Update on Fall and Winter Respiratory Illnesses

As summer winds down, COVID, Flu and RSV season is expected to ramp up, health leaders warn.  The University of New Mexico Health System partnered with the New Mexico Department of Health (NMDOH), Presbyterian Healthcare Services, Lovelace Health System and Christus St. Vincent to bring the community the most up-to-date information on COVID, influenza, and respiratory syncytial virus (RSV). This is the first fall and winter virus season where vaccines are available for all three viruses.

COVID-19 Vaccine Updates

Across New Mexico, state health officials reported a recent increase in COVID cases, hospitalizations, and deaths, but NMDOH medical director Miranda Durham, MD, said numbers remain low compared to recent years.

“We'd really like to see it stay that way through the winter,” she said during a joint news conference. “Which is why we're here talking about the great new vaccines that can help protect us all.”

Durham explained there are several new variants of the virus currently circulating, but the variants are all related and will respond to the latest COVID-19 vaccine, which will arrive in New Mexico by the end of this week and be available with most providers by the end of September.

“This is a COVID vaccine that's meant for this fall and winter season, and everyone six months and older can get one of these updated COVID vaccines, regardless of your past vaccination status,” Durham stated the exception would be for anyone who is currently COVID positive or has received a COVID vaccine in the past two months.

The Centers for Disease Control and Prevention (CDC) guidelines for isolation and COVID precautions remain unchanged. Those who test positive for COVID are asked to isolate for five days. Isolation can be discontinued after 5 days if a person has no fever and symptoms are improving. The CDC then recommends wearing a mask for an additional five days. Those who are in contact with someone who tests positive do not have to isolate, but it’s recommended they wear a mask and test after five days.

The NMDOH also announced it retired its former vaccination enrollment website but introduced a new website that allows New Mexicans to find vaccine availability in real time.  

Flu Vaccine Updates

UNM Hospital epidemiologist, Meghan Brett, MD, said there are no predictions for the severity of this year’s flu season. She recommends everyone take precautions, starting with the flu vaccine in September or October.

“The flu vaccines that are being offered this year, are all quadrivalent,” she said. “That means that they have four flu strains in them.” 

Flu vaccines are available for people six months and older. A higher dose or adjuvanted flu vaccine is recommended for people 65 and older. 

“However, if those are not available, then it is important just to get the flu vaccine itself that is otherwise available,” Brett said.

New this year, Brett said, is that anybody can receive a flu immunization, even if they have a history of egg allergies, because the amount of protein from eggs in the latest batch of vaccines is incredibly low.

New RSV Inoculations for Children and Adults

Associate chief medical officer for the UNM Children’s Hospital Anna Duran, MD, said she is projecting a normal timeline for RSV this year, peaking between November and early March.

“RSV is very contagious,” she explained. “It’s transmitted by direct contact, and it lives on surfaces for quite a long time. A majority of children will have seen RSV by the time they turn two years of age.”

Beyfortus is a new immunization approved by the U.S. Food and Drug Administration (FDA) to protect healthy children up to two years-old against severe RSV cases. Duran said recent clinical trials showed a near 75% decrease in medical and emergency room visits and hospitalizations, as a result of the immunization. Children who are newborn up to eight months, during RSV season, are eligible for a Beyfortus injection. Children eight months to 19 months of age, with certain medical conditions, are also eligible.

For parents with children older than two years old, Duran says RSV will typically present itself like a normal cold and can usually be treated with over-the-counter medication, but there are warning signs that parents should look for.

“If your child is showing signs of difficulty breathing, isn't wanting to drink or showing signs of dehydration, that's a great time to seek medical care in an emergency room,” Duran said. “If your child has a fever for more than five days, this is a time to start talking to your primary care provider or go to an urgent care center.”

Another new RSV vaccine is available for adults, ages 60 and older.

“Each year about 100,000 adults over the age of 60 are hospitalized in the U.S. due to RSV,” said Denise Gonzales, MD, medical director at Presbyterian Healthcare Services. “Additional risk groups include those with heart disease and those living in long term care.” 

Providers recommend treating RSV symptoms for both children and adults at home. If symptoms for adults include shortness of breath, chest pain, confusion, signs of stroke, or persistent fever beyond five days, then Gonzales would encourage them to talk to their primary care provider or seek emergency medical care.    

Vaccine Hesitancy

During a joint news conference, Lovelace Health System’s chief medical officer

Vesta Sandoval, MD, addressed the apprehension some people may have toward vaccines.

“Misinformation was disseminated about vaccines, not just the COVID vaccine, but many other types of vaccines as well and that has generated a lot of fear,” she said. “The World Health Organization (WHO) has recognized that vaccine hesitancy or resistance is actually a top threat to global health.”

Sandoval said before the pandemic, WHO estimated five million deaths per year could be saved by vaccinations. She encouraged people to talk to their providers if they are unsure about an immunization. 

“Go to a trusted source, go to somebody who has real information, who can tell you about the vaccine,” she said. “We've given millions and millions of these vaccines. We know they're safe. We know that the side effects are very minimal.”

Getting Care to Rural New Mexicans

In recent years, hospital leaders across New Mexico have worked to fill health care gaps in rural communities. For example, Santa Fe, Taos, Los Alamos and Colfax counties have higher flu vaccination rates than Union, San Miguel and Rio Arriba counties, where fewer than 50 percent of the population is vaccinated against the flu. 

“I think rural communities struggle to access care,” said David Gonzales, MD, chief medical officer at Christus St. Vincent in Santa Fe. “Some reasons are distance to their primary care location or transportation needs, and this can prevent people from seeking any type of medical care.”

In addition, Gonzales said rural hospitals struggle with staffing, finances and capacity.

“We're already over capacity, and we're all concerned about what respiratory season will look like,” he said. “So, it’s going to be really important that we form tight partnerships amongst our regional, federally qualified health centers, primary care clinics and community organizations, in both preventing and managing this respiratory season.”

Gonzales said it is possible to avoid illness, and in turn avoid over-saturating already overwhelmed hospitals. This year, there are effective preventive measures for all three major viruses that are contributing to respiratory season and hospitalizations.