Iowa doctor: Treatments, vaccines can keep flu, RSV, COVID at bay
- Oops!Something went wrong.Please try again later.
On Wednesday morning, Register opinion editor Lucas Grundmeier caught up with Dr. Tom Benzoni, a local emergency room physician, to talk about the coronavirus pandemic. He has been interviewed for the Register numerous times since the coronavirus pandemic hit Iowa.
Here are previous installments from 2020 on March 31, April 28, May 12, May 26, June 8, June 21, July 1, July 18, Aug. 10, Aug. 24, Sept. 11, Oct. 30, Nov. 16, Dec. 16, and 2021 on Jan 7, Jan. 26, Feb 22, March 22, April 15, May 11, June 1, June 23, July 24, Aug. 15, Sept. 13, Oct. 22, Dec. 4 and Dec. 27.
Here are edited excerpts from the Dec. 14 conversation:
Tell me what you've been seeing in the ER lately.
Everywhere, everywhere, it's absolutely full. Generally, any standard business that had customers lined up out the door would be like, “Wonderful, this is a great problem to have.” Health care doesn't work that way.
This is a system that operates best at about a 50% to 75% load. But when you get the load over 100%, the system gets constipated and stalls. And at some point, it stops functioning. That's kind of where things are now. The demand is so high, the system can’t operate in optimal condition. It's like your car engine; it has a certain torque curve. If you fall off the torque curve by getting your RPMs too high, your engine is going too fast and puts out less power.
Is anything particularly different now compared with earlier in the fall?
You have, of course, increased worries over the three various viruses we have going around — COVID, the flu and RSV. Therefore, you have worried parents and telling a parent not to worry is ridiculing them. That's their job.
When parents worry, they go someplace to get seen with their infant who appears ill. That place may say “Since your child looks so ill, I think you need to go somewhere else where they will do XYZ” or “I will do ABC.” And that is where the trouble may start.
What do you mean?
If a practitioner says “Your child has a viral illness, but I'm not sure so I'm going to put them on an antibiotic/dryg/inhaler to be sure.”
They’ve given the parent the expectation that this magic potion is going to make a difference in the child, which it won't. Plus, you've given the child something that is physiologically active, so it can make the child worse.
The practitioner has created an expectation in the parent that this drug will help, amoxicillin being classic, when amoxicillin has no effect on a virus. So the child can experience all the toxicities and none of the benefits. Two or three days later, the child's not getting better, the parents are getting panicked because the potion isn't working. Antibiotics may make the child worse because they can cause vomiting and diarrhea.
They then go and seek additional care, right? Maybe at the ER.
Now they’ve used two units of health care where one could have been sufficient.
Meanwhile, there’s another child that needs amoxicillin for a bacterial infection, but none is available. We are experiencing an amoxicillin shortage for this reason. So see how it snowballs? Proper diagnosis and treatment advice the first time is important. This is what family doctors and pediatricians do best.
Besides antibiotics, other things that don't work: steroids and breathing treatments.
So what can the hospital do?
Like with treating COVID patients, we can provide supportive care — hydration, nutrition and oxygen if needed.
Are you seeing a lot of RSV?
I've seen lots of RSV over the years, more this year. For you and me, it's red-rimmed eyes and nose running so much that you're afraid you’re going to get dehydrated. Got a little bit of a cough, low fever, but it goes away in two or three days. That is typical for somebody who has had RSV before. If you've never had it before, you have about two weeks of these symptoms.
Infants are nose breathers. If you were to plug a child's nose, they can suffocate. They have to have their nose open. So the infant with RSV is struggling to breathe. Perhaps they have a fever, they have all the snot, they can get dehydrated just from fever and rapid breathing. But now they're not eating because they can't take the time from breathing to eat, and I'll tell you what, eating plays second fiddle to breathing. So this child is already ill, and it's going to be that way for a couple of weeks.
