February 4, 2023

Varun Shetty, MD, served as the CDC Career Epidemiology Field Officer at the Texas DSHS before being promoted to acting Chief State Epidemiologist in October. On Sunday said Dr. Anthony Fauci cases of respiratory syncytial virus (RSV) among children across the country were at a critical juncture as hospital systems faced the threat of “tripledemicthis holiday season. Vetty spoke to State of Reform about the current public health picture in Texas as the holiday season begins.

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Status of the reform: What is the current public health situation in Texas? Are we seeing a “triple disease”?

Varun Shetty: “Usually we see respiratory viruses circulating frequently in our population. These include influenza, RSV, rhinovirus and enterovirus, the viruses that cause the common cold. Typically, we see increased activity during the fall and winter months. I definitely wouldn’t use those kinds of alarming terms. But I think we are seeing high activity earlier than usual and I think that requires our attention and some actions that we can all take to improve the situation.

We have a really effective monitoring system that allows us to monitor, for example, influenza activity, COVID activity, [and] RSV activities across the state. Currently there is no particular area that requires more attention than others. We are following this very closely. I think it’s really good that this is an issue that we are paying attention to. We want to make sure everyone can move through this holiday and winter season really healthy and safe.”

SOR: Why is RSV more prevalent this season than in the past?

VERSUS: “During the pandemic there has been some change, a lot of behavior change, a sharp decrease in interaction, coming together and gatherings due to a number of things. There were historically low years during the influenza pandemic and some of these other viruses. I think now that we’re coming out of that, one of the things that’s different about this season is that we’re seeing increased activity much earlier in the season than we usually do and have had in recent years.

RSV is a virus that we always keep a close eye on. It is a virus that can cause serious illness, especially in very young children or older adults. It is also one of the leading causes of a common pediatric condition called bronchiolitis as well as pneumonia. As a result, there may be a strain on hospital resources as community activity increases. Those are the reasons we are watching it very closely and again this year we had seen high activity earlier than expected. But in Texas and elsewhere we are beginning to see some encouraging trends that this increase is slowing and may even be trending down now.”

SOR: What is the department’s strategy against respiratory infections as we head into the winter?

VERSUS: “The good news is we have multiple tools and multiple strategies at our disposal that I think everyone in our communities can benefit from to prevent poor outcomes and ensure we stay healthy throughout the winter season.

The first and most important is to get vaccinated against the viruses that we can vaccinate against. Anyone six months and older is currently eligible for a COVID or flu vaccine. That is why we would like to encourage individuals to get vaccinated. It is one of the most effective tools we have to prevent infection and serious consequences of infection.

We are seeing that the influenza vaccine products available today are a really good match for the influenza that is circulating in our communities. And that’s really encouraging that we have a good tool at our disposal. Also with COVID, over many months we have seen how these products have impacted keeping people out of the hospital, keeping people safe and able to survive and thrive after infection.

The second part is really just the everyday, sensible approaches that we recommend every year heading into the winter season. These are things like making sure you stay away from people who are sick, making sure you stay away from others when you are sick, covering your coughs and sneezes, and then making careful decisions about the activities you choose to take part in the holiday season and winter activities to participate.

Then the third if you’re unlucky [enough] getting sick, know that we have a lot of really great tools that weren’t always available that you can use to reduce your risk of getting sick. First of all, there are numerous testing options available for COVID. Also at home tests that are very convenient. There are rapid flu tests. We have therapies available that may lessen the effects of these diseases on you.

For COVID-19, there is a drug Paxlovid, which a recent real-world study by the CDC has shown to be highly effective at drastically reducing the risk of being hospitalized for COVID-19. And then, in the case of influenza, the product oseltamivir can shorten the course of the disease. It’s really important that people start these treatments early. They are only effective if started within the first few days of illness. The moment you are concerned that you may be ill, seek testing, get tested, and then seek treatment early.

SOR: What’s the guidance for those seeking hospital or emergency care if they or a loved one are feeling sick this winter?

VERSUS: “One of the things we want to be careful about is not overloading hospital systems at this time. We have seen in other parts of the country and other parts of the world that there are situations where emergency systems are in place [and] Hospital systems can become overloaded very quickly.

Most of the steps I’ve outlined are things that people can do from either their home or their GP’s office. I really want to encourage people to take advantage of these options which I hope will keep you away from hospitals or systems that are resource constrained and you want to make sure we get these for the most ill.”

This interview has been edited for clarity and length.

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