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Last year's "tripledemic" of flu, COVID-19 and RSV left many of us wary of what the coming respiratory virus season might bring. But this year's landscape is already different, with new vaccines and treatments, like the game-changing antibody that protects kids from RSV, offering new ways to tamp down infections and transmission.

In this Q&A, adapted from the July 28 episode of "Public Health On Call," infectious disease epidemiologist David Dowdy, a professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health, discusses what we can learn from last year's virus season, how and why this year might be different, and why vaccinations continue to play a key role in determining how severe the viruses' toll will be.

Last year we saw a big respiratory virus season after a couple of years of not seeing as much flu and RSV. Should we be panic about another difficult season this year?

I think people have reason to be on edge. The COVID pandemic threw us all for a loop.

Last year, we did have quite a large spike in RSV, and the flu season was earlier but not necessarily worse than usual. It's hard to know exactly what's going to happen this year, but given that COVID hospitalizations and deaths are at all-time lows, and people are getting back to behaving as they did before the pandemic, I think we're likely to get back to the way things used to be with respiratory viruses as well.

We don't know for sure what's going to happen. But we don't have any evidence to strongly suggest that things are going to be much, much worse this coming year than they were pre-pandemic.

We've seen some reports of an uptick of COVID in some wastewater surveillance. What's going on here?

We are seeing a slight uptick in wastewater surveillance, but it's important to couch that in the probably more meaningful data on hospitalizations and deaths being at an all-time low. Both of the last two years, we saw a noticeable summer peak in COVID admissions and deaths. We really aren't seeing that at all this summer, for the first time since the start of the pandemic. So I think that's overall good news. So people may still be getting sick, but they're not getting really sick.

We also just had the Fourth of July, when a lot of people were gathering. Could that be why we're anecdotally hearing about more people getting sick?

That's certainly possible. A fair amount of immunity to COVID-19 now is due to people having gotten sick themselves, not just the vaccine, and I think that's providing some ongoing protection now. But certainly we've seen this both of the past two summers as well: There was a big surge in the winter, and then a smaller rebound right around this time—which, again, we're not seeing in terms of serious illness, but in terms of cases we might.

Last year it seemed, especially for families with younger children, that someone was sick at any given time. Is that part of this coming out of COVID? Do you think we might see that again this year?

There are probably a number of factors at play here. First of all, I think there is some component of coming out of COVID. A year or year and a half ago, lots more people were wearing masks and still distancing themselves much more than they are now, so there was this added layer of behavioral protection. Once that went away, these viruses that have been with us for centuries came back.

Since there are many of these viruses, you'd have one wave of one sort of virus, and then another wave of another, so people would feel like they were always sick. This is even more true for young kids. For example, those who were infants during COVID season never had that opportunity to build up that first layer of protection. But of course, if you ask any parent who has had a kid in daycare, even before the pandemic, you're always a little sick. Kids are coming in and infecting each other and then bringing those things home, and that happens in the summer as well as during the winter. There's probably an element of that as well.

So what you're saying is that humans are going to be humans and viruses are going to be viruses. We're just paying a lot more attention right now.

I think that's true. I do think that during the pandemic we were slightly different humans, so we didn't have quite as many of these viruses circulating. It took a little time to get back to our usual ways, but I think we're pretty close to being back there now.

What about the potential for an early flu season? Should people get flu shots earlier?

The advice hasn't changed. The advice is and has always been to get the flu shot in September or October, before the start of the flu season, and the flu shot is designed to deliver protection throughout the season. Those who participate in mandatory flu vaccine programs, like health care workers, are used to getting their flu shots in September to October. Given the fact that we had an early flu season last year, where the flu really spiked in November as opposed to January/February like it usually does, it's a little more relevant now. We probably are a bit more likely to have an early flu season this year—again, just because the last flu season was pushed early, too. And it might take another year or two for us to get back to the usual way of things.

The third virus in our "tripledemic" was RSV. Some big news just came out that there is a new antibody for RSV. Can you tell us a little bit about that?

On July 17, the FDA approved a new antibody for RSV called nirsevimab. This is the second antibody that's available for protection against RSV. But unlike the first antibody, this one lasts longer. It's designed to be stable in the body for four to six months, and it's been approved not just for those infants who are at highest risk, but for all healthy infants as well. We're expecting to see a lot more uptake of this antibody, and hopefully that will help protect our youngest infants against RSV this coming winter.

