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Brian Lehrer: Brian Lehrer on WNYC. For the parents among us currently raising kids, you will probably relate to this Washington Post headline from Tuesday, "RSV, COVID and the Flu are Keeping Kids out of School and parents out of work." The headline goes, and then the article says, "Workplace Absences for childcare reasons rose to an all-time high in October according to new data from the Bureau of Labor Statistics, that marking number in that article is 100,000. Americans missed work at some point last month because of childcare issues, even more than at the height of the pandemic," The Washington Post says

It's the huge number of sick kids plus labor shortages in childcare and education. What is this virus, RSV, that's filling up hospital pediatric wards and how can we prevent and manage it. With us now, Dr. Daniel Griffin, MD, PhD, infectious disease physician with a PhD in molecular medicine, a researcher at Columbia, chief of the division of Infectious Disease at Optum, and I'll say that there is a virology geek Daniel Griffin fan club that has developed during COVID for him as co-host of the podcast This Week in Virology.

Also, he's president of a nonprofit organization known as Parasites Without Borders, which sounds like a bad thing, but is really a good thing. He's been one of our most frequent COVID guests during the pandemic, and he'll talk with us now about this triple whammy moment. Dr. Griffin, always good of you to give us some time. Welcome back to WNYC.

Dr. Daniel Griffin: Thank you, Brian. It was a pleasure to be on and I appreciate the fact that the media is raising awareness of about RSV. This has been a problem for many years. It's great that people are aware, hopefully, that awareness is going to translate into a better winner than it could have been without that education.

Brian Lehrer: Yes. By the way, Parasites Without Borders sounds like something Vladimir Putin should belong to but never mind.

Dr. Daniel Griffin: [laughs] Okay.

Brian Lehrer: All right. RSV, Respiratory syncytial virus. I think I'm saying it right. What is it and is it new like COVID-19 was three years ago?

Dr. Daniel Griffin: It is not new. It is new as far as being on people's radar. I think that's a great question. My mom always gets the letters mixed up but wants to know what's this new virus that we're all hearing about. For a lot of people, this is the first time they're hearing about it but for those of us in healthcare, this has been a virus that's been with us for well many years and just to give people context. It's a respiratory virus. You get it.

Slightly differently than COVID, actually, I'm going to say, not only to get this by breathing but you can actually get this much more through contact so those of you that stopped washing your hands it's time to start washing those hands again. It is actually a major cause of death in children under age five and a major cause of hospitalizations for the little children. Around the world, we see over a hundred thousand deaths in children under five each year. In the US, we see between 103 hundred deaths in children under age five every year.

A misnomer and I think people need to know this, it doesn't just affect children. We see between five and 10,000 deaths every winter in adults, 65 and over and as I get closer to 65, I'm starting to appreciate that more as an issue. This is a virus that affects all ages. Every winter it causes problems with hospitalizations in children, thousands of hospitalization and as we're seeing right now, some of our pediatric units are overwhelmed with just the number of cases we're seeing.

Brian Lehrer: I see on the Centers for Disease Control website that the very youngest among us, babies less than a year old, are perhaps those most at risk for serious RSV complications. Is that your experience or understanding?

Dr. Daniel Griffin: Yes. We have a lot of ideas why, but it's really the first year of life, really the first six months that children are the most vulnerable, that we're the most concerned about them. I was just communicating with Jay Berger, the head of our pediatric group at Optum, just keep changing our name and we just had a six-month-old girl who just made it out of the hospital but, no, the youngest are really having the toughest time with this.

Brian Lehrer: Which sounds the opposite of COVID, where cases and children have tended to be mild. I guess we shouldn't assume that viruses would act alike just because they're viruses, but clinically speaking, what's the difference between the two that they would affect the same age group in different ways?

Dr. Daniel Griffin: Yes. I think that this is one of the reasons you're not seeing a lot of, I'll call them RSV deniers. I haven't run across an RSV denier yet. It doesn't look good to downplay a disease that is really, a problem for babies, for children. I don't know if we know exactly what the difference is as far as the mechanics and that's been actually a challenge for us. We very quickly came up with a vaccine for COVID, my gosh, within about a year. RSV we've been working on vaccines for decades and it's only now that we're actually starting to understand and have about four candidate vaccines that, hopefully, will be tools for us in the future.

Brian Lehrer: This is a decades-old disease but suddenly, it's big in the news now, and a lot of people are hearing about it for the first time. What's really different this year?

