Dr. Irini Daskalaki serves as Princeton’s Global and Community Health Physician Coordinator, a role first created when University Health Services (UHS) grappled with an onslaught of meningitis cases in 2013. In this role, Dr. Daskalaki oversees matters related to travel health, global medical incident response, medical surveillance, outbreak prevention, and student immunization compliance. During the COVID-19 pandemic, Dr. Daskalaki served as the University’s medical lead of the COVID-19 response. In that role, she worked to build protocols for contact tracing, isolation, quarantine, and COVID-19 vaccination clinics.
The Daily Princetonian sat down with Daskalaki to discuss a surge in influenza, respiratory syncytial virus, and other viral respiratory infections on campus just before winter break. Daskalaki also discussed precautionary measures that members of the University community can adopt to combat the spread of infectious diseases. This interview has been edited for clarity and concision.
Daily Princetonian: According to UHS, campus has witnessed a surge in cases of various viral diseases, including viral respiratory infections and viral gastro enterovirus. How has UHS been handling this onslaught of viral diseases and infections?
Dr. Irini Daskalaki: I think what we’re seeing is what the rest of the country is seeing, what’s essentially called a “tripledemic.” There is a surge in cases of RSV, or respiratory syncytial virus, which usually affects younger children. Adults will usually have enough immunity to deal with it and not even know that we have it or maybe have it as a minor cold. However, it can more severely affect older adults. This is a virus that usually has seasonality, typically starting in October. This year, it had a big surge starting in August. We see a similar pattern with the flu, where the flu in our area usually starts in January or mid-December and on-campus in February because we don’t have classes in January. But this year, we actually saw a surge in November that was consistent with the rest of New Jersey. That has happened all during a time when COVID-19 is still a concern and the pandemic has not officially ended.
So that’s what we call a tripledemic, and we’re seeing other viruses as well. There’s rhinovirus, an upper respiratory disease that can cause common cold-like symptoms. At UHS Medical Services, we’re used to responding to these surges with our staff. What happens is that students are very concerned especially when it comes around during the times of midterms and other exams, including Dean’s Date, when there are many deadlines and requirements. Unfortunately, we don’t have magic treatments to make these diseases go away faster. So prevention is truly what we want to focus on. We avoid having these surges as much as we can. We try to curb the effects that they have on campus and the students’ activities.
As far as the precautions that we can take for respiratory diseases go, we look at all diseases the same way: first, whatever we have a vaccine for, we want the vaccine. It’s usually the most effective and single most important measure to curb the effects of disease. For the respiratory diseases that we mentioned, we have two vaccines: the flu vaccine and COVID-19 boosters. We advise and recommend that every student be up to date with COVID-19 vaccines and get their flu shots early in the season. Even if they haven’t gotten it yet, there’s still time. Usually, in other years, the flu season hasn’t even started at this point. So we have a few months to go with the flu on campus.
But there are other respiratory diseases, like RSV and rhinovirus and all these other viruses that cause the common cold. There are a few precautionary methods that we can use for these viruses. One is when people feel sick, to avoid going into public places or to work. I know this is easier said than done, and we need to change the culture of our society around this. It is not okay for somebody to go out when they are sick. They may be able to do their work, but they need to think of the people around them. Another way is to cover one’s cough. Another way, of course, is to wash hands, since some of these viruses persist on surfaces. People can get infected by getting the virus from a surface.
And now, after COVID-19, we have been able to normalize the use of masks more, as is the norm in other countries and other cultures around the time of the respiratory season. So I would say whoever feels sick, the ideal is to stay home and avoid public places. But if they have to, I think it is quite effective to wear a good mask, like a surgical mask or a KN95 mask. Now we know that we can get a lot of things done with a mask on, and that’s a good thing to do.
DP: As a public health expert, could you speculate on the underlying factors fueling this tripledemic? For instance, has the relaxation of COVID-19 guidelines or the reduced efficacy of public health messaging exacerbated these trends in terms of increasing the spread of respiratory viruses?
ID: I think it was going the other way. When we had all the measures in place for COVID-19, that was preventing a lot of the other viruses from spreading. So with the relaxation of COVID-19 measures, with not so much masking and more congregation, for whatever reason the viruses are able to spread. Scientists speculate that one of the reasons why we have surges earlier this season is that because we have spent two years with very low levels of these viruses, our immunity to them has collectively gone down as a community. Now that the measures are relaxed, the viruses have been able to find way more susceptible people in the population and therefore spread and alter the seasonality of these viruses.
DP: On the matter of COVID-19 booster vaccines, apparently only about 35 million Americans have received their boosters. Are there any official statistics reporting how many members of the University community have received COVID-19 boosters? And how would you say public health messaging has affected the rate at which people get their booster shots, since there haven’t been many people receiving them in the first place?
ID: We have no data about the second booster. We have a lot of data about the first booster, because as you know, for a certain period of time it was mandated. At the time, we were at about 95 percent for students and employees. But since the mandate was lifted for the booster, essentially we don’t have the data to know if new students and new employees have received it or not.
DP: Has UHS witnessed an uptick in COVID-19 cases in particular, compared to last year, or has the uptick mainly been concentrated around cases of the flu and other respiratory infections?
ID: I think we’re seeing many more respiratory infections, not so much COVID-19. I think that also has something to do with the lifting of mandatory testing requirements, which allowed us to discover more cases of COVID-19. But the symptomatic students who come to McCosh usually have other viruses. They have already been tested for COVID-19, and they usually have other viruses instead.
Every year, there is a surge in respiratory viruses starting in October — that’s when the respiratory season starts. We just don’t expect the flu then. But other viruses are circulating in the community starting in October. I think this year, we have seen more than expected, although there is no easy way to compare respiratory viral infections other than the flu year after year. That is part of my job, looking at the different data and metrics, to understand what is different.
DP: Do you have any particular public health recommendations regarding precautionary measures that students should take this winter flu season? What measures can they take to curtail the spread of infectious diseases, as they spend time with family members and travel around the world?
ID: Again, these are the same precautionary measures that we talked about, if there’s a vaccine, make sure to get the vaccine. COVID-19 boosters and flu shots are absolutely highly recommended before students go and see their loved ones and before they embark on airplane travel or other kinds of public transportation. Beyond that, as I’ve said, covering coughs, being mindful of trying not to meet people or keeping a distance when one is sick, wearing a mask, washing one’s hands, disinfecting surfaces, and keeping hands away from the face are the main upper respiratory infection precautions.
DP: Lastly, is there any other information you would like to convey to the University community regarding public health?
ID: Yes, there are two things that I wanted to tell you. One is regarding travel. I want students to know that they can have travel health services, especially if they are traveling internationally, whether it is for personal reasons or as part of a University-sponsored trip. We are sending very comprehensive travel health emails and we can have face-to-face visits for travel health and offer recommendations about how to prevent a lot of diseases, including respiratory diseases.
And we also didn’t discuss gastrointestinal diseases. First of all, the term we use is “gastrointestinal disease,” or “GI” for short. We usually don’t call it gastro enterovirus. The preventative measures are similar, including washing hands and so on. But especially if people feel sick or they have vomiting or diarrhea, they must seek health care and stay away from others, including in public pools. The pools are well-chlorinated and all, but there’s still always the possibility of a gastrointestinal virus being transmitted through pools. It’s very easy on our campus for these diseases to get more spread out, and we have seen GI outbreaks in the past. So these precautions are very important.
Amy Ciceu is a senior writer who covers research and COVID-19-related developments.
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