RSV and flu: viruses that 'compete' with Covid-19

• ADRIAN CORDELLAT

  Madrid

Updated on Friday, December 31, 2021-18: 11

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Dr. Cristina Calvo, section chief of the Pediatrics, Infectious and Tropical Diseases Service of the La Paz University Hospital, Madrid, and

, attends El Mundo as best she can, in the midst of the stress caused by the epidemic of respiratory viruses that affect boys and girls. "We are working one hundred percent. I do not stop," he excuses himself.

After a fall winter season, that of 2020-2021, in which the prevalence of Covid-19 almost eliminated the rest of acute respiratory infections from the map, at this start of the 2021-2022 season many of these infections, such as the Virus Respiratory Symptoms (RSV) or rhinovirus-enterovirus are making a strong return to pediatric hospital wards. "For about a month we have been seeing cases of RSV. It is not like in years before the pandemic yet, but in turn several viruses are coexisting that other years did not circulate together, as is the case of metapneumovirus, which is more typical of spring, "says Calvo, who considers that the fact that RSV has not yet reached levels of other seasons may be due to the fact that

quite important and totally seasonally adjusted.

"It was something absolutely unprecedented. RSV is a winter virus; it has always circulated between November and March, and we have always thought that it needed the cold. However, this summer, although it has not been homogeneous throughout Spain, we have had a RSV epidemic almost like winter ones, and hospital wards full of children with bronchiolitis. The pandemic has changed everything in the world of viruses. "

Perhaps that is why, because the pandemic has changed everything and there is no longer a

, the president of the National Society of Pediatric Infectious Diseases prefers not to launch the bells to the flight due to the lower incidence of RSV compared to the seasons prior to the pandemic.

"We have to see how it evolves. In other countries they have had epidemics even greater than the years prior to Covid-19, so we have to

and be prepared just in case," he explains before venturing that there is at least another month ahead. or a month and a half with quite a few cases. "

Calvo considers, however, that it is "little foreseeable" that the epidemic of viruses such as RSV will increase.

"My opinion is that there has been a

, for the nasopharynx of patients, and Covid-19 has not allowed others such as RSV or the flu to circulate," he argues.

The flu: between calm and fear

Different is the tone and panorama that Francisco Sanz,

,

regarding the common flu

. "The Levante area is always a little behind due to a climatic issue, but the truth is that here for the moment we are calm, we do not have any patient admitted for the flu," he explains.

The pulmonologist, coordinator of the area of ​​Tuberculosis and Respiratory Infections of the Spanish Society of Pulmonology and Thoracic Surgery (Separ), recognizes that in the pulmonology plants there was a special fear of the flu this year - "after a year without circulating, almost all people are without immunity to the flu, we have no defenses against it, so it is a great breeding ground for there to be a good flu epidemic "- but consider that the spectacular increase in the incidence of Covid-19 produced in recent weeks seems to lead to a

. That is, more cases of coronavirus and less of flu.

"In the forums in which experts discuss these issues we play with a crystal ball, but there are arguments both for and against a possible flu epidemic. There are those who point out that there may be more flu circulation and that the The epidemic will be worse than in other years. And those who think that it will not be like that. In fact, in neighboring countries there are no alarms yet, although it is true that it may be a little early with respect to the flu season. But if the growth of infections that we are seeing due to coronavirus continues, surely we do not have the flu or we have very little, "argues Francisco Sanz, who shares the opinion of Cristina Calvo regarding the

in competition with other viruses for the ecological niche.

"All these acute respiratory viruses compete to occupy ecological niches, so when more coronaviruses are infecting people in people's nasopharynx, this leaves no room for other infections such as influenza. Last year, without going any further, co-infection by flu and coronavirus was very anecdotal, "he adds.

Iván Sanz,

not think the same

.

The biologist acknowledges that there seemed to be a certain competitive exclusion between viruses - "as biologists say, two firefighters don't step on the hose" - but he points out that in the current situation it will be difficult to maintain that axiom.