Dr. Daniel Griffin: The big thing that's different this year is just the overwhelming numbers. We are seeing this just skyrocket in cases. We're seeing to the point where just last week every single pediatric bed in Rhode Island was full, down there in Philadelphia. They actually had set up tents. It's the winter, we're setting up tents because the hospitals are being overwhelmed.

Brian Lehrer: Wow, really got to that point?

Dr. Daniel Griffin: Yes.

Brian Lehrer: Why is it spreading so much more rapidly, so much more far. Why this year than in other years if it's the same virus?

Dr. Daniel Griffin: Yes, we have a number of ideas and one of it is really, we call it the pandemic fatigue. People are tired of isolating, people are getting back to work. People are getting back together. Human beings like to be around other human beings.

We also are concerned that because it's been a couple years without exposure, that there may have been some drop in the amount of residual protection from getting infected the year before but this is just RSV, all our respiratory viruses are surging. Influenza is surging to the point we had to give it a new color this year, this dark purple. This is a problem for a lot of our contagious diseases.

Brian Lehrer: What does that mean, give it a new color.

Dr. Daniel Griffin: Oh, so there's a CDC map where if you have a lot of influenza, you get dark red, and apparently, we have so much influenza in parts of this country that they have introduced a dark purple.

Brian Lehrer: Wow. You think that this triple whammy COVID is still circulating, but the flu so much more than most flu seasons RSV, so much more than most RSV seasons. It's because people are gathering with abandon after the height of COVID.

Dr. Daniel Griffin: [laughs] I don't want to be judgy, Brian, I don't want to say with abandoned. I like to be reasonable, people like to be around other people and it's been hard for the [unintelligible 00:08:05].

Brian Lehrer: I wasn't saying that with a value judgment, but it's a question of volume, are people really getting together more than they did in 2019 before COVID and touching each other more and touching surfaces more and breathing in each other's faces more. It's hard to imagine.

Dr. Daniel Griffin: Maybe it just seems like that to me as an infectious disease doctor who always draws back when someone comes within my three-foot circle. Now, there's probably a number of factors going on here.

Brian Lehrer: You mentioned that it spreads on surfaces, so wash your hands, wash your hands, wash your hands. Is it also aerosolized like COVID? That is, can it stay in the air for minutes to hours even after an infected person has left the room?

Dr. Daniel Griffin: Yes. I'm glad you bring this up. There's this history of medicine, this distinction between contact and then we even take respiratory, we break it in half. We're like, well, there's the droplet, these large things that you have to be within three to six feet, and then the aerosol, which is a smaller circulating around.

I think that there's a historical baggage to that distinction in respiratory. We still talk about RSV, most of the contagion being within that three to six feet but influenza, RSV, a lot of our respiratory pathogens. If you are in a poorly ventilated suburban home, people are all getting together about that upcoming Turkey holiday that will be here before we know it, the holidays in December, there can certainly be a component of transmission that occurs even if you're that six feet away if the ventilation is poor. A lot of us are really pushing not towards bringing the mass back but let's keep doing what we've been doing about ventilation and hygiene and everything else.

Brian Lehrer: Listeners, your questions. Welcome here about care and treatment and prevention of RSV or the triple whammy moment, we're in with RSV, COVID, and the Flu. 212-433-WNYC, 212-433-9692 for Dr. Daniel Griffin, researcher at Columbia, chief of the division of Infectious Disease at Optum and co-host of the podcast This Week in Virology, 212-433-9692 or you can tweet your question or comment @BrianLehrer. One of the bad things about COVID is that it can spread while you're asymptomatic. That's the reason for all this testing before we interact with people, even if we don't feel sick. How much can asymptomatic people spread RSV?

Dr. Daniel Griffin: That's reassuring. We do not think there is as much of this asymptomatic or presymptomatic transmission with RSV. We really think and this is, hopefully, going to save us, to some degree, that it's when you're sick, it's when you're coughing, it's when you're not feeling well that you're spreading RSV. I know everyone wants to get back to work, but if you're sick, then it's not a great idea. We had a conversation recently with our urgent cares every Wednesday.

All the tri-state urgent care physicians get together and they suffer through my weekly update just talking about when someone goes to an urgent care, before we used to say, oh, it's just a virus. Now we want to know it's just a virus and it's RSV knowing that, hey, you got to be careful. You don't want to put those children at risk, your nephews, your nieces, your children or even the senior folks that you spend time around. We're starting to appreciate just how important it is to not be part of the transmission cycle.

