Flu Season During COVID-19

September 15, 2020

This flu season, health experts worry about an overlap of flu and COVID-19 and the potential double burden to patients and the healthcare system.

Will doctors’ offices and hospitals be strained by flu patients as they are still dealing with COVID-19? Or, will the new habits we’ve acquired because of COVID-19 – wearing masks, social distancing and frequent hand washing – reduce the spread of flu?

“We don’t have any experience with flu season plus COVID, so we don’t know,” said Dr. Jane Weida, a family medicine physician who cares for patients at University Medical Center.

She said there is one very important thing people can do to help, and that’s to get a flu shot. “It’s always been important, but it’s even more important this year,” Weida said.

She spoke about the topic with Dr. Tom Weida, UMC’s chief medical officer, during the September 11 UMC Town Hall.

TW: Can you tell us about your current roles and what you do at University Medical Center?

JW: I am the interim department chair for Family, Internal, and Rural Medicine. And I’m also the director of Clinical Affairs, which means the clinic director for six family medicine offices.

TW: What is Family, Internal, and Rural Medicine? What does that encompass?

JW: Family medicine physicians take care of patients from the time they are born until the time they die. Internal medicine physicians focus just on adult patients and they have a little more hospital training. Our department contains family medicine physicians as well as internal medicine physicians. And rural medicine is one of our goals. One of the things we strive for is to train family medicine physicians to go into rural and underserved Alabama to serve the people there.

TW: During COVID, what role do family medicine physicians play? You are not infectious disease physicians.

JW: We strive to keep up with all of the developments on COVID. It’s important for us to be updated, to check every day on everything that is going on with COVID.

TW: Has the pandemic affected appointments at University Medical Center?

JW: Initially, it affected them quite a bit. The first few weeks we hardly had any in-person appointments, but now we’re at about 90% to 95% of our regular volume. Still, about 10% to 20% of our patients prefer a telemedicine visit.

TW: What is a telemedicine visit?

JW: A telemedicine visit is where we connect with the patient, either via phone or Zoom or FaceTime, and we talk to them about what’s going on. We can’t do much of an exam, but we listen to them and we give them advice. So, it’s two-thirds of a regular visit.

TW: And they’re certainly not exposed to any kind of infectious disease if they’re doing a telemedicine visit.

JW: Absolutely not. I have a couple of patients who are still very scared to come in, and I don’t blame them. And we’ve done just telemedicine since March.

TW: Has the role of family medicine physicians changed during COVID?

JW: WE are the ones our patients come to first for information about COVID. Our role is, as always, a family doctor that educates our patients about what is going on in the world.

TW: It’s coming to fall and flu season. How are you preparing for flu season?

JW: One of the most important things is to make sure that as many patients as possible get an influenza vaccine. It’s always been important, but it’s even more important this year.

TW: When should people get a flu shot?

JW: They can start now. I just saw a CDC (U.S. Centers for Disease Control and Prevention) update this morning, and the American Academy of Family Physicians does endorse this, to get your flu shot by the end of October. That way it will carry on the immunity through probably about the end of April. Children who are 8 and under who need two flu shots should get the first one now so that they can complete the series in a little over a month.

TW: What happens if I miss October?

JW: Go ahead and get it (flu shot) as soon as you can. It takes a few weeks to develop full immunity, so the earlier you get it the better. But it’s not good to get it in July and August because then the immunity will wane before the end of the season.

TW: Are there different types of flu shots?

JW: There are different types of flu shots, and most of them can be used in almost anyone. The influenza vaccine that is nasal is only indicated for those up to the age of 50, and not for young children.

TW: How young can somebody get a flu shot?

JW: You can get a flu shot starting at six months of age.

TW: Why so early?

JW: We don’t want those children to get influenza. Influenza tends to afflict the very old and the very young in terms of being very serious.

TW: And children can spread germs easily.

JW: They spread germs around, and they don’t have much immunity yet. If you’re six months old, you haven’t been through a flu season yet.

TW: Is there any age limit to the flu vaccine?

