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Learning to live with COVID: Flu, RSV resurface in Triad as many go … – Winston-Salem Journal

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Rhonda Johnson, a CMA with Wake Forest Baptist Health, collects a nasal swab to test a patient for COVID-19 and the flu at the Wake Forest Baptist Mobile Health Clinic on Feb. 17, 2022, at Sin Fronteras Iglesia Cristiana in Winston-Salem. Experts predict another COVID uptick into early 2023 as more people spend time indoors during the holidays without mask restrictions in place.
Dr. Christopher Ohl, an infectious diseases expert with Wake Forest Baptist Health, said Thursday he believes the days of communitywide spread of COVID-19 “are over.” But Ohl cautioned again that he and other public-health officials expect clusters of cases involving unvaccinated individuals as more medium-to-large social gatherings are increasingly going mask-less.
2022 became the year of learning to live with COVID-19, its persistent subvariants and its frustrating tendency to resurge after declines.
We also relearned how potent and deadly influenza can be after two years of masking put the flu into retreat.
After just 17 flu-related deaths in North Carolina for the entire 2021-22 season, the state had already reported 91 deaths as of Dec. 21 for the 2022-23 season.
That’s compared with 186 flu-related deaths for the entire 2019-20 season and 203 in 2018-19.
In addition, a particularly virulent strain of respiratory syncytial virus, known by the RSV acronym, surfaced in 2022, creating particular problems for the very young and the elderly.
RSV is a common respiratory virus that typically causes mild, cold-like symptoms with most people recovering in a week or two.
However, the return to a mostly maskless society in 2022 led to significant community spread of RSV and crowded, if not full, pediatric hospital units.
There also was a short surge in monkeypox cases in the Triad and statewide between June and September, particular among Black males.
That virus proved to be more of an irritant with no known deaths among the 689 cases statewide as of Dec. 14. There have been between 20 and 99 reported cases in Forsyth and Guilford counties.
Even though the primary omicron subvariants began to wane in April, the continuing mutations — the N.C. Department of Health and Human Services was tracking 11 subvariants the week of Dec. 17 — have contributed to a modest uptick in new cases during December.
That’s the main reason why Forsyth and much of the Triad and Northwest N.C. have fluctuated between low and medium levels of COVID-19 community spread throughout the fall.
There have been 315 COVID-related deaths in Forsyth County through Dec. 17 this year — the latest DHHS dashboard update — compared with 396 for all of 2021 and 225 in 2020.
In terms of cases, Forsyth has — at 56,553 — nearly as many cases this year through Dec. 17 as in 2020 and 2021 combined at 62,260.
Forsyth health director Joshua Swift and Novant Health Inc. infectious diseases expert Dr. David Priest have stressed that the DHHS weekly case totals include only laboratory-confirmed cases, and don’t include most people who determine they are positive with an at-home test.
As of mid-December, about 67% of North Carolinians had received at least one COVID-19 vaccine shot and 63% at least two doses.
That includes about 98% of those ages 65 and older, 73% of those ages 18 to 64, but still just 35 of those ages 5 to 17 and 4% of those infant to age 4.
That means one-third of North Carolinians remain unvaccinated and 37% are considered undervaccinated.
When it comes to the bivalent booster doses, as of mid-December 59% of North Carolinians had received one booster and just 18% all boosters.
Even among those ages 65 and older, only 32% have taken every available booster dose.
Priest has said, “We’re hopeful we are transitioning from the pandemic to an endemic stage.”
A virus is typically considered endemic when it hits a predictable and manageable level, like the seasonal flu.
However, Priest cautioned that the transition “is going to be messy in a lot of ways.”
“There are individuals who have never wanted to take any precautions around COVID, who will believe the relaxing of COVID precautions is going too slowly.
“On the other end of the spectrum are individuals who do not want to turn down any of the precautions during the peak of the pandemic.”
Priest said he believes the majority of local residents “will be in the middle, not quite sure where and when to mask, which is natural in this transition stage.”
Until COVID-19 evolves into more of a seasonal illness similar to the flu, local infectious diseases experts say vaccine-boosted Triad residents remain susceptible to reinfections, though mostly with milder cases.
