year. “It is really important to remember that the viruses change,” Dr. Ascher said. “Likewise, the immunity that you get from the vaccinations changes and decreases over time.”
Everyone over six months of age should receive some form of the flu vaccine, Dr. Ascher explained.
Covid vaccine
When the Covid pandemic hit, the rapid response of scientists led to the development of new vaccines that have saved countless lives. As the virus mutates, researchers are continually developing new versions that combat the virus — Pfizer just released the latest this September (and Sandra Lindsay was once again the first to get the shot).
Dr. Ascher strongly recommends receiving both the flu shot and the Covid booster every year — even if you missed some or all. “It does not matter how many or how few Covid vaccines you have received in the past; we are still recommending the new Covid vaccine this fall,” he clarified.
And if you do get both, it doesn’t matter when or where you get them. Dr. Ascher confirmed that the flu and Covid vaccines can be received in the same arm, at the same time. In addition, he said, “It is absolutely acceptable to mix and match the Pfizer and Moderna vaccines.”
As with the flu vaccine, anyone over six months can — and should — receive the Covid vaccine.
RSV vaccine: A breakthrough in treatment
RSV is a common virus that targets the lungs and airways and can cause symptoms like shortness of breath and fatigue. The peak of RSV infection rates coincides with flu season.
In healthy children and adults, infection is almost always mild. But in vulnerable populations, which include children younger than two — especially newborns younger than one — and adults aged 60 and older, there is a heightened risk of advanced infection — potentially even progressing to conditions like pneumonia.
New to RSV treatment this year is the recent development and FDA approval of two RSV vaccines: Abrysvo and Arexvy. Abrysvo is approved for use in adults over 60 and women between 32 and 36 weeks pregnant, while Arexvy is only approved for adults over 60. Mundeep Kainth, DO, MPH, is a pediatric infectious disease doctor who has worked with previous contributors to RSV vaccine research. “The idea is that when Abrysvo is given at 32 to 36 weeks’ gestation for a pregnant mom, you're able to confer those same protective antibodies to the baby,” she explained.
Beyond vaccines: Antivirals and monoclonal antibodies
Sometimes you’ll get sick before — or despite — getting vaccinated. Not too long ago, your only option would be to suffer through sickness and manage the symptoms with over-the-counter painkillers and decongestants. No longer: Doctors can prescribe medications that limit the days you feel ill and may even be lifesaving.
New ways to protect your baby from RSV
We now have new FDA-approved options to protect newborns against severe RSV. You can choose an RSV vaccine during pregnancy, or your baby can be immunized after birth.
Antivirals
One approach to dealing with viral infection is to limit the virus’s ability to replicate. These prescription drugs can reduce the days you’re sick and help prevent a serious infection. Note that there are no recommended RSV antivirals for use in otherwise healthy infants and children.
- Flu antivirals include Relenza and Rapivab, which are used in hospitals, as well as Tamiflu and Xoflusa, used at home.
- Covid antivirals in pill form include Paxlovid and Lagevrio. In vulnerable populations — the very young, the elderly and people with weakened immunity or underlying health conditions — an intravenous antiviral treatment known as Veklury offers extra protection. It’s given once a day for three consecutive days. In hospital settings, Veklury is also used in conjunction with steroids to treat Covid pneumonia.
Monoclonal antibodies
Monoclonal antibodies offer a way to target the viral infection by supplying the antibodies you need to knock out the invader.
However, monoclonal antibodies offer what scientists call passive immunity — a substitute for your body’s response. Because your immune system hasn’t learned to recognize the virus and mount a defense (as it would with a vaccine), the protection only lasts as long as the non-native antibodies do. Fortunately, in the case of RSV monoclonal antibodies, Dr. Kainth said the protection they offer lasts for the duration of RSV season.
Still, monoclonal antibodies are a valuable tool. Before the recent development and approval of the RSV vaccine, for example, monoclonal antibody infusions were the only means of treating the virus.
Monoclonal antibody infusions are often employed as a spot treatment for severe infection or, in infants, as a proactive protection measure. Right now, flu monoclonal antibodies are still a work in progress, but research is ongoing and potential treatments are being studied in clinical trials.
There are monoclonal antibodies for Covid, but none are available to treat the prominent strains circulating this winter. Currently, the National Institutes of Health advises against the use of monoclonal antibodies to treat Covid.
RSV monoclonal antibodies
The good news is that such treatments exist for RSV, including nirsevimab, a newly approved monoclonal antibody treatment. An older monoclonal antibody — pavilizumab — has been available, but nirsevimab is more potent and longer-lasting. Dr. Kainth noted that clinical trials observed an 83% decrease in infant RSV hospitalizations thanks to nirsevimab.
Plus, nirsevimab can be used more widely: “We had palivizumab only for very high-risk infants population,” Dr. Kainth said. With nirsevimab, “we're able to use this on a widespread basis.” Dr. Kainth expects both the new vaccine and the monoclonal antibody treatment to be available at pediatrician’s offices and hospitals.
Ultimately, you have plenty of options for keeping yourself and your loved ones safe from respiratory viruses this winter, notes Dr. Ascher, and they are worth pursuing through the season and even year-round.
Related news
A joint study by the Feinstein Institutes and Karolinska Institutet details the connection and outlines potential therapies.
With the recent surge of RSV cases, Northwell's chair of Pediatric Services, Charles Schleien, MD, shares vital information on how to help keep your child healthy this Winter.
Ankita Sagar, MD, explain's Northwell's unique approach to treating long-COVID symptoms through the COVID Ambulatory Resource Support (CARES) program.