JW: Absolutely not.

TW: Do you expect this flu season to be worse than other flu seasons, or better because of what’s going on with COVID?

JW: We don’t have any experience with flu season plus COVID. So, we don’t know. It certainly would be nice if more people would get flu shots. And because of masking and social distancing it might be a little bit better in terms of a flu season. But we don’t have any way to know that. Health professionals are still working on that.

TW: What are the symptoms of flu, and what are the symptoms of COVID?

JW: They pretty much overlap – fever, chills, headache, muscle aches, cough, shortness of breath. Influenza doesn’t tend to cause as much diarrhea and vomiting, except in the very young, as COVID does. Interestingly, COVID can affect your sense of taste or your sense of smell, which is not something that happens with influenza.

TW: So, someone comes into the doctor’s office with those typical symptoms, that could be flu or COVID. How do you know?

JW: You have to test them. There’s no other way to tell. If it’s classic loss of taste or smell, it’s probably not going to be influenza and probably going to be COVID. But you should test for both.

TW: And there is a test for both?

JW: There is a test for both. We have tests for both of them (at UMC).

TW: And you can get an answer very quickly?

JW: Yes, within about 15 minutes.

TW: And wearing a mask coming into the (doctor’s) office is very important.

JW: Yes, wearing a mask helps protect the other person. If I have COVID and I don’t know it, and I wear my mask, I protect you from getting it from me, and vice versa.

TW: Some people say COVID is just a little bit worse than the flu. What are the statistics about that?

JW: COVID is not just a little bit worse than the flu. In fact, they are different virus categories, totally different families of viruses. They aren’t the same virus and they aren’t similar at all. COVID is a lot worse in terms of how dangerous it is. For people who get influenza, about .1% of patients die. That’s 1 person out of 1,000 that dies who contracts influenza. With COVID it is much worse, anywhere from 1.4% to 4.5% of patients who contract COVID are going to die. And that means 14 to 45 patients per 1,000 are going to die from COVID. Influenza tends to affect the very old and the very young. COVID tends to be deadlier in the older patients, but not necessarily. Some younger (patients) are catching it and dying.

TW: How many influenza cases were there and how many deaths, at its worse?

JW: The worst (flu) season in the last decade was 2017-2018, and about 900,000 influenza patients were hospitalized and about 80,000 of them died. Compare that to COVID, where there have been over 6.5 million cases so far, and well over 196,000 patients have died from COVID in six months.

TW: So, in less time, there have been more deaths.

JW: Well over three times more deaths.

TW: And we don’t have a vaccine for COVID yet.

JW: No, we don’t. You can’t develop a vaccine in a week or a month. It takes a long time. You have to test it. You have to make sure it’s efficacious and you have to make sure it’s safe.

TW: Why should you get the flu shot if you might get sick anyway?

JW: You don’t want to get the flu because, if you’ve ever had the flu, it makes you feel terrible. And, there’s also a chance that you could die, or you could give it to someone else who could die. You could give it to your elderly grandmother who could die. It protects you and it protects the people around you. So, you should get a flu shot.

TW: Do we know what happens with somebody who has both the flu and COVID?

JW: We don’t have those statistics yet, but it can’t be good.

TW: And what about getting the flu shot if you have COVID?

JW: It’s probably not a good idea. I would wait until you get a little bit better.

TW: If I get a flu shot, does that mean I won’t get the flu at all?

JW: No, it’s not 100%, but it does cut down considerably on your risk of getting the flu. And if you do get it, you tend to get a milder case.

TW: Does the flu shot change from year to year?

JW: It does. They have to develop a new shot each year based on what they think the new strain is going to be.

TW: Do you think it will be a milder season because people are, hopefully, continuing to social distance, wear masks, wash hands – do all those good preventive measures?

JW: We certainly are hoping so. There’s no guarantee but I would think it might be a little bit better flu season.

TW: How does a flu shot work? What happens that makes (the vaccine) protective?

JW: Well, you develop antibodies to the influenza virus that you’ve been given. And then when you’re exposed to it again naturally, then the antibodies protect you from getting sick.

