Are We Getting Sick More Often?

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Colds and respiratory illnesses are to be expected, but are we getting sick more often than we used to? And are there more viruses going around these days? Dr. Keith Armitage, infectious disease specialist at University Hospitals, sheds light on the newest infectious disease data and why some people are more susceptible to getting sick.

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Macie Jepson
You know it’s going to happen – every winter season comes this acceptance that somebody we know is going to get a cold and somebody we know is going to get something even worse, some type of respiratory virus. But you know what? I’ve noticed lately that there’s an onset of cold season, then launching a spread of something even nastier than a raw nose and hacking cough.

It’s really weird and it’s confusing, and it has me talking a lot about it with people I know. For me personally, I lost my voice. One daughter got a fever, the other just coughed nonstop for three weeks. My husband, who is never spared, did not get sick. It’s really bizarre and it made me wonder – were we all sick with something different?

Matt Eaves
Yeah Macie, two months ago we did a podcast on the immune system, and we talked then about how everyone in our families were sick. And unfortunately on my side, not much has improved. Family’s still sick. Every friend I know has a kid that’s sick or they’re sick. And so it just seems to come and go, in and out.

And you know it got me thinking, has what we experienced over the last few years with the pandemic, isolation and work from home made us more susceptible to getting sick?

Macie Jepson
I’m wondering the exact same thing.

Hi, I’m Macie Jepson.

Matt Eaves
And I’m Matt Eaves. And this is The Science of Health. A recent Bloomberg analysis found that 44 countries and territories that reported a resurgence in one or more infectious diseases, that’s at least ten times worse than pre-covid baseline. Here to shed some light on that is Dr. Keith Armitage, Co-Chair of the Department of Medicine and the Dr. Robert A. Salata chair in Infectious Diseases at University Hospitals, Cleveland.

Dr. Armitage, welcome.

Keith Armitage, MD
Hi, guys.

Matt Eaves
I’m always curious when I talk to physicians why they got into their specialty. How did how did you find yourself in infectious disease as your area of focus?

Keith Armitage, MD
I have two answers to that. When I was in medical school and especially when I came to UH to train, there was a lot of really strong role models and people I looked up to who were infectious disease doctors that kind of seemed like medical detectives, like Dr. House. It was interesting,

My father’s a biologist and very much a scientist. My mother is a historian who never met someone she didn’t like. And so infectious disease is kind of the combination of human existence, human health and the natural scientific world. And the interaction between the natural world and human health. You know, take a little bit from each parent.

Matt Eaves
All right, Dr. Armitage, let’s start with what’s going on here in the U.S. Twelve million people with the flu. Seventeen states are at a high or very high levels of respiratory illness. How does this compare to previous years? And are we sicker now than, say, five years ago or even 10 years ago?

Keith Armitage, MD
So every year in North America, there’s a 6-8 week period where we see peak influenza activity. And we’re in that right now in Northeast Ohio. Some years are worse than others. Some years the strains the virus circulates are stronger, the match between the vaccine in the circulating viruses isn’t as strong. There probably is some impact from the pandemic – the period of time when we were socially distancing people weren’t getting exposed to viruses – so there’s probably some increased susceptibility in general.

Macie Jepson
Another leftover effect from the pandemic is that fewer people are getting vaccinated. I think as of December, 43 percent of Americans got vaccinated last year. 37 percent this year. That has to have an effect, right?

Keith Armitage, MD
It does. I think it has a modest effect on transmission, has a huge effect on the vulnerable population, and there’s unequivocal data that the vaccine prevents hospitalizations and deaths. There’s unequivocal data that the vaccine prevents time off work. You know, for people who are otherwise healthy.

Macie Jepson
So, doctor, you mentioned earlier that the pandemic did have some effect on our immunity just from the time that we were away from people. But let’s talk about covid itself and getting it and what that did to our bodies. You know, kind of like getting pneumonia, then you’re more susceptible to pneumonia. With covid, are you more susceptible to respiratory illnesses? I mean, are we weaker? Is it leading to more illness?

Keith Armitage, MD
Yeah, that’s a great question. And there are individuals who we see who had bad covid pneumonia, whose lungs were damaged, and it will put them at risk for respiratory infectious pneumonia for the rest of their life. Thankfully, that’s not that many people. So I think the average person who got covid and wasn’t sick enough to be in the hospital and didn’t have a severe case, there’s probably no long term effect that makes him more susceptible.

