Should we wear a mask during the holidays to avoid COVID, the flu, RSV? Advice from a UNC doctor

With RSV, influenza, and COVID circulating, should we go back to wearing masks at large gatherings over the holidays, or are we safe to forgo face coverings if we get vaccinated?

The News & Observer spoke to Dr. David Weberassociate chief medical officer at UNC Medical Center and medical director of UNC’s Infection Control Department, for more on this season’s viruses.

Should we wear masks at holiday gatherings this year?

Particularly vulnerable people – such as people with underlying immune disorders, organ transplant recipients, people with cancer, the elderly – should consider wearing a mask when they congregate outside their typical home bubble, Dr. Weber said.

COVID, RSV and influenza are all droplet-borne diseases by environmental transmission. They thrive in lower temperatures with low humidity – our current winter environment.

Most hand sanitizers and household cleaning products kill all three viruses. Don’t underestimate good handwashing and hygiene practices this holiday season, Dr. Weber said.

“You can absolutely wear masks while traveling, but that’s not your greatest risk of catching and spreading these diseases. It all depends on what you do once you get to where you need to go,” he said. “Spending time in large crowds, eating and mingling in close surroundings. This is what will put you in the most danger.

Is COVID, RSV or the flu the biggest concern this year?

COVID is by far the biggest concern right now, Dr. Weber said.

RSV, or respiratory syncytial virus, spiked in September and October but softened. The most significant flu peak occurred from late October to November and has also subsided.

RSV and influenza are going down, while COVID is going up, he said.

“The latest data shows that test positivity has increased by 10%, hospitalizations have increased by 15% and deaths have increased by 60%,” Dr. Weber said. “We lose about 100 people a day to car crashes and gun violence, and we lose about 400 people a day to COVID. That’s more than double the other two leading causes of death combined.

Additionally, new variants of COVID render certain treatments such as monoclonal antibodies that have worked well in the past, obsolete.

The antivirals work and the vaccine is still very effective in preventing hospitalization and death, but not as strongly with the introduction of these new variants, he said.

How do you know if you have COVID, RSV or the flu?

Since the symptoms are so similar between these three diseases, you can only know for sure which one you have by getting tested.

UNC has 4-plex tests — which check for all three diseases at the same time — to determine which treatment you need.

Symptoms usually begin with a sore throat or runny nose, followed by congestion, coughing, and sneezing. All three can develop pneumonia, and other common problems, especially in children, can include nausea, vomiting, headaches, and diarrhea.

It is possible to have more than one disease (or even all three) at the same time.

Treatments: COVID and flu approved vaccinations, RSV did not. But high-risk infants can be given a long-acting monoclonal antibody to prevent RSV. Influenza treatment can be given to infants 14 days and older, and COVID treatment can be given to infants 28 days and older.

What is RSV?

RSV (or respiratory syncytial virus) is a common virus that generally increases each winter, although its peak in our region occurred a few months earlier.

Anyone can get RSV and get sick, but it’s especially a problem in premature infants and older adults. Most of those who catch it recover in about a week.

RSV is spread by droplets through environmental transmission: “If you rub your nose and then touch something in the house, then I touch that same place and rub my nose, I have a good chance of catching the RSV,” he said.

RSV is most commonly transmitted through coughing and sneezing.

There is no vaccine to prevent RSV, but there are antibody treatments (particularly effective for young infants) if you develop it.

The infection and death rate for RSV resembles that of the flu, so it’s a common disease to be taken seriously, Dr. Weber said.

This story was originally published December 20, 2022 2:02 p.m.