TW: What’s an antibody?

JW: An antibody is something your body produces when you’re exposed to something. And then when you’re exposed to it again, it kills it.

TW: So, it has memory?

JW: It does.

TW: Then why can’t I get one flu shot and I’m good for lifetime?

JW: That would be very nice, but it doesn’t quite work that way. With some diseases it does. But with influenza it doesn’t because the influenza virus tends to change from year to year. And the immunity might wane. There are some cases of people who are much older who got influenza, say, in 1940 and they still are immune to whatever strains were around then.

TW: How can you avoid getting the flu?

JW: You can’t avoid it 100%. But if you are very careful, and (do) the same things we are telling people about COVID – wash your hands, wear your mask, get enough sleep, stay healthy, eat right – you can avoid getting the flu as much as we possibly can. If you are going to be visiting someone and they’re sick, I’d put off that visit until they get better.

TW: With the flu shot, are there risks?

JW: There are not very many risks of a flu shot. Some people feel a little achy and have a sore arm for a couple of days. But they don’t get the flu. People who have a very bad reaction to eggs, it’s called an anaphylactic reaction, they should get a different type of flu shot. Most flu shots are grown in eggs. There are a couple that are not grown in eggs. So, they should ask their health-care provider to get that kind of flu shot for them.

TW: When do they have to start making these vaccines? How do they do this whole process?

JW: They have to start the year before. And they have to give their best guess about what the strains are going to be the following year because it takes so long to develop the shots.

TW: So, when they do get it pretty much on target it’s pretty good.

JW: Yes, absolutely. Some years we miss. Some years it’s 50% effective.

TW: When you say 50% effective, what do you mean by that?

JW: Some years, we only get about 50% of the people who are vaccinated who are actually protected because we didn’t quite get the mix right.

TW: Is there more than one type of flu?

JW: Yes. There’s influenza A and B.

TW: Does one seem to be more common than the other?

JW: It really depends on the year.

TW: Some people say they got the flu shot and they got the flu.

JW: You can’t catch the flu from the flu shot. So, if you got the flu, it means that the flu shot wasn’t effective that year because it was a different strain. Some people feel a little sick afterward and they think that’s the flu. But if you’ve ever had the flu, you know how terrible it makes you feel. It’s not just a little achy and feverish for a couple of days. For people who are not vaccinated, it can happen suddenly. One day you are fine and the next day you are flat in bed.

TW: With the flu shot, and the different strains, is there a difference in their symptoms?

JW: No. Influenza A and B both make you feel terrible.

TW: So, you get the flu shot, you feel a little achy, that might be with any vaccine because your body is responding to that.

JW: That’s right. Most vaccines can make you feel terrible for a day or two. But some of them don’t. Sometimes it can be mild and no symptoms at all. But then maybe a little bit of a sore arm.

TW: Are flu shots very available?

JW: Yes, they are available at your local health-care provider. You can also get them at your friendly neighborhood pharmacy. It’s better, if you can, to get it at your health-care provider because then they have a record of when you got your flu shot.

TW: Is University Medical Center providing flu shots for The University of Alabama campus?

JW: Yes, we are doing a flu (shot campaign) for the campus and I would recommend that (UA employees and students) take advantage of that.

TW: If someone gets flu symptoms, what should they do?

JW: They should not go to work because you don’t want to infect people around you. You should stay home, drink plenty of fluids, go to bed and don’t force yourself to do any activity that you don’t feel like doing. Take it easy until you’re feeling better.

TW: Is there any treatment for the flu?

JW: Sometimes there are treatments, depending on which type of flu that you have. There are medications that we can use. But depending on which type of flu, they’re not always effective.

TW: When should you get treatments and medications?

JW: You need to get it within the first couple of days of your symptoms, and it really just helps shorten the course.

TW: In the flu vaccine, are these live viruses or dead viruses?

