Winter Viruses in Russia: Expert on Symptoms and Treatment

Every week during winter, Rospotrebnadzor (the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing) reports which acute respiratory viral infections (ARVI) Russians have contracted. The same names of infections appear repeatedly in the reports — including in Orenburg. Our colleagues at 63.RU decided to figure out how these viruses are similar and different. They also learned whether superinfections really occur or are just scare stories, and whether a second flu epidemic should be expected.

63.RU discussed these and other questions with the chief freelance infectious disease specialist for Samara, head of infectious disease department No. 2 at the Clinics of Samara State Medical University, infectious disease physician Ekaterina Kindalova.

Can«t tell without a smear

— Rospotrebnadzor reports that currently the most common viruses among Russians are parainfluenza, adenovirus, RS virus, metapneumovirus, rhinovirus, and COVID-19. We would like to understand the specifics of each of these viruses. How are they different and how are they similar?

— The reports from Rospotrebnadzor are not surprising. Autumn, winter, and early spring are the traditional times when respiratory virus incidence rises. There are more than two hundred different ones; you listed those that occur most frequently in our region.

It probably doesn«t make much sense for an ordinary person to distinguish between them because they are similar. Sometimes even a primary care (outpatient) physician cannot say for sure without laboratory confirmation what you are sick with. All these viruses will be characterized by fever, signs of intoxication (i.e., weakness, malaise, muscle aches), and some damage to the respiratory system.

For some viruses, the name indicates their main manifestations. For example, rhinoviruses. «Rinos» means nose — these are the most common viral infections, accounting for up to 40% of all pathologies. The leading symptom is rhinitis, a runny nose.

Parainfluenza affects the larynx, manifesting as laryngitis with a rough, dry, barking cough. In children more often than in adults, laryngitis is complicated by laryngeal stenosis, which is also one of the main reasons for seeking pediatric or infectious disease hospitalization.

Adenovirus affects glandular tissue, i.e., lymph nodes enlarge, the eyes are affected — conjunctivitis may occur, along with sore throat and tonsillitis.

Respiratory syncytial virus affects mostly the lower respiratory tract. In children, it often presents as bronchiolitis.

Metapneumovirus. Children are more often infected with it, and clinically the disease resembles influenza. So I repeat: without laboratory confirmation, i.e., without a nasal or throat smear, we cannot always say for sure, «Yes, you are sick with exactly this virus.»

How to treat

— Are these viruses treated differently? Or are the medications similar?

— Specific therapy exists only for influenza virus (I mean drugs with direct action on the virus). For all other viruses, no such therapy has been developed, and treatment is symptomatic. For example, bed rest during a high fever, drinking plenty of fluids, nasal rinsing, vasoconstrictor nasal drops, and treating the throat if there is pain.

— Regarding antiviral drugs, for which symptoms should they not be used, and when are they definitely necessary?

— All antiviral drugs are most effective when taken early, within the first 48 hours, and preferably 24 hours, of symptom onset. After that, they simply lose the effectiveness we would hope for. And of course, these drugs should only be used as prescribed by a doctor.

What we can do without a doctor«s prescription is take an antipyretic, use vasoconstrictor nasal drops if there is congestion, monitor our condition, and keep an eye on any concomitant diseases we have. For example, patients with diabetes should carefully monitor their blood glucose levels, and those with blood pressure issues should monitor their blood pressure.

Every patient can do this at home themselves, but under no circumstances should they prescribe any antiviral drugs themselves, because such medications have both indications and contraindications.

— Can you name a few of the most typical mistakes that people repeatedly make when trying to treat themselves, despite all recommendations?

— Firstly, continuing to go to work or school with clinical symptoms like cough, runny nose, and fever. Not only does the person get sick themselves, but they also infect those around them. Therefore, when there are clear clinical manifestations, you should stay home.

Secondly, of course, is self-prescribing antibacterial drugs (antibiotics). For viral infections, they are absolutely ineffective and useless because the pathogen is a virus, not a bacterium. And in some cases, they can even cause harm by affecting a person«s own microflora, which is present in both the respiratory tract and the intestines.

I would also mention the overuse of antipyretics and nonsteroidal anti-inflammatory drugs. When the recommended dosages are exceeded, that can already lead to a number of quite unfavorable consequences.

