By Mahlon Meyer
NORTHWEST ASIAN WEEKLY
It started with a headache. But by that evening, Emma Nakamoto had a whirling dizziness, fainting spells, and a liquid in her nose and throat that resembled “split pea soup.”
Nakamoto, a teacher in the Issaquah School District, originally from Hawaii (who asked that we use a pseudonym for professional reasons), would go on to experience chills and other COVID-19-like symptoms that kept her out of work for weeks.
This was in the spring. And along with her absence, hundreds of other teachers and students across the district—and across other school districts in our state—were out sick.
“I feel like everyone around me is getting sick,” she said at the time.
But hundreds of at-home COVID-19 tests she and her colleagues administered all turned up negative. So what could it be?
There are a few other respiratory illnesses that may have similar symptoms with COVID-19.
According to Jim Boonyaratanakornkit, an infectious disease specialist at Fred Hutchinson Cancer Center, the viruses causing the infections could be one or more of many.
On one hand, these viruses were in circulation before the pandemic, he said.
“It’s just that now people are hyper-aware due to COVID-19,” he said.
But on the other hand, the emergence of COVID-19, and the extreme measures taken to shut it down, threw off the usual seasonal pattern when these other viruses typically emerge.
Moreover, during the pandemic, masking, social distancing, and the closing of schools and workplaces tamped down the spread of all respiratory viruses while COVID-19 continued to infect at a relatively greater rate because our immune system was not familiar with it.
To summarize, these respiratory viruses have been circulating since long before, and are not necessarily any new disease or pandemic. However, that is not to say people should not be careful, it is still important to protect your health, probably now more than ever.
Prior to the pandemic, viruses that creep up in the spring include the parainfluenza virus and enteroviruses. Winter viruses are influenza, respiratory syncytial virus (RSV), and human metapneumovirus. Rhinoviruses, which are associated with the common cold, occur year-round.
But when society started to open up in the summer of 2022, there was a huge surge of flu, COVID-19, and RSV.
“There was this anomaly where we noticed a lot of RSV cases in the summer,” said Boonyaratanakornkit. “RSV normally peaks in the winter.”
Whether this year will witness another off-cycle surge of viruses remains to be seen.
“I think it’ll probably return to a regular pattern because our society has mostly returned to its regular pattern of going back to work and school,” said Boonyaratanakornkit. “But I don’t have a crystal ball.”
RSV and young children
One of the viruses getting the most media attention, besides COVID-19, is RSV. One reason is because in the next year or so, it is likely a vaccine will be developed.
As of April, an article in the New England Journal of Medicine described phase three trials—or those in their final stages—of vaccinating pregnant women so they could pass antibodies onto their infants, according to Boonyaratanakornkit.
This is important because of the widespread rates of infection of RSV and its potentially critical impact, he said.
Well over half of all infants are infected.
By the time children reach 2 years of age, over 90% are infected.
Most people get reinfected multiple times throughout their lives.
RSV causes lung cells to fuse together to form “one big blob,” said Boonyaratanakornkit.
“Those cells can’t survive and are going to die, and so it can cause severe damage to our respiratory tracts,” he said.
Since RSV spreads most commonly among young children, one of the biggest factors that will determine whether or not one gets infected is exposure to elementary school kids.
Besides a vaccine, others such as Boonyaratanakornkit’s lab are working on preventative measures.
At home and at school, parents should also teach their kids to practice safety measures, especially when they notice people around them are getting sick. Children have a weaker immune system, hence parents need to pay extra attention. Once vaccines become available, parents should also consider getting that for their kids.
Can you test for other respiratory viruses?
According to health researchers, it is not that a diagnosis was impossible, but rather structural impediments and cost prevented most of the afflicted from getting them.
Boonyaratanakornkit said that tests do exist to determine what the virus is that is infecting a person.
But in most cases, insurance won’t pay for the tests because, while there are treatments available for the COVID-19-like symptoms these viruses cause, there is as yet no real way to treat the virus itself. Therefore, getting a test to identify what virus may not be necessary, at least not to the insurance providers..
“Still,” he said, “If I were infected, I’d want to know what has invaded me. But it’s not within the budget of everyone.”
Nor the time constraints.
Nakamoto, like most other teachers, rises at 5 a.m. to get ready for a long commute. She teaches all day. And when she arrives home, besides cooking and prepping for the next day, has barely any time for anything else.
At the same time, the insurance company that covers public school teachers in the state of Washington does not cover the kind of diagnostic tests Boonyaratanakornkit was referring to.