JW: It’s called an attenuated virus, which means it’s grown in eggs and it’s not as infective, but it’s still effective at promoting an immune response. The nasal spray is live, and I think that’s another reason why it’s not indicated for people over 50. Pregnant women are not allowed to get it, and children under 3.

TW: So, there’s a treatment for flu. What about COVID?

JW: I wish we did. We don’t have anything for COVID yet. We don’t have a vaccine. We don’t have any kind of anti-viral therapy. The best thing is to prevent it from spreading as much as we possibly can. I can’t tell you how important it is to wear your mask to protect other people. You’re not protecting yourself so much but you’re protecting other people. Always, always wear your mask.

TW: Why is COVID so serious?

JW: One of the things that it can do is that it can really affect your lungs. It can affect a lot of organs but particularly your lungs. And some people who get very sick from COVID can wind up on ventilators, and they can be sick for days and weeks on a ventilator, which is very hard on a person. When they’re on a ventilator, they have to be sedated and, unfortunately, people can’t visit them because we don’t want people around people who are very infectious with COVID, so they can’t have their loved ones around for comfort.

TW: You mentioned lungs. Does COVID have other effects that aren’t just respiratory?

JW: It can affect a lot of things. A lot of people go into kidney failure. It can affect so many organs in the body.

TW: So, there’s a lot we still don’t know about COVID.

JW: There’s so much. It hasn’t been around for very long. The reason it’s called COVID-19 is because we just found it in 2019.

TW: So, there’s not much information about this.

JW: No. There’s a lot of research about it but it’s all very, very new.

TW: We are seeing some places that have increases in COVID cases and other places that have decreases in COVID cases. What are good strategies to decrease the transmission of COVID in a community.

JW: One of the things is to not have in-door dining or bars. I think it was a very good idea to close down the bars in Tuscaloosa for a couple of weeks. When you’re at a bar, you’re going to have your mask off and you’re going to be close to people and that’s just going to spread (COVID) like wildfire. It’s better if you’re going to dine with people to be outside, socially distance as much as you possibly can. And just wait a little while. Eventually, we will get on top of this.

TW: What may be other hotspots for transmission of COVID?

JW: Nursing homes are hotspots. Hospitals, obviously, which is why we can’t, unfortunately, allow visitors in them. Doctor’s offices. We do our best to screen everybody that comes in (to UMC), but, unfortunately, we don’t allow too many visitors to come into our offices – just the patient, and if the patient is a child a caretaker or adult.

TW: And that’s to decrease the amount of transmission?

JW: Exactly.

TW: And everyone is wearing a mask?

JW: Everybody is wearing a mask.

TW: Have you seen infections at UMC?

JW: We have not seen very many. Very few of our residents and faculty, and our patients, have come down with COVID. Luckily, they’re following the directions and being very careful.

TW: So, it’s important to follow the directions in the office and also when you go home.

JW: Exactly.

TW: If someone is positive for COVID, what should they do?

JW: They should quarantine or isolate for 10 to 14 days. You should stay away from anyone else as much as you possibly can. Stay at your house and don’t go to work.

TW: What if you were next to somebody who had COVID, or you walked past someone with COVID. Does that mean you will get it?

JW: If you have a significant exposure, you need to quarantine. Walking by somebody does not constitute a significant exposure. But if you are within six feet for more than 15 minutes and you don’t have a mask on, both of you don’t have a mask on, then that’s a significant exposure. And then you need to quarantine for 14 days because you can develop symptoms anywhere from two to 14 days after your exposure.

TW: Does everyone who has symptoms test positive for COVID? Tell us a little bit about testing.

JW: The test is pretty accurate, but it’s not 100%. Some people can test negative one day and positive the next day. So, if they have COVID symptoms, even with a negative test, we assume, yes, you have COVID.

TW: To wrap up, what are the differences again between flu and COVID, and what do you want people to take away as a message?

JW: Both are serious. COVID is much more serious. But both can be and are deadly. You need to do whatever you can to protect yourself. We don’t have a COVID vaccine, but we do have a flu vaccine and you must, must, must get the flu vaccine, particularly this year, to protect yourself and to protect your loved ones.