COVID, RSV, flu: Should we wear masks at Christmas and New Years?


With COVID, the flu, and RSV still spreading, should we wear masks when at large holiday gatherings?

With RSV, flu, and COVID circling, should we go back to wearing masks at larger gatherings over the holidays, or are we safe to forgo face coverings if we’re vaccinated?

The News & Observer spoke to Dr. David Weber, deputy medical director at UNC Medical Center and medical director of the UNC Department of Infection Prevention, for more information on this season’s viruses.

Should we be wearing masks at holiday gatherings this year?

Particularly vulnerable people, such as those with underlying immune disorders, organ transplant recipients, people with cancer, the elderly, should consider wearing a mask when they meet outside their typical domestic bubble, Dr. Weber said.

COVID, RSV and the flu are all droplet-borne diseases through environmental transmission. They thrive in cooler temperatures with low humidity, our current winter environment.

Most hand sanitizers and household cleaning products will kill all three viruses. Don’t underestimate good hygiene and handwashing practices this holiday season, Dr. Weber said.

“You can absolutely mask up while traveling, but that’s not your biggest risk of getting and spreading these diseases. It’s about what you’re doing after you get to where you need to go,” she said. “Spending time in large crowds, eating and mingling in a close environment. That is what will put you at greatest risk.”

Is COVID, RSV, or the flu the biggest concern this year?

COVID is by far the biggest concern right now, Dr. Weber said.

RSV, or respiratory syncytial virus, increased in September and October, but has softened. The biggest peak of the flu was from the end of October to November and it has also softened.

RSV and flu are declining, while COVID is making a comeback, he said.

“The most recent data shows that test positivity increased 10%, hospitalizations increased 15%, and deaths increased 60%,” said Dr. Weber. “We lose about 100 people a day to car accidents and gun violence, and we lose about 400 people a day to COVID. That’s more than double the other two leading causes of death combined.”

Also, new variants of COVID are making some treatments obsolete, such as monoclonal antibodies that have worked well in the past.

Antivirals work and the vaccine is still very effective in preventing hospitalization and death, but not as strongly with the introduction of these new variants, he said.

As part of the effort to conserve and reuse N95 masks, Duke Environmental and Occupational Safety Employee Andrea Vogel hangs up used masks in March 2020. Shawn Rocco/Duke Health

How do you know if you have COVID, RSV, or the flu?

Since the symptoms are so similar between these three diseases, you can only know for sure which one you have by getting tested.

UNC has 4 plex tests, which check for all three diseases at the same time, to determine what treatment you need.

Symptoms usually begin with a sore throat or runny nose, followed by congestion, coughing, and sneezing. All three can develop pneumonia and other common problems, especially in children, can include nausea, vomiting, headaches, and diarrhea.

It is possible to have more than one disease (or even all three) at the same time.

Deals: COVID and flu have approved vaccines, while RSV does not. But high-risk babies can be given a long-acting monoclonal antibody to prevent RSV. Influenza therapy can be given to babies 14 days and older, and COVID therapy can be given to babies 28 days and older.

What is RSV?

RSV (or respiratory syncytial virus) is a common virus that usually spikes every winter, although its peak in our region occurred a few months earlier.

Anyone can get and get sick from RSV, but it is particularly a problem in premature babies and older adults. Most who get it will recover in about a week.

RSV is spread by droplets through environmental transmission: “If you rub your nose and then touch something in the house, then I touch that same spot and rub my nose, I have a high chance of getting RSV,” he said.

RSV is most commonly spread through coughing and sneezing.

There is no vaccine to prevent RSV, but there are antibody treatments (especially effective for young babies) if you develop it.

The infection and mortality rate for RSV is similar to that of the flu, making it a common illness that should be taken seriously, Dr. Weber said.

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This story was originally published December 20, 2022 2:02 p.m.

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Kimberly Cataudella (she/her) is a service journalism reporter for The News & Observer.

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