«We won»t get sick just from getting our feet wet«

— Can a person tell whether they caught a virus or just got a cold? For instance, they have a sore throat, and the day before they got their feet wet.

— We won«t get sick just from getting our feet wet. We get sick when some pathogen enters our body. Or if a person has some chronic issue, such as chronic tonsillitis or problems with the tonsils that have existed for a long time. The mere fact of hypothermia can activate flora that was already in the person — pathogenic flora that they had been controlling. Then it»s necessary to determine the cause and the specific pathogen.

— Can someone be infected with several types of ARVI at the same time? I mean the so-called superinfection that has been talked about lately.

— Yes, that is possible. For example, during the pandemic, we saw patients who were simultaneously infected with both influenza and COVID-19. So it«s quite possible to catch several viruses at once because they circulate simultaneously.

— What would the clinical picture look like then? Will one virus prevail and its symptoms be more pronounced? Or will the person immediately, so to speak, be hit with fever, sore throat, runny nose, and nausea?

— It depends on the amount of pathogenic agent that entered the body. The clinical picture of one respiratory disease may take precedence. Or it may be completely unclear what the person is sick with, with very different manifestations from different organs and systems. Once again, laboratory diagnostic methods come to our aid here.

But as a rule, such patients are more severely ill and more often require hospitalization, sometimes even intensive care measures.

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

— After encountering coronavirus infection, when approaches to organization were revised, filters and boxes were set up, we gained more diagnostic capabilities, and there are rapid tests for different viruses. So we are detecting and diagnosing more.

— How is the situation with COVID-19 incidence now?

— COVID-19 is not as common now as it was in 2020−2021, but COVID-19 has also changed — we very rarely see patients with severe courses and extensive lung damage now, fortunately.

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

— A question about a supervirus. Doctors are now talking about the possibility of an epidemic of some supervirus — a mix of monkeypox, rubella, avian flu, and Oropouche fever. Does an epidemic of such a supervirus threaten Russians?

— «Supervirus» is more of a non-medical term. In medicine, epidemiologists and infectious disease specialists have a concept like «X-agent», i.e., some unknown agent that could potentially emerge.

The potential risk of a new pathogen emerging certainly exists. All systems and all emerging outbreaks are carefully monitored. So I think we will not encounter anything serious in Russia in the near future.

— In winter, respiratory viruses circulate most often. What about spring?

— In summer, late spring, and early autumn, it«s intestinal infections: enterovirus, norovirus, rotavirus infections. Although they also occur throughout the year, the incidence is certainly higher during the warmer period.

«The influenza virus does not like dry, frosty weather»

— What is that related to? To the fact that respiratory viruses spread better indoors, in cold weather, and dry air?

— Each virus has different conditions in which it feels comfortable — different temperature and humidity. In winter and autumn, we are in crowded groups when everyone has returned from vacations to work, school, and daycare. And weather certainly plays a role, though the influenza virus, for example, does not like extremely cold, dry weather. It multiplies more actively when it is more humid and the temperature is −10 to −15 °C. That is better for it than dry, frosty weather.

— There is information that in February we can expect another epidemic — this time of influenza B. Are there such forecasts?

— As a rule, influenza B does not cause such large outbreaks, so there are no forecasts of a total epidemic. Currently, influenza A — H3N2 is actively circulating. Influenza B was and is included in the vaccines that the population was vaccinated with in the fall. I still hope there will be no large outbreak.

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

— Of course.

— What preventive measures are there? Obviously, if someone wants to get a flu shot now, it«s too late. How can one protect themselves from the flu or other ARVI right now?

— Maintain social distancing, which we all learned during the coronavirus pandemic. Wear masks in crowded places, do not touch your face, do not rub your eyes, use hand sanitizers. If someone is already sick, it is better for them to stay home. Other recommendations include a healthy lifestyle — getting enough sleep, limiting stress, walking in the fresh air, exercising, and eating a balanced diet.

I would like to say that vaccination, in particular against influenza, is currently the most effective, safe, and fortunately accessible way for our population to prevent this disease, to avoid future global problems — severe course, complications, and death. So we must not forget about vaccinations. And it is better to get them in September–October, because after any vaccine, the body needs time to produce antibodies and form protection.