Brian Lehrer: You said something about a vaccine earlier. I had read that there's some success now toward an RSV vaccine, but should I assume they're not going to have anything for this season?

Dr. Daniel Griffin: That is correct. There are a number of vaccines that look really promising. One of the things and I think this relates right into who do we worry most about the babies. There's some work showing a vaccine given to pregnant individuals during that last trimester. Can potentially give children during that critical most dangerous six months of life protection. We're looking at vaccines for pregnant individuals. We're looking at vaccines for children. We're actually looking at vaccines for adults. Remember those thousands of adults dying of RSV this winter just here in the US?

Brian Lehrer: Julie in Brooklyn, you're on WNYC with Dr. Daniel Griffin. Hi, Julie?

Julie: Hi and thank you for taking my call. I appreciate it. I'm a longtime listener and thank you for everything you do. My question is this, my daughter and son-in-law have a two-week-old newborn, they're marathon runners. One has entered in the marathon in Philadelphia and they would like me to go with them and take care of the baby, but outside among the spectators to the marathon. My worry is this might not be safe for the baby. I'd really appreciate any response that you have.

Dr. Daniel Griffin: Okay, great. Julie, thanks for asking this question because that's what I worry about sometimes is people are not sure what is safe, what is not safe, and that education can, hopefully, keep us safe. A couple things, one that Brian intimated there is that it's sick people that spread RSV. Someone who's feeling well, who's out there watching the marathon, if they're not coughing, they're not sneezing, they're unlikely to be transmitting, they're unlikely to be a danger for the child.

The other is outdoors. Outdoors is great. Then also there's going to be a little bit of judgment there. When you're watching that marathon, particularly you're baby going to want to get in there to be able to see the parents go by. When you get into that really densely packed crowd, you start to get to the point where the outdoors and the dilution effect is losing some of its protection there, but know outdoors continues to be very safe. This is, fortunately, something that is usually being spread by someone who has symptoms.

Brian Lehrer: Julie, thank you for your call. I hope that was helpful. What precautionary measure should people in circumstances in which they're around a lot of kids or a lot of kids are gathering take? As you mentioned before, we're not going back to widespread masking in schools. We're certainly not going back to remote learning in a widespread way, but you mentioned ventilation and in lots of places, that's nothing more than opening the windows and making the classrooms cold at this time of period. Are there best practices for preventing RSV transmission where kids gather like in schools or childcare facilities?

Dr. Daniel Griffin: The best practice, opening the window. I understand it's cold, but that good fresh air is helpful. There was a lot of funding for upgrading ventilation systems. I'm not sure how much that was taken advantage of, but also, a lot of this is transmitted through contact. Again, back to that cleanliness is next to godliness. That washing your hands. Then the other and this is I know a challenge because that's what we started off with over a hundred thousand folks missing work.

We're starting to stay home and keep our kids home when they're sick and that prevents this from snowballing. A lot of really the common sense, hopefully, what has become in common sense over the last couple years during COVID, washing those hands, using those alcohol sanitizers, those work as well, cracking those windows, letting a little fresh air. As we're [unintelligible 00:15:58] be my chance to give you advice about, Thanksgiving which is on the horizon.

Leave those fans on instead of auto, so you're getting more air circulation in those suburban homes. Doing all we can to decrease this. RSV is here, it really is very good at spreading. We're going to see RSV, but what we want to do again is flatten this curve. We don't want to be overwhelmed, if your child gets sick and needs to go to the hospital, we want there to be a bed there.

Brian Lehrer: Sophia Rose in Caldwell, New Jersey you're on WNYC. Hello, Sophia Rose.

Sophia Rose: Hi. Long-time listener, first-time caller. My question is, I recently started working in early childcare and we're told that if you don't have a fever and you come and masked, we should be okay. However, I know you were saying that it's important to not be part of the transmission cycle. If you are having symptoms but you don't have a fever, do you still think it's safe for us to be around children when we're masked, or is that still posing a risk?

Dr. Daniel Griffin: I'm not sure where this comes from, you have to have a fever before we consider you sick. You have to prove your illness with an elevated body temperature. I still remember a very vivid memory of myself as a high school being really quite sick. I was at a boarding school going to the school nurse and they had that very strict rule and she's like, "I'm really sorry, unless I can document a temperature, you must go to school."

