How to protect yourself from a triple-threat of viruses this holiday season

A triple threat of viruses has some health officials warning about a "tridemic" this winter season as influenza, COVID-19 and respiratory syncytial virus (RSV) surge at once.

Medication could be key to treat some of these viruses and keep people out of hospitals, especially those who are immocompromised, have multiple medical conditions or are elderly. 

Dr. Peter Lin spoke to CBC's Information Morning Halifax on Thursday about how people can best protect themselves from viruses this winter season, and how treatment options like Tamiflu and Paxlovid work. 

This interview has been edited for length and clarity. Listen to the full interview here:

If you have the flu, what are your treatment options?

Well, we all know [to rest and drink] and fluids, right? So we have high fever. You lose a lot of water, so you need to keep hydrated. Acetaminophen, ibuprofen, Advil, they all help. These latter two are anti-inflammatories. They can irritate the stomach lining. So if you have stomach ulcers we want to avoid these. They can also thin your blood. So if you're on blood thinners, just check with your pharmacist before you start these things. They can also slow down blood flow into the kidney. So if you have kidney disease or you have diabetes, we should avoid anti-inflammatories. 

Now Tamiflu is specifically designed to go after the influenza virus. You've heard about the H1N1. It sounds like an alphabet soup, but the "H" actually stands for hemagglutinin, which is the key that the virus uses to get into your cells, very much like the spike protein on the COVID virus is key. The "N" stands for neuraminidase and this is a pair of scissors that cuts the string that holds on to the virus.

Once the virus is fully made, the string is cut and then the virus can go infect other cells in your body and other people. Now Tamiflu blocks that pair of scissors, so no cutting and the virus gets attached. It can't leave and that's why you need to take the medicine within 48 hours of symptoms. Otherwise, the virus will have made millions of copies and release them all and then it's too late.

Most of us do not need Tamiflu, our body will fight it off. But for the elderly, [people with] multiple medical conditions, immunocompromised, they need some help because in the end this is a war. Anything that slows down the other side would be helpful. If you belong to one of those high-risk groups and you get the flu, contact your health-care team quickly to see if Tamiflu might be helpful to fight the war for you and then hopefully keep you out of hospital.

They need some help because in the end, this is a war. Anything that slows down the other side would be helpful.- Dr. Peter Lin

For COVID-19, we've heard about Paxlovid for high-risk people.

Paxlovid is actually two medications taken together. The first one is the thing that blocks the scissors. The second medication is meant to block the first guy from leaving the body and so that way it keeps it there so that you can just take it twice a day as a pill. Otherwise, we would have to send you to hospital, hook you to an intravenous to give you the medication.

However, by blocking that guy from leaving, you are also blocking other medications that you're taking from leaving. Keep a list of your medications so that pharmacists can go over what you should cut back on the dosing to make sure that we keep all the other medications at the proper level. Now, again, most of us will not need this medication, but if you're elderly, immunocompromised, then it will help slow down the virus and maybe that'll keep you out of hospital.

People tend to want to take antibiotics when they get sick. That's only appropriate in some cases, right?

Right. When there's a bacteria, antibiotics will work. We use different antibiotics for different types of bacteria. Strep throat is the streptococcus bacteria, and that's been making news in the U.K. because eight kids died from strep throat. That's unusual, because we have penicillin and amoxicillin that kills streptococcus. 

And yet we're having these deaths. So it turns out perhaps [the coronavirus variant] Omicron is a problem because it attacks the throat, so it gives you lots of sore throats. So now we have lots of Omicron sore throats. A kid with a strep throat pain might get lost amongst those Omicron sore throats. And we don't give antibiotics to Omicron kids, right? So therefore that strep throat kid might get mixed up in there and not get the antibiotics.

Pneumococcus is a bacteria that causes pneumonia, lung infection, and the virus weakens you. Then the bacteria comes and joins the party. So sometimes you hear people, I was getting better and then I got hit again. If you get hit a second time, there's a higher chance that that's bacterial. In that case, antibiotics may be helpful. So if you get hit twice, then get checked for the bacterial infection.

OK, good advice. Is the advice different when it comes to kids who are at high risk?

Kids, unfortunately, have been getting hit hard because their immune system hasn't been to many wars. Every virus is new to it. We do have flu vaccines and COVID vaccines that could train their immune system. But many kids have not been vaccinated. For RSV, there are no vaccines yet. Basically our kids have untrained armies and they're going up against this virus and bacteria that's been doing this stuff for millions of years. They know exactly what they're doing and our kids' armies are rookies trying to figure things out in the battlefield. That's why they're doing so poorly. 

As far as treatment, Tamiflu is for one year and older. Paxlovid is for adults only right now, 18 and above, so nothing for kids. If you're under six months, the vaccines don't work very well. They don't build those antibodies. That's why flu and COVID vaccines are not for kids under six months. So they're completely exposed. That's why when there's a lot of virus in the community, the youngest kids get hit hard because they don't have any defences. They have nothing to rely on. 

In the US, just after Thanksgiving, there's been this surge of cases and hospitalizations after people got together in large numbers. We've got Christmas coming up. I would imagine your advice would be to be careful around that especially leading up to it.

We have hospitalization doubling in the United States. They have flu, COVID, RSV, all of them. Some patients have two of them. It makes sense, right? I suck in the flu virus from you. I go talk to somebody else. I suck in the COVID virus from them. And now I'm fighting two wars. So think about defending your castle. The moat is the distance, the drawbridge is your mask and vaccinations will build up the army inside your body.

For kids, their castles are not well protected, so stay a little bit away from them so you're not carrying the viruses to the young folks and to the elderly.

Eating time is the highest risk because that's when everybody is sucking in a lot of things. Group people together in the same bubble during eating time and then once you're finished eating, they put on their mask and they can continue to socialize. Hugging, just hold your breath so you're not blowing out virus and you're not sucking in virus.

I know I sound like doctor doom and gloom, but I do want people to have a good time without getting sick. They always talk about protecting the hospital capacity. I say no, protect people. If we protect people then they don't need the hospital.

We have flu, COVID, RSV running really high in the community. So have fun but just think about defending your castle, watch out for the little people and old folks. We don't want to have a disaster after the holiday. 

If you're still self-conscious about the mask, just tell people I'm looking after so and so who's really elderly and frail and most people say, 'Oh, that's really good of you,' and then they won't bother you about the mask.