When you need to get the diagnosis
While Nakamoto and her colleagues suffered for weeks with a viral and post-viral infection that kept schools short-staffed, without knowing what virus was infecting them, in some cases it is essential to determine the exact pathogen.
For example, cancer patients awaiting treatment or transplants need to know what they are infected with so doctors can make decisions about whether to delay treatments or take other measures.
“At Fred Hutch, we test all our patients,” said Boonyaratanakornkit.
And when the doctors themselves get sick, they also take special precautions to protect themselves and their patients.
A physician’s assistant picked up a virus and had symptoms similar to COVID-19 that lasted for weeks. So she also had to stay away from work.
Worse than COVID-19?
Most of the time, the symptoms of these respiratory diseases are not too bad.
In the case of Nakamoto, the symptoms persisted for months. The liquid still filled her nose and throat for weeks, although it gradually thinned.
And other symptoms were superadded.
After she ate a big meal, she found she could hardly talk, her voice was so scratchy.
And in the case of the physician’s assistant at Fred Hutchinson, she had fatigue, brain fog, and other symptoms she described as much worse than when she had had COVID-19 in the past.
Stress and the immune system
One other factor that makes one susceptible to these viruses is stress.
“Our parents used to tell us not to go out in the rain and the cold, but the connection is with stress,” said Boonyaratanakornkit. “Stress can dampen your immune system.”
In the case of Nakamoto, the stress was both long-term and short-term, and painful.
When she started out teaching in Hawaii, the entire teaching staff was Asian.
In the whole school district, there were only two white teachers—and the kids would get them mixed up.
But teaching in Issaquah, she found the reverse was true. The resulting situation was not perhaps overly stressful or antagonistic. It did, ironically, seem to counter her earlier sense of belonging with a constant reminder of mainland American racial stereotypes.
In contrast with Hawaii, most of the teachers in Issaquah were white.
And at her school, there were only two teachers with Asian ancestry, herself included.
And while they had different body types and heights, the kids would regularly mix them up.
But the real stress came when her family discovered that her father’s cancer, which they thought was in remission, had spread to his ribs and lungs.
Nakamoto came down with her illness as he was being flown from the big island of Hawaii to Oahu for a CAT scan.
At the same time, her brother had become infected with COVID-19 and passed it to both parents.
In her father’s case, it had become pneumonia.
“I would go to sleep at 8 or 9 but wake up at 1 or 2 thinking about my dad and would be checking my phone to find out about him,” she said.
Despite her own sickness, she flew back to Hawaii to be with the family.
Nakamoto’s case once again points out how closely related one’s mental and physical well-being are. Stress is an unavoidable part of life, and everyone needs to find and practice stress-relief and stress-controlling methods that are appropriate for their situations.
One true test
For most people, like Nakamoto, fighting off a viral infection is only a matter of time. If a patient is severely impacted, and has trouble breathing, doctors may give oxygen, said Boonyaratanakornkit.
For fever and muscle aches, Tylenol is typically prescribed, unless one has an adverse condition, such as kidney disease (Boonyaratanakornkit advises checking with a doctor before taking any medication).
But for others, respiratory viruses can linger longer, particularly for those with complicating factors.
Boonyaratanakornkit himself has asthma. So when he gets a respiratory viral infection, he coughs for months.
Immunosuppressed patients can continue to shed viruses for months after they feel better, so caution must be taken in isolating them from other patients, so as not to spread infection, said Boonyaratanakornkit.
Still, in the wake of COVID-19, other respiratory viruses, despite their virulence and similar symptoms, often get short shrift.
“The public is just not as aware of them and maybe trivializes them, but as these teachers demonstrate, they have a huge impact,” said Boonyaratanakornkit. “My hope is that one day, we’ll be able to home test for all these viruses and they’ll be cheaply and widely available and so people can do it from the safety and comfort of their own home.”
For now, absent such a widespread application of home testing, the symptoms of COVID-19 and these other viruses are so close, it is almost impossible to tell them apart.
There is, however, one sure sign of distinguishing between them, without taking any kind of test, said Boonyaratanakornkit.
COVID-19, out of all of them, is the only one known to take away your sense of taste or smell.
Mahlon can be contacted at firstname.lastname@example.org.
Made possible in part by the Washington State Department of Health through a grant from the Centers for Disease Control and Prevention. This information does not necessarily reflect the official policies of the Washington State Department of Health or the Department of Health and Human Services.