I proceeded to vomit all over the nurse and apparently, that qualified. If you are not feeling well, a fever is not the only thing that tells us that you have an infectious problem, wearing the mask, washing the hands. It's this difficult balance between continuing to work and be there and not being part of this transmission cycle, which, ultimately, ends up putting us in situations where we are right now.

Brian Lehrer: Yes because this is where it gets back to that article I started with from The Washington Post where the large number of parents who are out of work because they have sick kids, is intersecting with the labor shortages that already exist in early childcare facilities and even in schools, according to that article. There actually becomes a balance like there is in healthcare facilities, when do you stay home or when do we need you so badly that come in anyway, but protect yourselves and protect your patients from you as much as possible, right?

Dr. Daniel Griffin: No, it is a challenge. I'm still in the situation where when I'm working in the hospital, I'm wearing an N95 from the time I enter the building until I leave. That's to protect me, but also is to protect our patients. This is a challenge I have to admit that's getting quite old and seriously impacting my job enjoyment. These are the realistic challenges that we struggle with.

Brian Lehrer: We're going to take a short break and then come back and finish this up with Dr. Griffin, with a couple of questions that are coming in about RSV vaccines that people say have been available. There's also a little piece of a COVID conversation that I want to have with you about this at this moment that's being described as a triple threat or triple whammy with RSV, flu and COVID. Stay with us, Brian Lehrer on WNYC with Dr. Daniel Griffin.

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Brian Lehrer on WNYC, going to get our near-the-top-of-the-hour legal ID in here, it's 10:57, and this is WNYC FM, HD, and AM, New York, WNJT FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are New York and New Jersey Public Radio and live streaming at wnyc.org.

As we continue for another few minutes with Dr. Daniel Griffin, researcher at Columbia, chief of the Division of Infectious Disease at Optum, president of Parasites Without Borders, and co-host of the podcast, This Week in Virology, as we talk about the triple whammy moment of so much RSV filling up pediatric hospital units plus a lot of flu and still COVID. Here are two questions that have come in on Twitter.

One of them says, sorry, Twitter moves pretty fast. This says, well, here's the one I really want you to answer. I had a preemie baby 14 years ago and spent weeks fighting insurance to cover the RSV vaccine that was available to us then, is that vaccine not available anymore? Also, is it worth mentioning that preemies are particularly at risk? That is true about preemies, right? Then talk about the vaccine.

Dr. Daniel Griffin: Sure. Vaccines, we're used to the vaccines where we get an injection and then our body produces the antibodies. There is the other, it falls into the passive vaccination where we actually give an individual the immunoglobulin, so there is an immunoglobulin for RSV, and that's probably what's being referred to here. The RSV-IGIV and that can be a challenge to get access to.

The traditional vaccines that we're used, those are not yet available and in testing. Let me give a bit of a history, maybe we felt like, boy, vaccines are so easy to create. It only took us a year, but unfortunately, the history of the traditional style vaccines where you get that injection, your immune system gets you protection, that was set back when we didn't quite understand enough and early trials showed that actually, we were making things worse. Now we've got about four vaccines that are looking really promising.

Brian Lehrer: Somebody else writes, can you ask Dr. Griffin about the new mRNA RSV vaccine from Pfizer? Is that a real thing?

Dr. Daniel Griffin: We actually have three different types, four different types of RSV vaccines in development. We have mRNA vaccines in development. We have protein subunit vaccines in development that's like your novavax. The mRNA is like your Pfizer and Moderna. We have the traditional attenuated type vaccines and we have the adeno vector. There's a bunch of different ones out there and we are seeing really encouraging data. Not this winter, but maybe next winter.

Brian Lehrer: Before you go, let me get your take on where we are with COVID right now as we approach another season of holiday gatherings. The New York Times had a story the other day called, As the Pandemic Drags on Americans Struggle for New Balance, and it says, as offices, restaurants, and schools fill up, people are adjusting expectations and habits and another moment of deep uncertainty. It quotes the White House COVID advisor, you know Dr. Ashish Jha saying, "We shouldn't act like it's 2019, but we also shouldn't act like it's 2020."

The article points out that more than 300 Americans per day are still dying of COVID, tens of thousands are hospitalized on any day. It leaves us with the question, how do individuals find the right balance of risk aversion and normality in this phase of the pandemic? I don't know if you as an infectious disease physician can answer that question. We might need a psychotherapist for each different listener with everybody's different risk tolerance. Do you have anything to say about the latest moment in what The Times calls the struggle for a new balance?

