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How bad is flu in 2025? What mask is best for wildfires? Is norovirus still surging? How do you get rid of a stomach virus?
AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, discusses the health impacts of wildfires and the harmful effects of wildfire smoke. Also covering the latest viral infections, like the surge in norovirus cases, and respiratory viruses like COVID-19 and flu. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Andrea Garcia, JD, MPH, vice president, science, medicine & public health, American Medical Association
Transcript
Garcia: We're definitely in virus season. Emergency department visits for flu and RSV are very high. And although COVID cases leading to ED visits are still low, they are increasing.
Unger: Hello and welcome to the AMA Update video and podcast. Today we have our weekly look at the headlines with the AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia. I'm Todd Unger, AMA's chief experience officer. Welcome back, Andrea.
Garcia: Thanks. It's great to be here.
Unger: Well, again, we have lots to talk about, beginning with the headline that everybody's reading about, which is, of course, the California wildfires. And we know there's been a huge amount of destruction and loss. And unfortunately, they're going to likely be lingering health issues for many. How exactly do wildfires and wildfire smoke affect health? And what do we need to know about that?
Garcia: Well, Todd, that's a good question. And it was covered recently by the Washington Post. And not surprisingly, the longer that these fires go on, the worse the air quality gets and the risk of health problems increases. An expert quoted in that Washington Post article explained that wildfire smoke contains fine particulate matter, or PM 2.5. And these are about 1/70 the width of a single human hair.
Because they are so small, they can easily infiltrate the heart, lungs, in some cases, even the bloodstream. In addition to this, wildfire smoke often contains other hazardous chemicals that are produced when common household products such as electronics, plastics and aerosols burn. And this mix can contribute to both short- and long-term biological harm. Taken together, this makes wildfire smoke particularly harmful to our health.
Unger: Exactly. And as you point out, there's a lot of different things in that combination that are burning. And of course, part of the smoke there. So, Andrea, when someone has been exposed to this harmful smoke, what symptoms would they experience?
Garcia: Well, according to the EPA, exposure to wildfire smoke can lead to short-term respiratory problems such as coughing and wheezing, difficulty breathing and asthma. The CDC also says it can cause that irritation in your sinuses, your throat, and your eyes. In more severe cases, that exposure can be linked to heart attacks and to stroke, as well as lung cancer and damage to cognitive functions.
There is a growing body of research that also suggests there may be links between wildfire smoke and long-term neurological effects, such as dementia and Alzheimer's disease. Children, the elderly, those with pre-existing conditions are the most susceptible to serious outcomes. But the CDC does say that everyone, even healthy people, are vulnerable to those risks posed by wildfire smoke.
Unger: That's quite a list of possible outcomes there, Andrea. Knowing this and how serious it can be, what can people do to protect themselves?
Garcia: Well, I think something people may not realize is that indoor air can also be affected by this type of air pollution. And smoke can travel sometimes very far distances. So while those fires are currently concentrated around Los Angeles, it's not just residents of that area that need to know how to protect themselves.
Obviously, the best thing you can do is remove yourself from the threat and reduce your level of exposure as much as possible. You're going to want to close your windows and doors to protect the indoor environment and evacuate if necessary and if you're able to. But you can also try to filter those particles before they enter your home using an air filter or an HVAC system with good air quality filters. And then portable air purifiers can also be helpful.
If you have to drive in an affected area, you're going to want to put the air on recirculate. This is going to stop your vehicle from pulling that outside air in. And you're going to want to wear a NIOSH-approved N95 respirator. That can help limit exposure if worn properly. However, it's important to keep in mind that other types of masks won't help as much here because the particles from the wildfire smoke are so small and can get through most of those materials.
And then you're going to want to stay aware of your local air quality by checking airnow.gov or other local websites and apps that report on air quality.
Unger: All right. Those are all good things to know. And we, of course, all hope the fires are contained as soon as possible. It's just unbelievable the destruction that we're seeing. And our thoughts are certainly with those in California right now.
In other news, we're once again at that time of year where at least someone we know is sick. Andrea, it seems like a lot of viruses out there. Which were the ones that seem to be circulating the most?
Garcia: Well, we left off last week talking about norovirus, so let's pick up there. And just as a reminder, norovirus is not a respiratory illness. It's a stomach bug. It's continuing to surge across the country. And it's really characterized by sudden and pretty unpleasant GI symptoms.