The period of time when people were not getting exposed to viruses did have a big impact. So every year, influenza circulates in North America. Other viruses circulate in North America. We get exposed to them every year, and through our lifetime we build up immunity and we’re much less likely to get sick. Naturally, that’s related to year after year of exposure and re-exposure and having our immune system stimulated. And we had a little gap in that.

One of the most fascinating pieces of data about the pandemic was influenza. You know influenza occurs in the winter. The worldwide pandemic started in January, February, March. Well, that summer in Australia, they had no influenza because they were masking and social distancing. Stunning and profound.

And then the same thing happened in North America. So there clearly was a period of time when we were masking and social distancing that we weren’t getting exposed to viruses, and it probably left us a little more susceptible. Particularly in kids, I think the first year of kind of normal behavior, not social distancing, not masking, in kids we saw a lot more RSV because kids had gone a year and a half, two years without being exposed to RSV, for instance.

Macie Jepson
When do they catch up? Is it taking longer for them to build up these immunities but eventually they’re going to be just as strong as they would have otherwise?

Keith Armitage, MD
I don’t think the average case of covid is impacting our immune systems long term. I think the kids that had a little gap in exposure, they should catch up over time.

One more thing. These modern tests that detect the RNA or DNA of viruses weren’t around 10 or 15 years ago in frontline settings. Some things are increased because we’re seeing them. So we’re seeing a lot more RSV in adults, respiratory syncytial virus. But we’re probably detecting cases and making diagnoses that we weren’t years ago. And that’s probably true for other viruses. So some of it is modern diagnostic techniques have allowed us to identify which virus we’re getting. But maybe it feels like a bit more because we’re saying you had RSV, you had adenovirus, you had metapneumovirus virus, you had parainfluenza, because these tests for them are so common now.

Matt Eaves
So we aren’t seeing a big increase in the amount of viruses, like you’re saying? Maybe it’s more of, we’re able to detect it more, so then people are associating that with now because we know what it is, this must be going around more.

Keith Armitage, MD
I think that’s part of it. I think because it’s in the news more you say, oh, we’re detecting these viruses. And before, we were getting colds and flu and we didn’t think about as much because we can’t identify what it is. Some years are worse for virus A, some years are worse for virus B. There’s a bacteria called mycoplasma pneumonia, the classic cause of walking pneumonia. Big surge in cases this year in September, October, November.

Matt Eaves
Now is pneumonia contagious? I keep hearing mixed things on this.

Keith Armitage, MD
The classic causes of pneumonia, we don’t really think of them as contagious. These are bacteria. They’re in the environment, although kids carry it and then give it to their parents and grandparents and they end up carrying it. And then some get pneumonia. So not contagious. But there is a kind of spread in populations.

Matt Eaves
Shifting back to vaccines and maybe, you know, going off topic a little bit. I hear people in my inner circle say often after they get a vaccine, they get sick. And I’m pretty certain there’s some bias going on there. But in fact, recently a friend’s mother got a shingles vaccine and then immediately after it got shingles. And Macie, I think you had said after a flu vaccine, you’d gotten the flu.

Macie Jepson
I sure did.

Matt Eaves
But can you get sick from getting a vaccine?

Keith Armitage, MD
So there are some vaccines that we call reactogenic. Muscle aches and fever for a day. The shingles vaccine is actually known to be reactogenic, especially the second dose of the modern shingles vaccine. A lot of people have a fever for a day. There are some vaccines that almost never do that.

But the flu vaccine does not give you the flu. The shingles vaccine does not give you shingles. And if you think about, say, the flu vaccine, when 60 or 80 million people are getting a flu vaccine, some of them are going to randomly get sick the next day, whether they got the vaccine or not. Vaccines don’t give you the infection, but some vaccines are what we call reactogenic, where people feel sick for a day.

Matt Eaves
And when you get the vaccine, is that weakening your immune system? Is that opening a window, so to speak?