Priest expects another uptick into early 2023 as more people spend time indoors during the holidays without mask restrictions in place.
“COVID has yet to become seasonal like other respiratory viruses, a little bit lower at times and a little bit higher,” Priest said.
“We will see COVID throughout the winter months pretty consistently, with most hospitalizations among the unvaccinated and under-vaccinated, particularly those who did not complete their vaccine regimen.”
Priest said the danger of navigating a 100-year pandemic “is not knowing what exactly the threshold is.”
“People yearn for an objective standard, an objective piece of information … that if we get to here, we’ll do this. It helps tell a story and it helps people understand where we’re going and at least there is something we can all shoot for.”
Priest said that at the current stage of the pandemic, positive test rate and case count measuring sticks “are artificial cut-offs, and it goes back to what your tolerance is for risk.”
Priest said federal Centers for Disease Control and Prevention data this fall show that the majority of COVID-19 related deaths have occurred again in the elderly, particularly those not fully boosted.
“You are more protected if you receive the bivalent vaccine booster,” Priest said.
Dr. Christopher Ohl, an infectious diseases expert with Atrium Health Wake Forest Baptist, said that after nearly three years of COVID-19, some public-health patterns are beginning to emerge.
There have been fears of a tripledemic involving COVID-19, influenza and RSV all spreading vigorously at the same time this winter.
However, it’s become apparent that the three viruses don’t surge at the same time, but rather one emerges to dominant in a wave for weeks at the time before waning.
“Influenza and COVID tend to act like a teeter-totter when they are both active, one is up and the other down,” Ohl said. “We don’t really know why that happens.”
Ohl said that Baptist’s Brenner Children’s Hospital had been particularly busy with RSV-related hospitalizations.
However, Ohl said that as of mid-December, RSV cases are down enough “to be almost out of the picture.”
“Influenza is still up high, but we may have come past the current peak.
“COVID is starting to come up, but we’re still seeing about 15 times more cases of influenza than COVID in the area.”
Still, Ohl projects COVID-19 will emerge again in early 2023 as the dominant respiratory virus, mostly in the form of a COVID cold lasting three to seven days.
“My prediction is I don’t think the (respiratory virus) season will be as strong as it was last winter,” Ohl said.
Ohl said the primary reason is the community buildup of forms of COVID-19 immunity, whether from vaccine boosters or being infected or re-infected.
“I think we’re going to have severe disease, fewer hospitalizations and fewer deaths,” Ohl said.
RSV symptoms typically include a runny nose, cough and low-grade fever that can be treated in many cases with pain relievers such as Tylenol or Motrin.
Parents are cautioned to be watchful for symptoms such as persistent cough that is interfering with sleep, labored breathing and lack of appetite.
They are advised to seek emergency care if an infant or child appears to be experiencing breathing difficulties during the night.
Novant pediatrician Dr. Amra Zuzo said the system “is seeing a lot of complications related to RSV, the flu and other viruses that are occurring two to three weeks later.”
Zuzo said that includes ear infections and pneumonia.
“Parents should look at their children’s chest to make sure they are not breathing too fast … which can be a symptom of fever if the breathing settles down after 30 minutes after taking Tylenol or Motrin,” Zuzo said.
For breathing fast symptoms not resolved by taking Tylenol or Motrin, Zuzo said it’s advisable to have your child evaluated, whether by their pediatrician during normal office hours, or at an urgent care or emergency department.
More severe cases of RSV can involve a child “making some weird noises in their breathing that are scary sounding,” Zuzo said.
Baptist said it has “seen a substantial increase in children with RSV and respiratory illnesses other than COVID-19 in primary care and outpatient clinics and emergency departments throughout our health system.”
“We are seeing more of these cases than we typically see in the early fall.
“In addition, an increasing number of children are being admitted to Brenner Children’s Hospital as a result of infections caused by these viruses that are circulating in our communities.”
Monkeypox is a rare but potentially serious viral illness that typically involves flu-like symptoms, swollen lymph nodes and a rash that includes bumps that are filled with fluid before scabbing over.
Doctors say monkeypox has thus far spread largely among gay and bisexual men and transgender people.