COVID deaths and hospitalizations are down. Last year's flu season was early but otherwise not that different from what we've seen before. What's the lesson to take into the upcoming respiratory virus season?

Get your vaccines. It's true that we're seeing hospitalizations and deaths due to COVID 19 declining, and for the first time since the beginning of the pandemic, we're seeing all-cause mortality starting to normalize. All of this is good news. But we have to remember that these are still deadly viruses. Tens of thousands of people die from COVID and the flu every winter, and that's likely to continue being the case.

Just because we're coming out of the pandemic doesn't mean that we're suddenly immune to these other viruses, and we need to continue to do what we can to prevent those viruses from taking hold. That means getting your flu shot when it's available, getting your monovalent COVID vaccine when it becomes available, getting your infant children these new antibodies for RSV, and if you're indicated to, getting an RSV vaccine yourself. The way that we prevent the brunt of deaths from all of these viruses is to take each of these different steps in tandem.

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Salter Labs is a captive molder of disposable medical respiratory products based in Arvin, CA. If you've never been there, it's just off state highway 223, southeast of Bakersfield, a few miles east of Weed Patch. "We have to be pretty self-sufficient," says toolroom supervisor Russ Kinney. "The company is out here in the middle of the desert all by itself."

Salter is a 14-press shop running machines from 22 to 350 tons. The predominant material is PVC. The 350-some employees work three shifts, seven days a week. All tools are made in-house on a healthy collection of CNC mills, lathes, EDM centers, and automatic and hand-operated surface grinders.

Time was, a few years ago, that if any of Salter's molds had small nicks, scratches, or pits, Kinney had to pull the mold out of the press, throw it in a truck, and drive it the 11*2 hours southwest to Los Angeles where the nearest microwelder would take a day or so to repair the damage. Kinney was making this run about twice a month. "I kind of miss going down there," says Kinney. "We are pretty good friends."

Kinney stopped going to Los Angeles for his mold repairs because he's started doing the welding himself. He didn't invest in the traditional welding equipment used by most microwelders. He invested instead in the MoldMender, a nonarcing spot welding process that he says is easy enough to be used by any one of his toolmakers. "For fixing corners, flash areas, and deep scratches, it works excellently," Kinney says. The bonus is that the system is portable; in a pinch Kinney can throw it on a cart, roll it right up to the press, and perform the repair without wasting time and money to pull the mold.

Such was the case for John Morrison, president of Ideal Molds and Tooling in South Elgin, IL. Although his is strictly a tool shop, next door is Progressive Plastics, a molder of auto, medical, and housewares products. Morrison builds some of the tools Progressive uses. He also is the first called if the molder finds damage on a mold. Morrison estimates that sending the mold out for repair used to cost him $100 to $150 just for the weld, plus another $300 or so in time and labor to polish the repair or make new electrodes to EDM the tool again.

Now Morrison either does the repair himself on his own bench or, like Kinney, he wheels his MoldMender up to the press and does the fix on the fly. Repaired areas are usually diamond polished to specification, and all is well again. "About 80 percent of the damage on your tools can be fixed by a microwelder," Morrison says. A notable example, he says, occurred recently when Progressive was molding a door handle for the Dodge Dakota truck. The parting line in the mold had worn, causing the glass-filled material to flash fairly severely. In less than an hour Morrison says he welded a ribbon of fresh steel around the parting line, filed it down, textured it to match the rest of the mold, and reduced the flash by about 90 percent.

The device that made all of this possible, the MoldMender, is a product of Rocklin Manufacturing, based in Sioux City, IA. This modular unit is a low-heat system that uses an electrode you press against a ribbon or wire of ferrous material on the damaged area - a scratch, corner, parting line, or small hole. The electrode is activated by a foot pedal. It welds a spot .03125 inch in diameter; these welded spots are then interconnected over the affected area to lay down the fresh, hardened material. The advantage over traditional welding, says Rocklin president James Rocklin, is that the MoldMender does not generate a lot of heat, which can lead to sinks and voids in the repaired area. Nor does the welder splatter the material to adjacent areas. Also, unlike traditional microwelding, learning to use the MoldMender system only takes a few minutes. "Play with it for 10 minutes and you're an expert," says Kinney. "It's no joke."

