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COVID-19 Update 12/14: COVID, RSV, Flu, Boosters, and More

December 15th, 2022 | 5 min. read

By Steve E. Bishop, M.D.

COVID-19 Update 12/14: COVID, RSV, Flu, Boosters, and More

In this COVID-19 update, Dr. Steven Bishop discussed the increase in cases of COVID, RSV, and the Flu, and he provided an update on the COVID boosters and the use of Paxlovid. Watch the update below or read on for the full recap. 

Case Updates: COVID, RSV, Flu

I think we are seeing a surge and we're seeing an uptick in numbers, but that's been commensurate with an increase in both flu and RSV. We had a surge in late November. It's bottomed out a little bit, and then we're having a little bit of an uptick again, and I think the numbers coming out of the Virginia Department of Health pretty much bear that out.

We're seeing a fair number of cases over the last few weeks that have sort of dipped and came up, and we're kind of going through another little hump again probably over the next seven to 10 days, I would guess. That is pretty much what you would expect to see for a seasonal respiratory virus.

Again, I think this really shows us that, for the most part, COVID's been integrated, for good or ill, into our normal respiratory virus milieu, so to speak.

It's here to stay. It's not going anywhere. We're going to keep seeing cases throughout the year. There'll be peaks and spikes, just like we have been saying for a long time, and we're going to go through an uptick in the fall and the winter like we do with the flu and some of the other things.

RSV Update

Now, one thing that has been a little bit unusual this year is the number of RSV cases. They are pretty high. RSV is a respiratory syncytial virus. It typically affects children, for the most part, very young children. Not always, but generally young children, and RSV can cause asthma exacerbations and asthma-like symptoms in young children, especially.

Adults and older kids can get RSV as well. The symptoms tend to be much more minor. And so the bottom line is there's really no good way to tell the difference clinically between RSV and COVID and the flu.

They can have overlapping symptoms. There are some minor differences in terms of the symptomatology, but for the most part, it's very hard to tell them apart except by testing results.

That's why frequently now what you're seeing is, especially if it's a sick kid, you're getting testing for all three things to figure out which one it is and which of the ones it is not.

We're going to continue to see that. We're probably going to have another peak here in January or February of that over the next couple of months. And again, that's a pretty typical RSV season.

What's been a little bit atypical is the number of cases we saw in October and November. That's been a little bit odd compared to prior years, but again, ever since we had the start of the pandemic, these normal respiratory virus seasons seem to have shifted for various reasons. Who knows?

That's probably partly from the lockdowns, partly from masking, partly from other behavior changes we've seen these shifts in the seasonality of some of these viruses that we've had over time.

COVID Booster Data

We've had just a little bit of data come out related to COVID boosters, and I think, unfortunately, it's really not that great of news on the COVID boosters, the bivalent boosters.

They seem to work about as well as the older boosters, which is to say they weren't great. They do provide some protection. It's about on par with the flu vaccine in terms of how well it works compared against the flu. These vaccines work about as well against COVID as the flu vaccine does against the flu, so you do get some protection, about 60% protection in the first month, and then it does wane pretty rapidly over about a three to four-month period, with only about a 20% protection remaining after a few months.

The bottom line is that if you are a high risk for COVID, it's still a good idea to get a booster, especially at this time.

Again, if you've got a lot of medical problems, if you're over the age of 65, definitely worth considering chatting with your doctor and asking whether it's a good time to get a booster.

Otherwise, it's a little bit harder to tell. You're going to want to get specialized one-on-one advice from your physician on whether it's a good thing for you to do to get a booster.

I know the recommendations from CDC and the public health authorities remain that everyone should get boosted, and that's their recommendation, and that's fine. What I'd say for all these things is to check with your doctor about what you should do in your particular situation, especially because the data coming out is not really showing extremely favorable results in the real world for these booster shots for the vast majority of people.

But again, if you're a high-risk person, probably a good idea to get a booster.

Again, not a whole lot of new news here lately, but the one thing that is good that I will note is, of all the patients that I've diagnosed with COVID the last several weeks, most of them have only mild illness, whether they've been boosted recently or not, and I think that's a good thing.

Omicron continues to show itself mostly as a relatively mild virus for most people. Again, we're talking about your average person in average health. Of course, for people who are older, people who have got lots of medical problems, it's still worse and we are still seeing fatalities from COVID all the time.

It is still a serious disease, but for the vast majority of people and especially for those who are generally healthy, it's proving to be a relatively mild illness still regardless of booster status, and I think that that is, again, something to be celebrated.

I think that's wonderful, and hopefully, as the virus continues to evolve in the coming months and years, we continue to see that it's pretty much a mild illness for the vast majority of people.


People ask about Paxlovid a lot. We are prescribing Paxlovid. We do use it here routinely, especially with the high-risk folks.

Younger folks, people who aren't high-risk, you're not likely to benefit from the medication. If you're in the older population or the high-risk population, definitely if you get COVID, have a conversation with your doctor about whether it might be helpful for you to take Paxlovid. There are some pros and cons to that, so again, it's one of those things where you want to get nuanced advice from your doctor on this issue.


"Do you think we will have mask mandates again in Baltimore City or county?"

That's a good question. I don't know. I think a lot of these decisions are probably going to definitely be made at the local level. I think it's going to depend on the politics in your local area, and what kind of appetite people have for going back to the masking.

I think going back to a mask mandate anywhere is going to be challenging after us having been out of masks now for a pretty long time, but I would think the case rates would have to get pretty high, but who knows?  I know in certain areas of the country, they are talking about bringing back mask recommendations. I know I think New York actually has a mask recommendation and may be doing masking in schools, and perhaps out in LA as well, they're doing selective masking in schools in certain situations where there have been kids with positive tests.

But I think in general, you're not going to see the widespread return of mask mandates, but in certain localities, you may certainly see that here and there, and they're going to make those decisions based on their local data essentially.

And I think that's the right way to approach it. Let the local people and the local governments make these choices for their folks.

In Virginia, I doubt we'll see the return of mask mandates anytime soon, unless, again, we have a pretty dramatic change to what's going on with the numbers and things like that.

Steve E. Bishop, M.D.

As a board-certified internist and concierge doctor in Richmond, VA, Dr. Steven Bishop is passionate about helping his patients improve their lives through better health. He helps healthy adults adjust their lifestyles as they age and helps patients with complex medical diseases manage and improve their health.