Keith Armitage, MD
No. Really the opposite. Vaccines stimulate your immune system. In general, vaccines give you a stronger immune system. There’s no vaccine that is zero risk. You look at the net benefit for society and the vaccine wins. But there are rare side effects that can occur with some vaccines related to the immune system.

Macie Jepson
Another conversation that always seems to happen – along with I just got the shot and now I’m sick – is somebody is always sick these days and everybody talks about it. Where were you exposed? What do you think it is? How did you get it? Your symptoms are different than mine? What do you think that is? We were all dealing with something a little bit different. Are there more variants out there right now or are we just talking about it more?

Keith Armitage, MD
I think we’re talking about it more. I think we’re more focused on it and we’re more focused on getting the diagnosis because we have the diagnostic techniques. There’s clearly seasonal variation and annual variation. And we talked about how influenza is stronger and more widespread some years than others. This fall we had this mycoplasma that a lot of people experienced and didn’t get diagnosed, and so there’s annual variation but I don’t think that we’re more susceptible.

Matt Eaves
Is there a benefit to getting sick from the real virus versus getting a vaccine?

Keith Armitage, MD
You know, in general, natural infection probably gives you better and longer lasting protection. There’s some exceptions where the vaccine may be better than natural infection which is risky in some cases. And so that’s why the vaccines are generally safer than natural infection.

Matt Eaves
Well and also costly. Like for the flu, you could be out of work for 4 or 5 days, right?

Keith Armitage, MD
Influenza – full-blown influenza – is high fever, muscle aches, headache and a nonproductive cough. Most adult Americans have had that at least once in their life. It is not good. You feel really sick. And again, most of us, especially when we’re out of our 20s or 30s, don’t get full-blown influenza because we have some immunity from being exposed to flu strains every year. We hopefully have immunity from the vaccines. But when you get the full-blown influenza, it is like getting run over by a truck. It’s bad.

Macie Jepson
And then those who have never had it will likely say, you know, I’m just going to take my chances. I mean, I don’t think this conversation is going to change anybody’s stance on whether or not to get a vaccination. Either they’re going to do it or they’re going to say, I’m not afraid of the consequences, and I’m going to take my chances. And I’m wondering, are healthy people dying of respiratory illness?

Keith Armitage, MD
With influenza, the people who die of influenza and the typical seasonal influenza are people who have some underlying frailty, lung disease, heart disease or other chronic condition. There’s clearly people who do die from those illnesses and there’s clear data that vaccine prevents that in a big population. Whether an individual person would or wouldn’t have gotten sick, it’s harder to tell.

It was pretty clear with covid, we’d see people who would end up on a ventilator and dying of covid and the data was pretty strong that had they been vaccinated, they wouldn’t have. I know it’s a controversial topic, but that’s the truth, that’s the science. That’s the facts. And again, I know there’s lots of controversies around vaccines and that’s not what we’re here to talk about. But in general, vaccines have a net benefit in terms of preventing fatal illness in more specific subgroups. That’s why covid is so unique.

And of course, now there’s a concern about a novel influenza strain. And if you think back – I think it was 2008, 2009 – we had a novel H1N1 strain, and that’s the year we did see young adults dying of influenza. We saw young adults in their 30s and 40s on a ventilator from influenza. And that’s because it was such a novel strain. They didn’t have any kind of a library of immune responses. That’s the public health concern. Covid caught people by surprise in terms of it being covid, but there’s always been a public health concern about a novel virus that we have no immunity to and that’s what happened with covid.

Macie Jepson
Absolutely. I mean, I remember when you were walking us through this and you said, you have to understand this is novel.

Keith Armitage, MD
Yeah.

Macie Jepson
And I’d never even heard that, to be honest with you. But I think we’re all intimately aware of what that means now.

Keith Armitage, MD
Well there’s a lot of focus now on the flu in chickens and cows, this new strain of avian flu. And the big worry among experts in this area in general, was that there would be a strain of flu that was both aggressive in human beings and easily transmissible from human to human, and that was what kept people up at night before covid.

And that still kind of keeps you up at night – that we’d have a strain of influenza that both can infect humans and make us very sick, to which we have no immunity and then is highly transmissible among us. And so far it hasn’t happened. And what’s happening, I think there’s been six or seven cases of people getting this new avian flu. There’s just no transmission between people to speak of. So it’s currently not a public health threat, but the wrong mutation, the wrong change in the virus and then, you know…One pandemic in my career is enough, hopefully we won’t have another pandemic. But that does worry people.

