Tis the season to spread joy, cheer and yes germs!

Tis the season to spread joy, cheer and yes germs!
Lisa Mathis MSN, FNP-BC

As the holiday season is upon us, we look forward to the season of cheer and joy. Holiday parties are planned, decorations are hung, and gifts purchased. Red and green lights twinkle, adorning the Christmas trees. Little ones are so excited to have a jolly, obese man come down the chimney to bring gifts. (unless he has been on a GLP1 and he may have slimmed down). The season is one of anticipation and excitement. But with the good also comes the bad. Seasonal illness we are so accustomed to also come out of hiding just like the boxes of red and gold ornaments.

Of course, the common cold peaks in fall and winter and is easily spread as crowds gather and the mucous flies when kisses are given in greeting.

Influenza also rears its ugly head and depending on the immunization status and the strain, some seasons are far worse than others. Also easily spread in a crowd, this can pass through a room as fast as a tray of sausage balls.

Norovirus is the gift that just keeps on giving and is quite virulent and can become a horrible gift to give that cousin that came from out of town.

Acute Bronchitis and sinusitis can hold hands with the common cold and flu along with strep throat. And let us not forget our newest Grinch, COVID.

So, what can we do? This is a yearly event just as predictable as that gift you get that you really don’t want like socks or a candle.

We know as health care providers prevention is the main point we need to educate our patients about, but who wants to stay home on Christmas Eve? I mean just because little Johnny has a temp of 102, let’s do some Tylenol and go to the party. However, we do need to continue to educate and remember to explain to parents and patients when and how long they are contagious. We need to explain that this illness can be spread with coughing, touching toys with little mucous covered hands and not washing hands after explosive diarrhea at Pawpaw’s house.

But we all know some will not listen. Some people will only want antibiotics “to get better fast!”. That anxious mom does not want to leave your office without something to make her little one better. So, what do we do?

Antibiotics are not always the answer, especially in a season where a lot of illnesses are viral. “When people are miserable and naturally want to feel better quickly, they often think antibiotics will help.” Says UNC Health ID specialist Nikolaos Mavrogiorgos MD (1) Still patients will push for a prescription. Not only will antibiotics do nothing for a virus but taking them when not needed can do more harm. 28% of prescribed antibiotics are unnecessary according to the CDC.

But what do we do? We don’t want the patients to be mad and upset and refuse to see us.

Take the time to sit down with the patient, or parents and explain the difference in bacterial infection and viral illness. Speak on the level they can understand. Do not use medical terminology to the rural person who may not understand medical jargon. If the patient presents within 72 hours you can give antivirals like Tamiflu for Influenza. Paxlovid for COVID or try Zofran for severe vomiting with GI viral illness. Also reassure them if not better in 3-days, mucous turns green, or fever persists they can call, and you may consider antibiotics or reevaluate at that point. Do not get so busy with the increase load of patients on your schedule that you just hand out Rx for Amoxicillin, as you are hurting those in the long run. Continue to educate as much as possible and encourage those ill to stay home when febrile and contagious to prevent the spread of the illness.

Our best weapon is education. I know that is not always what makes the patients or that anxious parent happy, but it is a fact. Pull out those pamphlets on supportive measures, fluids, and Vitamin C data. Decorate your walls not only with holiday cheer but of data supporting misuse of antibiotics. They can read while waiting on you, this is a helpful tool!

As advanced care practitioners we desire to be liked by our patients, we like for patients to “want” to see us. We want our schedule to be full, and that dreaded sentence “I want to see a physician, not a NP” is like getting a lump of coal in our stocking. But do not let those feelings keep you from practicing safe and evidence-based medicine.

We can all hope that this year will be one of minimal illness. Currently influenza is minimal to mild across the USA. Covid numbers are low, and the common cold seems to be the issue most are dealing with. (2) But make no mistake this will change as gatherings increase, so be ready.

Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. (3) There are continuous updates on recommendations and new guidelines regarding resistance and current infectious conditions prevalent. Please keep yourself up to date by continuing to follow the data, so you will be educated and can accurately update your patient.

Good luck and Happy Holidays!

https://www.cdc.gov/fluview/surveillance/usmap.html

https://myclevelandclinic.org/health

http://www.cbc.gov/antibiotic use