The respiratory syncytial virus (RSV) “season” this year is notable for a number of reasons, including the relatively early and large spike in cases that is challenging the capacity of children’s hospitals nationwide. But the spotlight on pediatric cases is overshadowing how this virus also raises risk for people 65 and older. RSV in older Americans “remains under-recognized by both physicians and especially the public.” The symptoms of RSV in younger and older people are often similar. “Many things are the same, especially the prominence of severe cough and airway disease,” says Richard G. Wunderink, MD, a professor of medicine in pulmonary and critical care at Northwestern University Feinberg School of Medicine. But because children have smaller airways than adults, the inflammation caused by RSV can cause more trouble in younger patients, Wunderink says. Clearing increased mucus can be more difficult, for example. That much mucus can plug the child’s airway and even cause a lung to collapse. This condition, known as atelectasis, “is a major reason for admission to pediatric ICUs,” Wunderink says. In contrast, he says, “Adults have bigger airways, so we don’t see as much mucus plugging and atelectasis.”

The coronavirus, flu and RSV are all circulating at such high levels that hospitals are overwhelmed. Health experts warn it’s best not to fly if you have any symptoms. Not only do you risk getting the passengers around you ill, but the environment on board could make you feel even worse. Respiratory illnesses affect your sinuses and Eustachian tubes, which connect your middle ear to your throat. Both are air-filled chambers, so when you’re on a plane, the pressure inside needs to equalize with the cabin pressure after takeoff and upon landing. When you’re sick, those tubes become inflamed and narrow, making equalizing pressures more difficult. Jeffrey A. Linder, professor of medicine at Northwestern University Feinberg School of Medicine, said the “calculus has changed” in recent years to reduce the need to travel while ill, thanks to the ability to quickly test for covid and the proliferation of remote work. “If you can’t get your symptoms under control with over-the-counter medicines, you should try to avoid flying,” Linder said.

Skin of color is underrepresented in medical training and textbooks, which can lead to missed diagnoses and inequities in care. More and more, dermatologists have been calling for action, raising awareness of the dearth and taking matters into their own hands to launch their own training programs. Doctors in training rely on images to develop familiarity with how skin conditions present. Eczema, psoriasis, inflammation, acne and other skin conditions show up differently in various skin tones. For example, psoriasis patches in Black and Hispanic patients may be dark brown or purple-grey, and the scales that cover them can also be a grey or silver in color. In white people, these are pink or reddish in tone. Faculty and trainees can help textbook publishers hasten change, wrote professor of dermatology Roopal Kundu, MD. She implored medical schools to begin implementing student-led curriculum review panels. “Text publishers and editors are steadily beginning to address these disparities, but bottom-up change from trainees is necessary to comprehensively address this issue,” she wrote.

While demand for testosterone therapy has soared in the United States, a new study from Northwestern Medicine found several direct-to-consumer companies offering the therapy did not follow medical guidelines nor convey the health risks of therapy. Josh Halpern, MD, MS, a Northwestern urologist and assistant professor of urology at Northwestern University Feinberg School of Medicine, co-authored a study that was published in JAMA. “Low testosterone is really quite prevalent,” Halpern said. “We’ve seen an increased use in testosterone overall over the last few years. It really does need to be prescribed and monitored carefully, and so, that was the reason that we wanted to explore the kind of quality of care that these platforms were offering.” The study, published online, does not name the companies involved. The authors said they believe there is value in telemedicine improving access to this kind of care.