Matt Eaves
Is there an easy way to answer why something can pass from, say, a chicken to a human, but not a human to human? Or is it getting into the molecular sciences?

Keith Armitage, MD
Yeah, that’s a great question and probably something that I’m not an expert in, but it’s very clear that throughout human history there are influenza strains in birds and other animals. I’m old enough to remember the big swine flu epidemic. And maybe this is in the 1970s. Gerald Ford was president and a soldier at Fort Dix in New Jersey (I think it’s where it is) died of what they thought was swine flu. And there was a sudden concern that this was going to spread from human to human. And it turned out it didn’t. And then that vaccine caused controversy and led to people being vaccine hesitant.

But why these flu strains? You know, the great flu epidemic of 1918 was a novel strain. It was highly transmissible. The genetic components of these viruses, why they do or don’t require the genetic ability to be so transmissible, is not an area that I’ve done a deep dive in, except it’s the issue. And I think when people went back and looked at using modern molecular techniques, modern science on the 1918 strain, they did probably identify some genes that made it highly transmissible.

Macie Jepson
What did we learn from this novel virus, COVID-19 as a medical community that you feel is going to better prepare us for a future pandemic?

Keith Armitage, MD
We certainly learned that if the resources are there, modern medicine can produce vaccines and medicines at warp speed. So we do have these new incredible technologies. These mRNA vaccines in April, May of 2020, which does seem like a lifetime ago. They started working on the covid vaccine and I had highly respected colleagues that said no way this would be ready in the calendar year. And it was.

I think we have learned we have the capacity and the science to produce highly effective vaccines in a pretty short time period. And one reason I think people were a little less worried about influenza is we have the technology now to produce influenza vaccines and if there’s a novel influenza strain, we can make a vaccine quickly.

Macie Jepson
I am curious to know what does keep you up at night. You kind of touched on that in general, but what are you worried about right now?

Keith Armitage, MD
Yeah, there are a lot of things I worry about, but in terms of public health and pandemics and viruses, another a novel virus that emerges from wild animals that passes into human beings. It’s important to continue to invest in public health and monitor.

I got a text from, a dear friend today that a nurse in Kampala, Uganda, died of Ebola. So there’s been a mini outbreak in eastern Africa and now it’s in the major city of Kampala, which is a big booming capital city with a lot of people, so that’s something to keep an eye on. And we are never going to not have any of these threats. The key is to is to pay attention and use science and expertise to respond.

I think based on what we went through with Ebola a few years ago, what we went through with SARS-CoV, the new COVID-19. We should continue to invest in public health and expertise apolitically. There’s nothing political at all about science, nothing political at all about public health. But monitoring what’s going on so we can respond appropriately is critical.

Matt Eaves
I feel like we’ve reached a place of extremes in our society. On one side, it’s like challenging science is seen as anti-science. And then on the other side, people blindly accepting or unwilling to accept revised findings. So as a clinician and a scientist, where do you see or where do you draw the line between healthy discussion and where it becomes unproductive?

Keith Armitage, MD
It’s kind of a cliche, but the key is what we call evidence-based medicine. Scientists are incredibly independent and critical of each other, looking at data and analyzing papers. And then what comes out in terms of recommendations usually goes through a lot of discourse and discussion. And it does evolve. There’s nothing in science or medicine that is infallible.

Macie Jepson
What is your last word to people who are listening today?

Keith Armitage, MD
My last word would be that we’re always going to have seasonal viruses. Every year is different, pay attention to what’s going on. There are some viruses that have a treatment. Influenza has a medication, it’s pretty effective. It’s not for everybody. It’s not for people who are mildly ill. Certainly high risk people should think about getting a medicine for influenza. People who are really symptomatic for a day or so. Having some knowledge about when to think, do I need a medicine or not? Thinking when to call a doctor, persistent high grade fever, shortness of breath, chest pain. Maybe it’s just not a simple cold or flu. That’s some of my advice.

Matt Eaves
Dr. Keith Armitage, University Hospitals Cleveland, thank you for joining us.

Keith Armitage, MD
Thanks for having me.