UT Health San Antonio physicians offer advice for flu, RSV, COVID-19 triple threat

Woman and two children, a boy and girl, washing their hands at a white double sink.
UT Health San Antonio physicians offer advice on avoiding seasonal illnesses.


Unlike triple threats celebrated in sports and the entertainment world, no one is celebrating the possibility of a triple threat of the flu, respiratory syncytial virus, or RSV and COVID-19.

With the winter holidays fast approaching, UT Health San Antonio physicians are encouraging the community to get vaccinated for both the flu and COVID-19, wash their hands frequently, stay home when feeling sick and wipe down surfaces.

“Washing your hands can cut down on the transmission of respiratory infections by 16% to 21%. There is significant protection you can garner by simply washing your hands,” said Jason Brownell, MD, FACP, a UT Health San Antonio primary care physician.

According to the Centers for Disease Control, incidents of RSV across the nation have risen rapidly, straining pediatric hospital wards earlier than usual. In a typical year, the RSV season begins in September, peaks in late December, and tapers off in April or May. Texas follows a similar pattern.

Maria F. Fernandez Falcon MD, FAAP, a UT Health San Antonio pediatrician, said she recommends the flu vaccine early to the parents of her young patients and children 6 months old and older. Usually, she said the flu peak is in November or December.

She said getting the vaccine early gives the body enough time to build antibodies before the virus spreads quickly. She said this flu season started early and “many people were not completely prepared.But it is always a good time to receive the flu vaccine, even if you already got the flu.”

Since the flu and RSV have similar symptoms, it’s challenging to know which has been contracted.

“This year, they were like twins and trying to come up at the same time. What makes it so difficult this time around is as they peak together, they present so similarly. It’s clinically difficult to look at somebody and say, ‘This is RSV or this is flu.’ Timing my help in a standard season, but even then, because flu is always around, you can’t tell unless we do testing,” Brownell said.

Both physicians said no one knows why flu and RSV seasons collided so intensively this year, but there are theories. Brownell said one theory is that immune systems were not exposed to viruses like the flu and the common cold during the pandemic. Consequently, immune systems were not hardened by seasonal exposure.

“Other theories out there are about long-term memory of our immune systems,” Brownell said. “Can our immune system forget all the prior exposure? While not a matter of hardening the immune system, it just feels like it’s never been exposed before.”

RSV is a disease generally associated with young children; most contract it by age 2; however, adults 65 and older and those who are immunocompromised are vulnerable to contracting the virus and suffering severe symptoms.

“The immune system is not as robust or adaptable as we gracefully acquire experience in life. Not everyone who is older and contracts RSV will get sick. It’s a small portion of people but significant enough that it puts a burden on the healthcare system,” Brownell said.

He said those with chronic conditions such as COPD, heart failure and diabetes, combined with a weakened immune system, are especially susceptible to severe illness.

Currently, there is no vaccine for RSV; however, a preventive medication is available for infants at risk for severe disease. Premature infants, those with heart disease, or infants with chronic lung disease are candidates for the multi-injection medication. It is not used for infants who have already contracted the virus.

Nationally, CDC officials said the flu hospitalization rates are higher than in a decade, and the agency website shows Texas as one of three states with highly active flu cases. Texas Health and Human Services tracks flu-like symptoms across the state and reported that on the last week of November, the percentage of positive tests for the flu rose by just over 4%.

In Bexar County, the COVID-19 seven-day moving average increased slightly from the week of Thanksgiving to the last week of November from 200 to 248 cases. While the county shows the risk as low for contracting the virus, during the last week of November, there were 418 cases of COVID-19 in the county, with 119 hospitalized.

Both physicians agree the best way to avoid spreading and contracting flu and COVID-19 is to vaccinate. At the end of November, Bexar County is reporting almost 9% of individuals 5 years and older have received the latest COVID-19 booster, and 201,712 have received the flu vaccine. CDC officials said the current flu vaccine is effective against the flu viruses in the community.

To protect babies, Fernandez Falcon recommends vaccinating all family members to create a cocoon effect.

“The only protection for very young infants is us,” she said. “If the family is vaccinated, it protects the babies that are too young to be vaccinated.”

Brownell said avoiding social situations, getting vaccinations and washing your hands will help prevent contracting and spreading viruses. If leaving your home is unavoidable when feeling sick, wearing a mask helps prevent others from becoming ill. He also recommends cleaning surfaces, since RSV can live on surfaces for hours.

He said adults with RSV and flu should begin to feel better after the second or third day, and over-the-counter medications will help alleviate symptoms. But if symptoms are not improving or are worsening, it’s best to see a physician.

Fernandez Falcon said over-the-counter cough medications are not recommended for very young babies with upper respiratory infections. She said it’s essential to keep their upper airways open.

If a baby has RSV, she recommends creating steam with a shower and allowing the baby to breathe the steam for 10 to 15 minutes two to three times a day as needed for nasal congestion. She said a humidifier works the same way.

Fernandez Falcon said using a nasal aspirator to remove mucus from the nose and feeding regularly are other supportive care actions caregivers could offer to young kids with colds.

“You, as a parent, are the best person that knows your child,” she said. “If you feel the baby is not getting better, you should talk to your physician.”

She said the time to contact a physician is if a high fever is present for more than 24 hours and the baby is not eating or is lethargic. She said if the baby is breathing rapidly, having difficulty breathing or turning blue, call a physician immediately or go to the emergency room.

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