“It’s important to remember that anyone in any group of people can get monkeypox, which spreads mostly through prolonged skin-to-skin contact,” state Health Secretary Kody Kinsley said.
The Forsyth health department is not releasing any information about infected individuals, citing public-health privacy policies. County public health officials are doing contact tracing to identity close contacts who may benefit from vaccination.
The state reported that Forsyth and Guilford had between 20 and 49 cases, while Alamance, Davidson and Randolph had between 3 and 19 cases, and Davie, Stokes and Surry had one to two cases.
The most recent monkeypox case count in Forsyth was at 22, involving only men.
Joshua Swift, Forsyth’s health director, said local cases have stabilized in recent weeks, following statewide and national trends.
As we learned to live with COVID-19 in our communities during 2022, the local news focus on my beats centered once again on public health, legislative and economic developments.
Forsyth County’s largest employer — Wake Forest Baptist Medical Center at more than 13,000 workers — became a part of the national healthcare consolidation churn for the second time.
After tying its future in October 2019 to Atrium Health in a “strategic combination” featuring a long-sought medical school in Charlotte, Baptist became on Dec. 2 part of the nation’s fifth-largest healthcare system when Atrium merged with Advocate Aurora to form Advocate Health.
The great debate on Medicaid expansion in North Carolina came close to reaching an agreement between the state House and Senate in June, only to be carried over into the 2023 session by Republican legislature leaders.
That meant between 450,000 and 650,000 potential beneficiaries were forced to wait another year for action as North Carolina remained one of just 12 non-expansion states, all with Republican-controlled legislatures.
The stunning overnight collapse of United Furniture Industries Inc. on Nov. 22 permanently closed five Triad facilities — where it was reported to have had between 530 and 600 employees, including between 50 and 70 in Winston-Salem. United also eliminated 199 jobs in ending local production in July.
United’s shutdown — one of the largest manufacturing job cuts in the nation at 2,700 overall — sent employees into a job market offering the promise of other manufacturing employment and the nation’s most stringent unemployment benefits.
A major factor of COVID-19 during 2022 involved more Triad residents becoming overwhelmed by medical debt burdens, an issue that became heated talking point in the legislature.
A local example was Kernersville resident Alicia Pender, whose life turned into a physical and emotional tailspin since her COVID-19 diagnosis in December 2020.
However, what is causing Pender the most stress, she said, is being overwhelmed by more than $30,000 in COVID-19 related medical bills.
In April, the nearly 18-year saga surrounding controversial Winston-Salem Dr. Anne Litton White came to a conclusion when she closed her practice as part of the indefinite suspension of her medical license issued in March.
White had been the operator of Carolina Laser and Cosmetic Center since 2004.
White has been subject to a board notice of charges and allegations six times before closing her practice, the others occurring in 2004, 2005, 2008, 2017 and 2018-20.

Atrium Health, the parent of Wake Forest Baptist Medical Center, said Friday it has completed its mega-merger with Advocate Aurora.

The great — and potentially legislative-defining — debate on Medicaid expansion in North Carolina will not continue in 2022.
LEXINGTON — Betrayed. Disgusted. Infuriated. Disbelieving. Devastated.
Contracting COVID-19 has sent Alicia Pender’s life into a physical and emotional tailspin since her diagnosis in December 2020.

Controversial Winston-Salem Dr. Anne Litton White has closed her practice.
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Rhonda Johnson, a CMA with Wake Forest Baptist Health, collects a nasal swab to test a patient for COVID-19 and the flu at the Wake Forest Baptist Mobile Health Clinic on Feb. 17, 2022, at Sin Fronteras Iglesia Cristiana in Winston-Salem. Experts predict another COVID uptick into early 2023 as more people spend time indoors during the holidays without mask restrictions in place.
Dr. Christopher Ohl, an infectious diseases expert with Wake Forest Baptist Health, said Thursday he believes the days of communitywide spread of COVID-19 “are over.” But Ohl cautioned again that he and other public-health officials expect clusters of cases involving unvaccinated individuals as more medium-to-large social gatherings are increasingly going mask-less.
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