Dr. Daniel Griffin: I think that the best way my advice on how to best deal with this is to deal with it with honesty, to follow the science. We can't just decide, I'm done with this and then I'm going to decide it's not a problem. We still have over 2000 people dying every single week from COVID, and when did that become something that we don't care about? I hope that never happens. We need to be honest about who's at risk and what can we do. Ashish Jha actually really said, boy, if we approach this intelligently with the science and tools we have, we should not be having 300 people dying a week. That number might be 30 or 40.

Brian Lehrer: A day?

Dr. Daniel Griffin: Yes. Sorry. That number should be down to 30 or 40 a day. How do we do that? Number one, the vaccines are incredibly effective, but the other is early treatment. We know who those high-risk individuals are. They're individuals who are older, they're individuals who have medical problems. If you can jump in with early treatment, forget about the Paxlovid rebound, just think about the Paxlovid reduction in chance of death or hospitalization being somewhere between 70% to 90%.

What is the common denominator in people that end up dying of COVID? It's that they did not get all the tools that we have brought to bear on this disease. We can go forward but we can go forward with our head in the sand with 300 people dying a day, or we can follow the science and that number can be greatly reduced.

Brian Lehrer: All of you with Long COVID, who are not on the verge of death but are struggling and struggling and struggling, we see you, and that obviously is another risk from getting it at all. Do you, as a virologist, see any arc in which this really goes away, or is this level of risk of death and long COVID going to be with us for years now as the backdrop for our choices? Because I think it really affects people's choices.

At the beginning of the pandemic when we really thought it was temporary, people were much more willing to isolate themselves. Now, I think for a lot of people, the choice is, if this level of risk, even though it's certainly not 2020, if this level of risk is going to persist for years to come, then they're probably choosing to open themselves more than they would have if you say this is going to end at the end of this winter.

Dr. Daniel Griffin: Maybe that message had a certain amount of traction early on, you only need to do this for so long. That was true until we got our vaccines, that was true until we got effective antivirals, which we now have. If you put all these tools together, yes, COVID is here to stay. This will be part of the backdrop, but I do not see us ever here in the US getting back to the 3,000 to 5,000 deaths per day.

For those folks that didn't decide to get vaccinated, there is a protection that we see from people who've survived that first bout. Unfortunately, as we're seeing those second bouts are not innocuous. Then I think we really need to embrace instead of 3% to 4% of eligible people getting antivirals, if we can really roll that out and make it as common as getting your amoxicillin for your strep throat, your Tamiflu for influenza. Once it becomes more standard, I think that we can really move forward in a positive way.

Brian Lehrer: Last thing, about testing, as that day that you refer to before as a day coming up where a lot of people eat turkeys and a lot of people are going to watch the Giants play the Cowboys. Testing as the other very effective but imperfect way to protect yourself and the people you gather with, how good can you say at this point that the rapid tests are at picking up an asymptomatic infection before you go into Thanksgiving dinner?

Dr. Daniel Griffin: Yes, I think that that's the right way you couch that there, Brian. These are imperfect, but don't let imperfect stand in the way of perfect or however that expression goes. Now, before we gather, the same things we've learned from the past, we do not need to have a massive surge after Thanksgiving, coupling testing before we get together with individuals who are high-risk, staying home if you're not feeling well, remember it's not just COVID, it's all this other stuff out there, ventilation and all the rest. I do think that those rapid tests, before we go to these gatherings, they certainly can reduce your risk of being that presymptomatic or asymptomatic person who's going to create a super spreader event.

Brian Lehrer: Right. I get that reminder that it's not just COVID. If you have some symptoms and you give yourself a COVID test and you're negative, you still might have RSV or the beginning of the flu, so also don't go. Right?

Dr. Daniel Griffin: Exactly.

Brian Lehrer: Dr. Daniel Griffin from Columbia, Chief of Infectious Disease at Optum. Is that what they call ProHealth now? Optum?

Dr. Daniel Griffin: Yes. We've now been renamed. We're now Optum, Optum Tri-State

Brian Lehrer: President of the group, Parasites Without Borders, and co-host of the podcast This Week in Virology. Thanks as always for so much good information. We really appreciate it.

Dr. Daniel Griffin: Oh, thank you so much. Brian and everyone, else be safe.

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