A New York Times article that was updated last week reiterated that there have been an unusually high number of norovirus outbreaks right now, according to an article in Fortune and CDC data. Nationwide, test positivity was at nearly 23% the week ending December 28. That compares to less than 11% six weeks earlier, so that's a pretty big increase in a short amount of time.
There are nearly 50 different subtypes or genotypes of norovirus, with different ones circulating in different years. This year, CDC data shows that the strain known as GII.17 accounts for nearly 70% of the outbreaks in the United States. And it's also the strain behind a surge in Britain.
Unger: Now, I kind of remember a lot of norovirus every winter. Is this kind of normal for this time of year, or are we kind of in increased territory?
Garcia: Unfortunately, yeah. Outbreaks can occur throughout the year, but they are definitely most common between November and April. And as we briefly talked about last week, this virus is highly contagious. It sickens an estimated 19 to 21 million people nationwide each year. And although most people recover within three days each year, norovirus is responsible for about 465,000 ED visits, most of which are in young children.
It also typically leads to more than 100,000 hospitalizations and nearly 1,000 deaths, mostly among adults 65 and older. Unlike many of the other viruses we talk about, like flu, COVID and RSV, norovirus doesn't have an FDA-licensed vaccine.
Unger: Is there any hope for a norovirus-free future for us? Any kind of vaccine or medication in the near future?
Garcia: Well, developing an effective vaccine for norovirus has been a challenge because with 50 different versions, each genotype requires a different immune response to provide protection. So a norovirus vaccine would likely be similar to a flu vaccine in that we would need—it would need to be updated each season based on the best available data as to which strains are going to be circulating.
I think with that being said, there is a vaccine in development. And Time Magazine reported on this just last Friday. And according to that article, scientists at Moderna are in the late stages of testing a norovirus vaccine using mRNA technology. And that company is currently enrolling 25,000 people around the world in a phase III trial of that vaccine, after earlier testing showed encouraging results.
The company does expect to finish signing up volunteers in the spring and plans to follow them for at least six months. The mRNA platform is likely well-suited for this vaccine because it allows scientists to change and update those viral targets more quickly. So we'll, of course, continue to keep a close eye on that.
Unger: All right. Well, that's potentially good news. And we will await more on that. Andrea, what about respiratory viruses? Are we seeing more cases of those as well?
Garcia: We are. And according to a recent CNN article and CDC data, COVID and flu are now increasing in most parts of the U.S. We're definitely in virus season. Emergency department visits for flu and RSV are very high. And although COVID cases leading to ED visits are still low, they are increasing. Wastewater testing also indicates high COVID levels. And I think added to this mix, we are seeing viruses that cause the common colds and bacteria that leads to strep throat as well.
Unger: Well, the symptoms for many of these are so similar that it can get pretty confusing about what you've got. What do people need to know if they get sick?
Garcia: I think the first question many encounter when they begin to feel sick is whether or not they should get tested. And I think one way to think about this is whether or not knowing what is causing you to feel sick will change what you do. There are more than 200 viruses that cause the common cold, and most healthy people will have mild symptoms like a runny nose, congestion and fatigue. In these instances, the recommendation will be rest, drink lots of fluids, take over-the-counter medications to relieve fever and body aches.
But we know that testing for respiratory viruses like flu and COVID can help you decide what to do next, like getting treatment to reduce your risk of severe illness, and taking those steps to lower your chance of spreading the virus to others.
Unger: All right. What do you think in terms of symptoms kind of warrant the level of going to see the doctor or getting more help?
Garcia: Well, obviously, if symptoms worsen or persist, you should always contact your doctor, especially if symptoms don't clear up within five to seven days. Those people who are at high risk for developing serious disease from COVID or flu should always get tested. These include older individuals, those with chronic underlying medical conditions. And pregnant people can also be vulnerable to certain complications, so they should seek medical care early as well.
Beyond respiratory viruses, if you or your child has a sore throat, it may make sense to rule out strep throat, which is bacterial and would need antibiotics. For stomach illnesses, like norovirus, which we talked about earlier, there is no real treatment. Generally, testing is not recommended to confirm a diagnosis. That recommendation changes, though, if your illness becomes severe or if you develop fever or severe abdominal or if you're a population at increased risk, such as babies, older adults, people with chronic kidney or heart problems.
Obviously, the real concern here is preventing dehydration. So in those instances you will want to seek out the care of a clinician.
Unger: All right. Well, that's the express trip through what's out there. Andrea, thank you so much for providing your perspective and updating us. If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join.
You can always find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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