"We are indeed observing flu activity even a little higher than that which usually occurs at this time of year, so this thesis would be a bit taken by the hair because we are seeing that the rest of the respiratory viruses are unleashed, thus It seems that there would not be so much competition. In fact, if we look at the graphs of the Red Sentinel Sanitaria de Castilla y León, we can see that there are acute respiratory infections due to other viruses several logarithms above Covid-19. What's more, any of us it

, because we have all become ill at the same time, "he clarifies. Specifically in relation to the flu, Iván Sanz points out that in Castilla y León they have almost 40 cases of influenza diagnosed in the laboratory, all of them of people admitted.

And, he adds, he is aware of other Spanish microbiologists that in other regions of the country they are diagnosing these figures per week. "I think that when the flu epidemic overflows, it will be difficult for one virus to stop the other. It is true that Covid-19 and flu co-infections were very rare last year, but the flu is then it did not circulate. So we cannot guarantee that this competitive exclusion will occur this year ", reflects the biologist, who recalls that

, although with current data this year It might even be a little ahead of it.

Based on these trends, which according to Iván Sanz are also being observed in all the countries of the northern hemisphere, it could be said that

marked by Covid-19, the old normality in terms of respiratory viruses and influenza returns to prevail. "We already have data to think that we have returned to the figures prior to 2019, and perhaps even a little more than normal, although without exaggerating, for now. The 2020 situation of complete absence of respiratory viruses is over," he says, and He claims to fear not so much the common colds caused by other respiratory viruses as the fact that this boom joins the peak of the sixth wave of the pandemic and the peak of the flu epidemic.

"With the omicron variant, the flu after two years without circulating and other respiratory viruses dancing can create a perfect storm that could be potentially stressful for an already exhausted healthcare system."

Whether or not this situation finally occurs,

that the most important thing of all is to take preventive measures.

Among them,

: vaccination.

"The best we can do is to get vaccinated against the flu, especially people with underlying diseases or who are included in risk groups for flu vaccination," says Francisco Sanz.

In this sense, Dr. Amelia Carro,

, recalls that influenza epidemics are correlated with an increase in the rate of myocardial infarctions: "It is a direct aggressor , but also indirect, since it forces the heart to work much harder than it is sometimes capable of, which can trigger an arrhythmia or lead to myocarditis, which is more frequent in young and apparently healthy people ". The interrelation of influenza with cardiovascular diseases also goes beyond the moment of infection.

And it is that, even after the flu, the

continues to be higher in the following years for these patients. The vaccine, as the expert explains, is essential to mitigate these risks.

"Vaccinating for the flu reduces cardiovascular risk by between 15 and 45%; a percentage of risk reduction comparable to that of statins, antihypertensives or smoking cessation," he explains.

To the

, Iván Sanz adds the need to continue adopting individual and collective protection measures such as masks as much as possible.

"Outdoors they don't make much sense, but indoors they do, especially if we are with a person who is at risk or if we notice respiratory symptoms. The flu and RSV are often asymptomatic, so it is very difficult to anticipate, but whenever we notice symptoms we have a duty to protect others ", he concludes.

RSV, a risk for children under six months

Hygienic and protective measures partly prevent the transmission of respiratory viruses. However, as Cristina Calvo recalls,

. And precisely babies, especially those under six months, are the most susceptible to Respiratory Syncytial Virus, which begins, like any cold, with mucus and cough, progressing to bronchiolitis.

"The worst thing about this virus is that it affects completely healthy children, and it is those under 6 months of age who, above all, can become very ill and need hospitalization, sometimes in intensive care. And as if this were not enough, the Children who have serious symptoms and who need hospitalization are later at greater risk of suffering similar episodes throughout the first years of life, and even of developing long-term asthma, "he explains. RSV is manifested above all by a

minor's

.

And that, precisely, is the main symptom that can give the

, in which case they should not hesitate to consult their reference doctor. "Young infants tend to breathe quickly and sink their ribs and gut to breathe, they can even make respiratory pauses. They can also refuse feeds, be more irritable and have a fever, although not necessarily. Older children, on the other hand, tend to to have a bronchitis with wheezing, "he lists.

Although there are now many studies and clinical trials underway that could soon find a solution for this virus - most of them to prevent or immunize children against RSV - the truth is that RSV does not currently have a curative treatment, so the only thing that can be done during the admissions is to

, hydrate them and alleviate the symptoms with oxygen when they need it.

According to the criteria of The Trust Project

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