Winter Viruses in Tolyatti: How They Differ and How to Treat Them

Every week in winter, Rospotrebnadzor (the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing) reports which acute respiratory viral infections (ARVI) have affected residents of Tolyatti and the Samara region. And the reports time and again feature the same names of infections. We decided to find out how all these viruses are similar and how they differ. We also learned 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 by the chief freelance infectious disease specialist for Samara, head of the infectious diseases department No. 2 of the Clinics of Samara State Medical University, infectious disease physician Ekaterina Kindalova.

Without a swab, you can«t tell

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

— The reports from Rospotrebnadzor are not surprising. Autumn, winter, and early spring are the traditional times when an increase in respiratory virus cases is noted. There are more than two hundred different ones; you listed those that are most common here.

It probably doesn«t make much sense for the average person to distinguish between them because they are similar. Sometimes even a primary care physician (outpatient) 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 pain), and possible damage to the respiratory system.

For some viruses, the main manifestations are clear from the name. For example, rhinoviruses. Rhinos is the 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 rough, dry, barking cough. In children, more often than in 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, i.e., lymph nodes enlarge, eyes are affected, there can be conjunctivitis, sore throat, and tonsillitis.

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

Metapneumovirus. Children get sick more often with it, and clinically the disease resembles the flu. Therefore, I repeat, without laboratory confirmation, i.e., without a swab from the nose or throat, we cannot always say clearly that yes, you are sick with this particular 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 a high fever, plenty of fluids. Or nasal irrigation, or vasoconstrictor nasal drops, throat treatment if there is pain.

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

— All antiviral drugs are most effective when taken early, within the first 48, and preferably 24 hours, from the onset of symptoms. After that, they simply lose the effectiveness we would like to achieve. 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 drops in our nose if there is a feeling of congestion, and monitor our condition. And monitor your comorbidities if you have them. For example, patients with diabetes should carefully monitor their blood glucose levels; monitor blood pressure if you have problems with it.

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 cure themselves, make time and again, despite all recommendations?

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

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

I would also mention the abuse of antipyretics, non-steroidal anti-inflammatory drugs. When recommended dosages are exceeded, this can already lead to a number of rather adverse consequences.

«We don»t get sick from getting our feet wet«

— Can a person understand for themselves—did they catch a virus or did they get 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, problems with tonsils that have existed for a long time. The mere fact of hypothermia can activate the flora that the person already had, pathogenic, they were just controlling it. And here we need to figure out what the cause is and what the pathogen is.

— Is it possible to become infected with several types of ARVI at the same time? I mean that very 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 influenza and COVID. Therefore, catching several viruses at once is quite possible, as they circulate simultaneously.

— What would the clinical picture look like then? Will one virus still predominate and its symptoms manifest more strongly? Or will a person, so to speak, be hit all at once with fever, sore throat, runny nose, and nausea?

— It depends on how much of the pathogenic agent entered the body. The clinical picture of one respiratory disease may come to the fore. Or it may be that it will be completely unclear what the person is sick with, when there will be 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 require hospitalization, sometimes even some intensive care measures.

— Have superinfections become more common lately? Or has diagnosis simply improved?

— After encountering the coronavirus infection, when several approaches to organization were generally revised, and filters and isolation boxes were organized, we have more diagnostic capabilities, and there are rapid tests for different viruses. We began to detect more, diagnose more.

— How is the situation with COVID incidence now?

— COVID is now less common than 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 a supervirus. Doctors are now talking about the possibility of an epidemic of a certain supervirus—a mix of monkeypox, rubella, bird flu, and Oropouche fever. Are Russians threatened by an epidemic of such a supervirus?

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

The potential risk of the emergence of some new pathogen certainly exists. All systems, all emerging outbreaks are carefully monitored. Therefore, I think that in the near future, we in Russia will not encounter anything so serious.

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

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

«The influenza virus doesn»t like dry and frosty weather«

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

— Each virus has different conditions in which it feels comfortable, different temperature, humidity. In winter and autumn, we are in crowded groups, when everyone has returned to work after vacations, to school, to kindergartens. And the weather, of course, plays its role, although the influenza virus, for example, does not like very cold, dry weather. It multiplies more actively when it is more humid and the temperature is around 10–15 degrees below zero (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. Now we have influenza A—H3N2—actively circulating. Influenza B was and is part of the vaccines with which the population was vaccinated in the autumn. And I still hope there won«t be a major outbreak.

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

— Of course.

— What preventive measures are there? It«s clear that getting a flu shot now, if someone wants to, is already too late. But how can you protect yourself from the flu or another ARVI here and now?

— Observe social distancing, which we all learned during the coronavirus infection, wear masks in crowded places, do not bring hands to the face, do not rub eyes, use sanitizers. If someone is already sick, it is more appropriate for them to stay at home. Another recommendation is to lead a healthy lifestyle, which includes sufficient sleep, limiting stress, walks in the fresh air, sports, and rational nutrition.

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