Preparing for flu season in the era of COVID-19

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Preparing for flu season in the era of COVID-19
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By Dr. Vivek Sinha

The COVID-19 pandemic has changed every aspect of our lives.

Now that it’s October, and the colder weather is rapidly approaching, it is even more important to stay diligent and stay healthy. This includes being aware of another viral illness that is common this time of the year: seasonal influenza, also known as the flu. There are similarities between COVID-19 and the flu. However, there are also important differences.

Influenza is a viral illness that can occur throughout the year but is more common during flu season. Flu season starts in late autumn and can last until early spring of the following year. Every year at the start of flu season, I have conversations with my patients about methods that they can use to decrease their chances of catching influenza. This conversation invariably leads to conversations about how influenza is transmitted and how to recognize signs and symptoms of influenza.

The primary way the influenza is spread is through respiratory droplets from an infected person coughing and sneezing, although there is also evidence that smaller aerosolized droplets can be spread by talking. Surfaces that have come into contact with the droplets can also be a cause of spread if not cleaned properly. At this time, experts say that COVID-19 has a similar spread pattern. Masks are one way to reduce transmission when distancing is not possible.

There is a lag period between when a person is exposed to influenza and when they start to show symptoms, usually one to four days. This is called the incubation period, and it is during this time frame that the person has been exposed but is not yet symptomatic. It is also during this time that the person can start to spread influenza.

The spreading period, also known as viral shedding, can start as soon as 24 hours after exposure, and it increases in severity as the person starts to show symptoms. For most people, the viral shedding period for influenza stops somewhere between six to 10 days of illness, but in children, the shedding period can be longer.

The incubation period for COVID-19 can be much longer, anywhere from one to 14 days, although most people who develop COVID-19 start to show symptoms two to five days after exposure. The viral shedding period for COVID-19 is less clear. We do know that infected people can start spreading the illness a few days before they start showing symptoms, but how long they can spread the illness is still being determined.

As I tell my patients, the important message is that there is a period of time where a person can have influenza or COVID-19 and not yet know it but still be contagious. Therefore, prevention is the best policy.

The symptoms of influenza can be mild in the beginning and then progress to more severe symptoms. The symptoms of COVID-19 can have a similar pattern. Typically, symptoms of the flu and COVID-19 can include fever, chills, cough, shortness of breath, fatigue, sore throat, muscle aches and headache. COVID-19 may sometimes present with changes in smell or change in taste of food. People with underlying medical conditions, older individuals and pregnant women are considered to be higher risk for both of these conditions. 

Depending on the course of illness, complications can be severe. Both influenza and COVID-19 can lead to conditions such as pneumonia, respiratory failure, inflammation of the brain and heart and secondary bacterial complications. In addition, COVID-19 has been shown to be associated with blood clots in the blood vessels of the brain, heart and lungs.

Oftentimes, the only way to differentiate the illnesses is to be tested for both. There are tests available for both COVID-19 and Influenza A and B, the most common strains of influenza, that can help guide treatment. Influenza nasal swabs have been around for many years and are used quite regularly in doctor’s offices, urgent care facilities and emergency departments. The rapid flu swabs can come back with results in minutes, and the send-out swabs, which are often used for confirmation, can take up to a few days to come back with a result. COVID-19 swabs have evolved rapidly over the past few months and depending on the type of test, they can have varying degrees of accuracy and result time.

The biggest question I am asked by patients, is, “How do we treat for these conditions?” In my opinion, the best defense is a good offense. In other words, while there are medical treatments with various degrees of efficacy for both conditions, prevention is the best treatment.

It starts out with the basics: washing hands with soap for at least 20 seconds multiple times a day as often as needed, staying home if you are not feeling well, keeping up with your regular medications and vaccinations, covering your mouth with your elbow when you cough or sneeze and, especially in the case of COVID-19, wearing masks or facial coverings when not able to distance from others. It is critical to know that even if someone does not have any symptoms, they can still spread the virus.

This is also the time of year when we are educating the public about the flu vaccination. The flu vaccine is an inactivated vaccine that cannot cause the flu. It stimulates the immune system into recognizing the influenza virus and building antibodies that would help fight the invading virus. It’s important to note that while the flu vaccine may not completely prevent someone from contracting the flu, it will decrease their chances of getting the flu and make their symptoms less severe if they do catch the flu.

Unfortunately, at this time, we do not have a COVID-19 vaccine. However, there are considerable resources being spent on making one available for the general public.

Talk to your doctor about keeping on top of your chronic conditions so you can stay healthy.

The bottom line is: Stay socially distanced as appropriate, wash your hands, get the flu shot and don’t forget to wear a mask.

The writer is the chief medical officer of Belleview Medical Partners, an office and house call practice based in Old Town.

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