Antibiotics Are Useless: Winter Viruses in Samara, Differences and Treatment

Every week in winter, Rospotrebnadzor reports on what ARVIs residents of Samara Oblast are falling ill with. And in the reports, the same infection names appear time and again. We decided to figure out how all these viruses are similar and how they differ. We also found out whether superinfections really occur or if they are just scare stories? Is the region threatened by a supervirus? And should we expect a second flu epidemic?

These and other questions were answered for 63.RU by the chief freelance specialist in infectious diseases for Samara, head of infectious disease department No. 2 at Samara State Medical University Clinics, infectious disease physician Yekaterina Kindalova.

Without a Swab, It«s Hard to Tell

— Rospotrebnadzor reports that currently, residents of Samara Oblast most often have parainfluenza, adenovirus, RS virus, metapneumovirus, rhinovirus, and COVID. I«d like to understand the features of each of these viruses. How do they differ, and how are they similar?

— Rospotrebnadzor«s summaries are not surprising. Autumn, winter, early spring — this is the traditional time when there is an increase in the incidence of respiratory viruses. There are more than two hundred different ones; you listed those that are most common here.

Distinguishing them probably doesn«t make much sense for the average person because they are similar. Sometimes even a primary care physician (outpatient) cannot say for sure without laboratory confirmation what you have fallen ill with. For all these viruses, characteristic symptoms will include fever, signs of intoxication (i.e., weakness, malaise, muscle pain), and possibly some kind of damage to the respiratory system.

With some viruses, the main manifestations are clear from the name. For example, rhinoviruses. Rhinos means nose, these are the viral infections that occur most frequently, up to 40% of all pathologies. The leading symptom is rhinitis, a runny nose.

Parainfluenza affects the larynx, expressed as laryngitis, a harsh, dry, barking cough. In children more often than adults, laryngitis is complicated by laryngeal stenosis, this is also one of the main reasons why children are admitted to hospitals, pediatric or infectious.

Adenovirus affects glandular tissue, meaning lymph nodes enlarge, eyes are affected, there can be conjunctivitis, sore throat, tonsillitis.

Respiratory syncytial virus affects more the lower parts of the respiratory tract. In children, it often manifests as bronchiolitis.

Metapneumovirus. Children get sick more often, and clinically the disease resembles flu. So I«ll repeat that without laboratory confirmation, i.e., without a swab from the nose or throat, we can»t always say clearly that yes, you are sick with exactly this virus.

How to Treat

— Are these viruses treated differently? Or are the drugs for their treatment similar?

— Specific therapy exists only for the influenza virus (I«m talking about drugs with direct action on the virus). For all other viruses, it has not been developed, and treatment is symptomatic. For example, bed rest during high fever, plenty of fluids. Or nasal rinsing, or vasoconstrictor nasal drops, throat treatment if there is pain.

— Regarding antiviral drugs, for which symptoms should they not be used, and for which is it absolutely necessary?

— All antiviral drugs are most effective when taken early, in the first 48, and preferably 24 hours, from the start of symptoms. After that, they simply lose the effectiveness we would want to achieve. And certainly, these drugs should only be used as prescribed by a doctor.

What we can do without a doctor«s prescription is take a fever reducer, use vasoconstrictor drops in the nose if there is a feeling of congestion, monitor the condition. And monitor any concomitant diseases if they exist. For example, patients with diabetes should carefully monitor blood glucose levels; monitor blood pressure for those with such issues.

Every patient can do this at home themselves, but under no circumstances prescribe themselves any antiviral drugs, because this medication has both indications and contraindications.

— Can you name a few of the most typical mistakes that people, trying to self-treat, make time and again, despite all recommendations?

— First, with some clinical manifestations, i.e., with cough, runny nose, fever, continuing to go to work, educational institutions. Not only is the person sick themselves, they also infect people around them. So during the period when there are bright clinical manifestations, one should stay home.

Second, certainly, is prescribing antibacterial drugs (antibiotics) to oneself. For viral infections, they absolutely do not work and are useless because the pathogen is not a bacterium but a virus. And in some cases, they can even harm, because they affect a person«s own microflora, which we have in the respiratory tract and intestines.

I would also name the abuse of fever reducers, non-steroidal anti-inflammatory drugs. When recommended dosages are exceeded, this can lead to a number of quite adverse consequences.

«We Don»t Get Sick from Getting Our Feet Wet«

— Can a person understand on their own whether they caught a virus or just got a cold? For example, their throat hurts, and the day before they got their feet wet.