Says Morrison, "It takes a knack. You have to practice with it a little bit. But once you learn, it's easy to use." Kinney estimates that he uses the welder every other day, but says it's best used for repairs of .02 or .03 inch or less. More than that, he says, and you should take the mold to a traditional welder. Morrison also admits that "you cannot put gobs of weld on." Both toolmakers say the welder comes in quite handy for shimming core pins. Kinney and Morrison also report that MoldMender repairs require less grinding and polishing to bring the mold within spec.

As for cost, Morrison says his MoldMender was $5500, about one-third that of competitive systems he'd looked at. Kinney says, "I think we paid for the machine in the first six months we had it."

A former Missouri therapist initially accused of murdering two patients had been sentenced on manslaughter charges, after admitting that she injected them with medications they weren’t prescribed.

KTTN reports that 42–year-old Jennifer Anne Hall was sentenced to 18 years behind bars for the 2002 deaths of Fern Franco, 75, and David Wesley Harper, 37. Both deaths happened at the Hedrick Medical Center in Chillicothe, during “medically suspicious” events.

As CrimeOnline previously reported, in the five months Hall worked at Hedrick Medical Center, between December 2001 and May 2002, there were 18 sudden cardiac arrest events at the hospital, resulting in nine deaths. The facility typically averaged one per year.

An autopsy on Franco identified the presence of succinylcholine and morphine, which were not prescribed to the patient or ordered by her doctors.

Three days after being admitted to the medical center for bronchitis, Harper died, prosecutors said. A nurse said she discovered Harper sitting on the edge of his bed before experiencing a sudden “complete respiratory arrest,” DailyMail reports.

“Because of Hall’s singular proximity to stricken patients, her access to pharmaceuticals which are deadly if misused, and her discovery and method of notifying staff of every patient’s cardiac emergency, nursing staff believed Hall was responsible for the patient deaths,” Chillicothe Police Officer Brian Schmidt wrote.

Administrators put Hall on leave three days after Franco died; the cardiac incidents “returned to normal frequency,” court records state, according to CBS News.

The hospital then fired Hall months later upon learning that she had been convicted of arson at a different hospital where she worked previously, even though she was later acquitted.

“A sentence 20 years in the making,” Livingston County Prosecuting Attorney Adam Warren said in a statement, following the sentencing.

“I am happy that justice is finally served for Jennifer Hall. Families of loved ones, Doctors, and Nurses have been waiting for this day. It wouldn’t have happened without the efforts of the Chillicothe Police Department who gave this complicated cold case enough time and energy to get this conviction.

“The sentence was for 18 years. Jennifer Hall will be able to parole someday. But for now, we all sleep better knowing she is behind bars.”

Initially facing two charges of first-degree murder, Hall ultimately took a plea deal in April and admitted to lesser charges of first-degree involuntary manslaughter for the two deaths. She also pleaded guilty to one count of attempting second-degree assault.

Hall will be eligible for parole. Check back for updates.

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[Feature Photo: Jennifer Anne Hall/Livingston County Sheriff’s Office]

...EXCESSIVE HEAT WARNING NOW IN EFFECT UNTIL 10 PM CDT FRIDAY...

* WHAT...Dangerously hot conditions with daily heat index values
of 105 to 115 expected during the afternoon and early evening
hours.

* WHERE...Portions of southeast Kansas and central, southwest
and west central Missouri.

* WHEN...Until 10 PM CDT Friday.

* IMPACTS...Extreme heat and humidity will significantly
increase the potential for heat related illnesses,
particularly for those working or participating in outdoor
activities.

* ADDITIONAL DETAILS...Minimal overnight relief with lows around
75 to 80 and humid conditions.

PRECAUTIONARY/PREPAREDNESS ACTIONS...

Drink plenty of fluids, stay in an air-conditioned room, stay out
of the sun, and check up on relatives and neighbors. Young
children and pets should never be left unattended in vehicles
under any circumstances.

Take extra precautions if you work or spend time outside. When
possible reschedule strenuous activities to early morning or
evening. Know the signs and symptoms of heat exhaustion and heat
stroke. Wear lightweight and loose fitting clothing when
possible. To reduce risk during outdoor work, the Occupational
Safety and Health Administration recommends scheduling frequent
rest breaks in shaded or air conditioned environments. Anyone
overcome by heat should be moved to a cool and shaded location.
Heat stroke is an emergency! Call 9 1 1.

&&