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The medical community is trying to find out how it is prepared for double whammy in influenza COVID-19 predicted in the fall of 2020. The diagnosis, the management of vulnerable patients, and the overflow of medical centers that have made the COVID-19 crisis extremely cruel: Seasonal flu..
Louis Jay Kaplan, MD, FCCPHe is a paramedic at the University of Pennsylvania Philadelphia and has seen a share of severe COVID-19 patients in his supervised surgical ICU. He is approaching the next flu season and is poised to clash with the ongoing COVID-19 pandemic, ready to listen to each patient to distinguish one from the other and make treatment decisions. I will.
“Every patient with an underlying comorbidity has a story, and it’s up to you to understand which chapter you are in and how far you are going,” he said. “This is a very interesting approach to care and medical storytelling.”
As the flu season is approaching, pulmonologists will need to distinguish between COVID-19 and traditional flu symptoms, and identify the most vulnerable patients, their underlying illness, respiratory disease and children. I regret how to manage it. According to Centers for Disease Control, the flu kills 12,000 to 61,000 people annually and hospitalizes 140,000 to 810,00 people. Having the flu season in the midst of a pandemic of illnesses with multiple overlapping symptoms can overwhelm practitioners, hospitals, and health care systems.
Dr Kaplan said that each patient’s story can point to the right clinical approach. “In addition to sharing data during the round, we are telling the story of someone.” It details how the disease affected them, details of their symptoms, how their signs and symptoms are normal and how. Results from a series of questions about how they responded to treatment and how they responded to treatment. “It also helps you do what you’re doing. It may look very, very complicated, to an unmedically sophisticated individual, and they do what you do now It helps me understand why I am doing what I am doing.”
This will help reach patients with respiratory illness who claim to have or not have COVID-19, not influenza. “They form another group that brings them different fears and concerns, and you also need to help them navigate it: all this data and your decisions about testing and admission, and you What they can omit and what you have to do, help them navigate their story,” Dr. Kaplan said.
Benjamin D. Singer, MD, Northwestern University, Chicago Pulmonologist, editorial Science Advance addressed four factors that determine the extent of influenza spread for the coming season. Immunization rate; Co-infection rate; Health disparities among ethnic minorities. Incidence of influenza and COVID-19 tends to be high.
Influenza vaccine “very important”
COVID-19 and influenza fusion could overwhelm health system Daniel A. Solomon, MDBrigham and Women’s, Boston He co-authored JAMA Insights Clinical update The flu season during the COVID-19 pandemic presents features and overlapping signs and symptoms of the two diseases.
He said the influenza vaccine is “especially important this year”, especially for patients with pre-existing respiratory disease, but COVID-19 has raised vaccination barriers. Telemedicine is replacing hospital visits. “People may miss that easy opportunity to get the flu vaccine, so perhaps it has to be creative to make the flu vaccine so accessible in nontraditional ways,” Dr. Solomon said. It was Some of the ideas he provided are pop-up vaccine fairs in schools and churches.
However, just as COVID-19 interferes with the influenza vaccine, it may also help reduce the transmission of influenza. “The interesting thing about influenza transmission is that it’s transmitted just like COVID. So if you really knew how to reduce the transmission of COVID, we did it-we did it- We can actually reduce the transmission of influenza,” said Dr. Solomon. Studies in Hong Kong and Japan have reported a reduction in the number of cases of influenza at the outbreak of COVID-19 (Lancet public health. 2020; 5: e279-88; JAMA. 2020;323:1969-71).
Risk of superinfection
About 1 in 4 COVID-19 patients have been diagnosed with additional respiratory infections, including influenza (JAMA. 2020:323:2085-6). Dr Singer said pulmonologists need to keep this in mind when managing COVID-19 suspects.
“In most cases it is true that COVID-19 travels alone, but in the literature and in our own experience there are many examples of COVID-19 being accompanied by another bacterial infection, including another virus or influenza. Yes,” said Dr. Singer. “The distinction is important, not only because of diagnostic and publicly reported reasons, but also because influenza and COVID-19 have different requirements on how to care for patients from a health system perspective. .”
The clinical suspicion of superinfection remained high when both COVID-19 and influenza were highly prevalent in the community, he said. Megan Conroy, MD, Chief Lung and Emergency Medicine Fellow at Ohio State University, Columbus. “We were at the end of the flu season when the coronavirus first settled in the United States in March 2020, so it’s hard to predict what the next flu season would actually be in terms of superinfection. “
Differentiate COVID-19 from influenza
Multiple signs and symptoms between COVID-19 and influenza overlap. Fever, chills, headache, Muscle aches, coughs, fatigue. Nasal congestion and sore throat are hallmarks of influenza. COVID-19 has been widely reported for shortness of breath and loss of smell. “Many uppers Respiratory infections The odor may be lost. This may be more common with COVID-19. “Dr. Conroy said. Other symptoms unique to COVID-19 are: diarrhea Skin rash such as terminal ischemia.
However, the test is the key to differential diagnosis. “Symptoms alone cannot confidently distinguish between them,” Dr. Conroy added.
“I think the challenge we face as clinicians is to care for people with nonspecific symptoms of respiratory viral disease, especially in the early stages of the disease,” Dr. Solomon said.
But even then, it is difficult to distinguish the symptoms.
“After illness, COVID is more associated with hypercoagulable states,” he said. “More relevant Viral pneumonia Chest imaging is similar to the diffuse frosted glass infiltration that we all are used to, but influenza can do both of these things. Therefore, without examination, it is impossible for the clinic to distinguish between the two infectious diseases. “
But when the influenza season clashes with the COVID-19 pandemic, the test can have its drawbacks. “Taking a test is not the same as getting a test result,” added Dr. Solomon. “Many people can take the test, but if it takes 7 or 8 days for the test results to be returned, the results will be useless.”
Extensive and rapid testing relies on transportation of viral media and proper feeding of swabs. “I think this is something we should focus on right now. Expanding access to rapid turnaround testing,” he said. It is also important to distinguish between the two in order to conserve hospital resources. COVID-19 has more stringent standards than influenza for personal protection and patient isolation in hospitals.
Having chronic lung disease is not always a risk factor for COVID-19 and/or influenza, Dr. Solomon said. “It’s a risk factor for severe illness.” Again, he found that the influenza vaccine not only affected these patients, but also the elderly, heart disease, diabetes, obesity..
In managing children, it’s important to remember that they communicate differently than adults about their illness, Dr Kaplan said. “They may not have the words to teach you the same kind of things adults do to you.” That’s where families can help shape history. “They, if they do, may appear less so initially, but less importantly, a small percentage of them return to the polyinflammatory syndrome and then become a serious illness. .”
Dr Kaplan said that young people now account for a large share of COVID-19 patients, compared to the first wave that hit the northeast in the spring. “I don’t know if the viruses are a little different or if the sick are a little different.”
The emerging COVID-19 strain may be less virulent than the strain that hit early spring, he said. “That doesn’t mean there aren’t many people with serious illness who have COVIDs of different ages, but many people are now positively diagnosed, but not so deeply. I’m as sick as when I landed in the United States.”
It may be somewhat welcome as the flu season comes.
The doctor interviewed has no relevant disclosures.
This article was first published MDedge.com, Part of Medscape Professional Network.
