“Cold and flu” season is nearly here; however, language matters, and I would argue that it’s important to change our lexicon to more accurately reflect the true health risks of the season. This year, when I talk to my patients, I will be referring to the winter months as “winter respiratory illness” season. The colder months in the northern hemisphere increase the prevalence and spread of respiratory illness through several factors. Cold temperatures and shorter periods of sunlight encourage people indoors and into closer quarters, and heated, drier air inside buildings dries out mucous membranes and may facilitate the spread of viruses. Furthermore, certain viruses may be more active and easily spread in colder and drier conditions. Some research suggests that cold weather and reduced exposure to sunlight may further weaken the immune system, making individuals more susceptible to infections. Lastly, some hypothesize that holiday gatherings and travel may quickly and efficiently facilitate the spread of viruses to different regions.

COVID, RSV, Flu & Beyond

Influenza (flu) viruses follow a predictable pattern, peaking during the winter months. They can cause a wide range of symptoms, from mild to severe, and even death in some instances. The burden of flu can vary widely from year to year and from region to region; however, the CDC has estimated, from data collected from 2010-2020, that each year flu causes 9 million to 41 million illnesses, 140,000-710,000 hospitalizations, and 12,000-52,000 deaths. Furthermore, flu costs the United States an estimated $90 billion annually.

Similar seasonal patterns exist with respiratory syncytial virus (RSV), a common virus that has an outsized impact on very young or elderly people. RSV is estimated to account for 2.1 million outpatient visits, 58,000-80,000 hospitalizations, and 100-300 deaths each year for children under 5, as well as 60,000-160,000 hospitalizations and 6,000-10,000 deaths for people 65 and older. RSV treatment-related costs are estimated to be over $700 million annually.

COVID-19 is the newest member of the family of winter respiratory illnesses and we are still learning about its patterns; it may have a seasonal pattern of transmission that mirrors the more studied RSV and flu virus, but time will tell. Prior to COVID-19, the traditional four main types of coronaviruses did follow a similar seasonal pattern, with peaks in mid to later winter. The COVID-19 pandemic’s impact cannot be captured in numbers alone, but as of September 2023, COVID-19 has been the direct or contributory cause of death in more than 1.1 million individuals in the United States and has cost an estimated $16 trillion in lost productivity, premature deaths, and disability.

Lastly, we can cluster other winter respiratory illnesses into the catch-all phrase “common cold,” which, although it can be miserable, is rarely severe and has self-limited symptoms. Colds account for 1 billion cases annually in the United States and their annual cost in lost productivity has been estimated at $25 billion.

New Tools to Fight Winter Illness

As we enter winter respiratory illness season in 2023-2024, everyone’s goal is to stay healthy and to keep our patients healthy. So, what’s different this fall compared with every other year? In addition to traditional methods of infection control—such as regular handwashing, surface disinfection, wearing a mask, good ventilation, and air humidifiers, as well as staying home or avoiding close gatherings when ill—we have three new and powerful tools to prevent illness and, most importantly, severe illness.

• Vaccinations are one of the best tools we have against respiratory viruses. In addition to the annual flu vaccine, we now have an RSV vaccine for those older than 60 and an updated COVID-19 vaccine to better match the circulating virus.
• Additionally, we now have nirsevimab, a new monoclonal antibody to provide RSV protection to infants less than 8 months old or those born during winter flu season, as well as children less than 2 years old with underlying medical conditions, who are more vulnerable to illness.

These are amazing new tools that the entire medical community must embrace to prevent illness or severe disease. As a family physician, that is my whole goal: prevent illness. Why would we treat disease when we can practice primary prevention? Globally, the amount of illness and death which vaccines have prevented is truly astounding, making them the most impactful medical intervention of the 21^st century. In fact, vaccines have been so effective that as a society we have collectively forgotten about many of the horrific vaccine-preventable illnesses that have occurred within some of our grandparents’ lifetimes. Although there has been a flood of misinformation and disinformation surrounding vaccines, they are incredibly safe, effective, and based on decades of research.

Each of these tools against the big three winter respiratory illness helps prevent illness or spread. None of them is perfect, nor do they work in isolation; collectively, though, they are exceptionally powerful. Each vaccine serves a specific purpose. Although the efficacy of the seasonal flu vaccine may vary from year to year depending on the dominant strain, the annual flu vaccine is always a good idea. The FDA also removed the contraindication to egg allergy this year, so even those with egg allergy can safely receive the vaccine. The COVID-19 vaccine has been shown to be exceptionally effective at reducing severe illness and death. One study of hospitalized patients demonstrated that 2 or 3 doses of mRNA vaccines reduced the risk of mechanical ventilation or death by 90%. Since the COVID-19 illness has mutated, we must receive an updated vaccine to match the dominant circulating strain of the illness.

How Can Physicians Encourage Vaccine Uptake?

Doctors and health care workers are the most trusted source of information when it comes to health, and a patient’s individual doctors rank highest of all when patients are asked. Doctors and health care workers have a critical responsibility to connect with our patients, address concerns, and safely counsel and administer vaccines. Addressing questions and building trust takes time and often occurs over several visits, but there are a few simple tactics we can use to increase vaccine uptake.

Physicians should offer vaccination, ask open-ended questions if the patient refuses, and then listen to the answers so we can understand and empathize with their position. Then we can ask permission to provide our professional opinion and experience. This subtle change in approach can reduce barriers and align with the patient in a collaborative and effective manner. Providing personal information and experience as well as individually tailoring the message will be far more effective than just responding with facts and data. Lastly, acknowledge the patient’s autonomy in their health care decision and encourage them to reach out or follow up if additional questions arise or they change their mind. These simple steps take a little time but can go a long way to improving trust, understanding, and ultimately vaccination, which we know is best for our patients and our community.

Reducing the spread of winter respiratory illness such as flu, RSV and COVID-19 is critical to reduce illness and death. Taking a few minutes to educate your patients and provide vaccinations will reduce their risk and just may save a life.