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Scott Paparello, chief of infectious diseases at Emerson Hospital, being vaccinated.
Scott Paparello, chief of infectious diseases at Emerson Hospital, being vaccinated.

CONCORD — With students back in school, the rapid spread of the delta variant of the coronavirus, and allergy and flu season upon us, people have a lot of questions about how to stay safe during this phase of the pandemic. Scott Paparello, chief of infectious diseases at Emerson Hospital, answered some of the questions that are on the minds of many.

What are the primary symptoms of COVID-19 (the delta variant)? If I just have a routine cold, do I need to get tested for COVID-19?

It is difficult to distinguish symptoms of seasonal allergies, versus typical viral upper respiratory infections, versus COVID-19 infection. Especially among children, sneezing, head congestion and sore throats are very common with COVID-19, especially the delta variant. In general, if you or a child has any of these symptoms, I recommend testing for COVID-19 and/or evaluation by your health-care provider.

Are there other variants than delta that are concerning?  

There are a number of COVID-19 variants circulating worldwide. The delta variant is concerning because of its ability to spread quickly and widely — it is now predominant worldwide. The (Centers for Disease Control and Prevention) is tracking a number of “variants of interest,” including the mu variant that was first noted to cause outbreaks in South America. The mu variant is present in most areas of the U.S., but represents a very small percentage of infections to date.

Researchers are studying how the current COVID-19 vaccines provide protection against this variant. Currently, the COVID-19 vaccines provide strong protection against severe illness, hospitalization and death against all of the circulating strains of the virus, including mu.

Should my kids wear a mask at after-school activities, such as during athletic practices, if they are too young to be vaccinated? 

In general, outdoor activities are safer than indoor activities. However, crowded areas during sporting events, either as a spectator or a participant, can pose a significant risk to catching COVID-19. Wherever there is close crowding either indoors or outdoors, it is prudent to wear a mask to protect yourself and others.

Should we take extra precautions when visiting a family member who is immunocompromised?   

If there are unvaccinated family members getting together, including young children, and one of the family members has significant risk for serious consequences from COVID-19, such as being elderly or immunocompromised, it is recommended that at minimum, the people unvaccinated and those at personal risk for COVID-19 wear a mask.

The vaccine is at least partially protective against the virus among those that are immunocompromised, but it is hard to quantify this protection and people in these high-risk groups can certainly become infected with serious consequences.

Is it still safe to be outdoors without a mask?

In general, outdoor activities with adequate spacing among people are much safer than indoor activities. However, crowded outdoor spaces such as concerts, sporting events, etc., may pose a significant risk for spread of COVID-19. In these crowded situations, I recommend wearing a mask to reduce infection.

Should I book a vacation for the winter that involves air travel?

In general, airports and airlines have done a good job putting measures in place to protect airline passengers. Airplanes have enhanced air circulation and airports and airlines typically have mask mandates. As long as people adhere to the mask mandates, then air travel itself is likely relatively safe. More worrisome are the destination and activities done during travel. It may not be prudent to travel to areas where there is widespread circulation of COVID-19 in the community.

Regardless of the destination, it is recommended that travelers exercise caution and avoid crowded indoor spaces where there may not be widespread mask utilization.

Are indoor swimming pools safe to use?

In general, swimming is safe. The coronavirus cannot survive in chlorinated water. However, if you are using an indoor swimming pool, I would take precautionary measures when using the locker room and other indoor spaces. Precautions should include distancing from others and wearing a mask. Consider wearing a swimsuit to the pool and avoiding the locker room and other indoor areas.

How do you think the flu season will be this year?

Last year’s flu season was very mild with very little influenza circulating worldwide. The exact reason for this is not yet entirely clear. Measures to prevent coronavirus infection such as distancing, avoiding crowded areas and mask wearing likely contributed to the low rates of flu last year.

So far this year, there has not been much influenza circulating in the Southern hemisphere, which usually is predictive of the season in the Northern hemisphere, though not always. It is likely that coronavirus will circulate more widely in the Northeast during the winter months. Due to this, it is recommended people receive a flu vaccine by late October this year to help reduce respiratory infections.

What are your tips to stay healthy during flu season?

Tips that help avoid COVID-19 translate to protection from the flu as well. These measures include distancing, mask wearing, handwashing and getting the flu and COVID-19 vaccines. Adequate rest, healthy nutrition, and managing other chronic medical issues such as diabetes and hypertension will also help prevent or ameliorate the consequences of the flu.

What should I know about booster shots?

The guidelines regarding a booster dose of the COVID-19 vaccine are not yet finalized by the FDA and CDC.

There is some data on the efficacy of a third dose. To date, it looks as though side effects from the third dose are similar to those with the first dose or doses, including possible headache, muscle aches and fatigue. There is no indication that more serious side effects would arise from a third dose of an mRNA vaccination or a second dose of an adenovirus-based vaccination such as Johnson & Johnson.

It is important to clarify that a third dose of the mRNA vaccination for patients who are immunocompromised is not considered a booster, rather a third dose as part of a three-dose series.

(After this was written, the Associated Press reported that the CDC stated that people 65 and older, nursing home residents and those ages 50 to 64 who have chronic health problems such as diabetes should be offered a booster once they’re six months past their last Pfizer dose. Those 18 and older with health problems can decide for themselves if they want a booster. People at increased risk of infection because of their jobs or their living conditions such as health care workers, teachers and people in jails or homeless shelters can also get a booster.)

What are you hopeful for regarding the pandemic? 

I am most hopeful that more people will become vaccinated. The more the virus circulates, the more likely it is that variants arise. Eventually, variants that escape immunity from the vaccination will develop.

People who were infected with COVID-19 may have some immunity which could provide some protection for a relatively short time, but is quite variable. The current vaccines offer a more durable level of protection. It is up to the people who are eligible for the COVID-19 vaccine to get it, which would protect those that cannot be vaccinated, such as young children and those who are immunocompromised or at a higher risk of severe consequences from the disease. Widespread vaccination will go a long way to prevent the development and spread of variants. The pandemic will end when there is widespread immunity to the virus. The fastest way to achieve that is by getting more people vaccinated.

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