— We don«t get sick from getting our feet wet. We get sick when some pathogen enters us. Or in case a person has some chronic problems, for example, chronic tonsillitis, issues with tonsils, existing for a long time. Simply the fact of hypothermia can activate the flora that the person already had, pathogenic, they just controlled it. And with this, we need to figure out what the cause is and what the pathogen is.

— Is it possible to contract several types of ARVI simultaneously? I mean that superinfection that has been talked about lately.

— Yes, that«s possible. For example, during the pandemic, we saw patients who were simultaneously infected with both flu and COVID. So catching several viruses at once is quite possible, since they circulate simultaneously.

— How would the clinical picture look then? Will some virus still predominate and its symptoms will manifest more strongly? Or will the person immediately, so to speak, be hit with fever, sore throat, runny nose, and nausea?

— It depends on how much of the pathogenic pathogen entered the body. And the clinical picture of one respiratory disease may come to the fore. Or it may be that it«s completely unclear what the person is sick with, when there are completely different manifestations from different organs and systems. Here, laboratory research methods will again come to our aid.

But, as a rule, these are more severely ill patients, and they more often need hospitalization, sometimes even some intensive care measures.

— Have superinfections become more common lately? Or has diagnostics just improved?

— After encountering the coronavirus infection, when several approaches to organization were revised in general, and filters, boxes were organized, we have more diagnostic opportunities, and there are rapid tests for different viruses. We have started detecting more, diagnosing more.

— How is the situation with COVID incidence now?

— COVID is not as common now as it was in 2020–2021, but COVID has also changed now, we very rarely, fortunately, see patients with severe course, with significant lung damage.

There is quite a lot of adenovirus infection, we see a lot of parainfluenza.

— A question about the supervirus. Doctors are now talking about a possible epidemic of some supervirus — a mix of monkeypox, rubella, bird flu, and Oropouche fever. Is an epidemic of such a supervirus threatening Russians?

— Supervirus is more of a non-medical term. And in medicine, epidemiologists, infectious disease specialists have such a concept as «X-agent», i.e., some unknown agent that can potentially arise.

Potentially, the risk of some new pathogen arising certainly exists. We carefully monitor all systems, all emerging outbreaks. So I think that in the near future, we in Russia will not encounter anything so serious.

— In winter, respiratory viruses circulate most often, but in spring?

— In summer, late spring, early autumn — it«s intestinal infection, enterovirus infection, noro-, rotavirus infection. Although they now occur throughout the year as well, but incidence is certainly higher in the warmer period.

«The Influenza Virus Doesn»t Like Dry and Frosty Weather«

— What is this related to? Is it that respiratory viruses spread better in enclosed spaces, in cold weather, with dry air?

— Each virus has different conditions in which it feels comfortable, different temperature, humidity. In winter, autumn, we are in crowded groups, when everyone has returned from vacations to work, to school, to kindergartens. And weather, of course, plays its role, although the influenza virus, for example, doesn«t like very cold, dry weather. It multiplies more actively when it is more humid and the temperature is minus 10 to 15 degrees Celsius (14 to 5°F). This is better for it than dry frosty weather.

— There is information that in February we are expecting another epidemic — this time of influenza B. Do such forecasts really exist?

— As a rule, influenza B does not cause such large outbreaks, so there are no forecasts for a total epidemic. Right now, influenza A — H3N2 is actively circulating. Influenza B was and is included in the vaccines that the population was vaccinated with in autumn. And I still hope that there won«t be a big outbreak.

— If a person has had influenza A, can they potentially get influenza B?

— Of course.

— What preventive measures are there? It«s clear that getting a flu shot, if someone wishes to now, is already too late. But how can one protect oneself from flu or other ARVI here and now?

— Maintain social distance, which we all learned during the coronavirus infection, wear masks in crowded places, don«t bring hands to the face, don»t rub eyes, use sanitizers. If someone is already sick, it«s more appropriate for them to stay home. Other recommendations — lead a healthy lifestyle, which includes sufficient sleep, limiting stress, walks in the fresh air, exercise, rational nutrition.

I would like to say that vaccination at present, in particular against flu, is the most effective, safe, and, fortunately, accessible way for our population to prevent this disease, to avoid further global problems — severe course, complications, fatal outcome. So we shouldn«t forget about vaccinations. And it»s better to do them in September–October, because after any vaccination, the body needs time to produce antibodies, form protection.