If these children get low oxygen levels and are having more trouble breathing, they end up in a hospital, often in an oxygen-rich environment, rarely on a respirator. If they're not able to eat or drink, they may require hydration either through a tube through the nose into their stomach. Occasionally we use an IV to keep them hydrated and to get them the calories they need.
For very ill children, RSV is indeed a scary disorder. The very elderly and the immune-compromised are very similar to infants. And so the very elderly can get extremely ill and even die from RSV. We currently don't have a vaccine, but there’s one in the works.
Speaking of vaccines, do you know if the current flu vaccine is effective against what's been circulating?
The flu vaccine this year is an extraordinarily good match. It is very effective. People who get flu after getting the flu vaccine have at worst a cold, the sniffles for a day or so, that's about it. So people with good immune systems, ones who can respond to the disease, are doing extremely well with a flu shot.
The last few flu patients I’ve seen who haven't bothered to get a flu shot yet are busy regretting that decision. One told me the other day, “I feel like I've been hit by a Mack truck and the Mack truck looked better after it hit me.”
Just the high fevers, muscle aches, not too many GI symptoms this year. Chest pain; burning in the center of the chest when you take a deep breath is a classic symptom. But the muscle aches are so bad for some of these poor people that it hurts them just to move their eyeballs. Even those little muscles hurt.
Bottom line: get a flu shot.
Many Iowans have not received the newer, bivalent COVID vaccine. Can you explain how that works and your other thoughts on it?
Bivalent means it targets two recent versions of COVID. The original vaccine targeted only one.
The easiest way to understand the bivalent vaccine is to understand how the flu vaccine is made each year.
We studied flu activity six months ago in Australia and South America. The CDC sequences those viruses and sends that information to the pharmaceutical companies. The companies then make a vaccine that matches what's going on in the Southern Hemisphere. Plus they try to accommodate a bit for something that's termed “drift.” That's because having studied the influenza virus for decades, they know what it's going to be like, just a little bit changed.
We’re seeing the same thing with Covid. Over time, it’s going to drift and change. These are called variants. It will probably gradually settle into a little bit more stable form, but it's going to take probably 10 or 15 years before coronavirus number five (COVID 19) is stable in the human population, like the other four coronaviruses.
Is that booster pretty effective against the variants that we're seeing now? Or is it already moving on?
The current booster is most effective in people who have had COVID before and then get a booster. That's been a cool finding. But it makes sense because your immune system has seen the global map of the virus. And now gets told, “Focus on these two sites.” I think in the future, what we'll find is, as the coronavirus mutates, which it should — it's kind of like a fire, it’s looking for kindling — it will find new fuel by generating new sites and seeing if the human immune system can attack them. And if the immune system can't, that's a “successful” mutation. It'll make a lot of false starts, but COVID will occasionally get it right. There will be a new variant. So probably what you'll see is each year, until this thing settles down to a more stable form, is a new bivalent or trivalent booster come out along with the flu shots.
What's the latest thinking on Paxlovid?
The drug itself is working extremely well. It does have a lot of drug interactions, unfortunately. And the elderly, the ones who most benefit from it, are the ones on the most medications it interacts with, but it is still working quite well against the new variants.
The original monoclonal antibodies aren't working as well. But that simply makes sense because they were generated against yesterday’s variants. So Paxlovid has been showing excellent efficacy. It’s worked great for keeping people out of my shop.
That is the goal. You want to keep people well, out of the ER, off a respirator and away from the morgue.
Should we be wearing masks in public places again?
Yes. New cases, hospitalizations and deaths are up.
Any parting thoughts?
You know, there's an expression: “May you live in interesting times.” We're living in interesting times. I'm getting near retirement; I'm going to hate to retire because it's been such an interesting career. But I think that if we can just learn to stop fighting with each other, stop being so easily manipulated during times of crisis (generally for financial gain), we as a nation can do extremely well together.
This article originally appeared on Des Moines Register: Iowa doctor: Treatments, vaccines can keep flu, RSV, COVID at bay
