In ordinary years, the cold, cough, achy, sneezy, sore throat, fever season is complicated enough, with clinicians having to sort through the various viruses circulating among their patients.
As we all are keenly aware, 2020 is no ordinary year.
“We’ve got a real challenge on our hands because not only as we go into the fall months is COVID-19 still with us, but we’ve got the flu season,” Gov. Ralph Northam said during his latest coronavirus response briefing this week. “So step No. 1 for those of you who are listening, and I appreciate you listening, is get your flu shot. That’ll help at least with part of it.”
Get your flu shot. You will be hearing that message earlier and more often than in ordinary years. Usually, flu vaccine messaging kicks off in late September and picks up steam in October and November. But this year, the shots are already being stocked in pharmacies and physician offices. Health care providers say if more people get vaccinated to protect themselves from influenza, they will also be helping to build herd immunity in the community and lessen its impact.
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Count Dr. Chris Mertes, vice chair of Carilion Clinic family and community medicine and a primary care physician in the New River Valley, as a convert to early flu shots.
“We prefer to give it a little later. But these times are unprecedented. I think people need to prevent a complete chaos of clinical symptoms. The sooner people get the flu shots, the better,” he said. “Anything we can do to prevent the flu from commingling and confusing with COVID is going to be vital for the safety of the people we serve.”
Recall when COVID-19 arrived in late winter and early spring, as flu and respiratory viruses were still circulating.
Testing supplies for the new virus were scarce, and people who felt ill worried they had the new coronavirus rather than seasonal flu.
“The testing has come a long way since then,” said Dr. Thomas Kerkering, professor of medicine and infectious diseases at the Virginia Tech Carilion School of Medicine and a member of the Roanoke City and Alleghany Health Districts’ communicable disease team. “We will be able to distinguish between COVID and flu with testing, maybe not necessarily with rapid testing within 15 minutes, but some of it will be in the 24- to 48-hour turnaround. So I don’t expect the issues to be one of diagnosis.”
He said there is a one-hour test for flu, but even if someone tests positive, they should have a COVID-19 test as it’s possible to have both viruses simultaneously.
“They would still be asked to quarantine not only because they have the flu, but at least until we get their COVID results back. So people will end up getting tested for both because if you have one, you may have the other,” Kerkering said.
About 5% of patients had co-infections earlier this year, he said.
The health districts have already scheduled drive-through clinics in most of the localities starting at the end of September. Carilion expects to announce events as well.
“People come up with all types of reasons for why they’d prefer not to have” the flu vaccine, said Dr. Matthew Kelly with LewisGale’s Valley View Family Medicine Clinic. “It makes them sick, is one of the bigger ones. It doesn’t work, is another one people complain about.”
Kelly said the vaccine is made to match strains of influenza that are happening in Asia, and sometimes it doesn’t always match up.
However, he said, the symptoms tend to be milder in people who have the flu vaccine than in those who don’t.
“I know a lot of people feel like the flu vaccine gives them the flu, which isn’t actually the case. It’s just your body building a slight immune response to it so it can give you some of the symptoms, but they are much milder,” Kelly said. “There are very limited side effects to the flu vaccine, where actually contracting the flu can be quite deadly.”
Mertes said some people do get a sore arm, redness or mild flu-like symptoms.
“For the majority of people, that doesn’t happen. People need to look at what’s the trade-off. If I have some mild side effects, which is a minority of people, it can help benefit society and vulnerable people,” he said.
Mertes said he gets the flu shot every year to protect his patients.
“My main side effect is about three or four days later there is a Band-Aid on my arm and I can’t figure out why I have a Band-Aid on my arm. Then I think, yeah, that’s right, I got a flu shot,” he said.
Going to the doctor’s office has changed with COVID-19. Once the flu returns, it could become more complex.
“We are in the early drafting stages of what to do in our family medicine clinics. Do we have enough personal protective equipment? If people are coughing and sneezing, then we probably need a good supply of N95s in addition to face shields, gloves and gowns,” Mertes said.
Then there is air circulation to think about.
“What kind of turnaround time do we need in a sick clinic with someone symptomatic to safely use that room again? That’s something we are working closely with our property management and infectious disease people to come up with the best answer,” he said.
One solution could be having separate clinics to keep possibly infectious patients from those who are not. Another could be having well visits early in the day and seeing sick people later on so the building’s air can circulate overnight, he said.
“We are looking to be as nimble as possible,” Mertes said.
Both he and Kelly said virtual visits will be helpful, as providers can triage people to figure out if they can be managed safely at home or if they need to be seen in the office, at an urgent care center or at an emergency department.
Kelly said virtual visits also are useful for patients who worry they will be exposed to the coronavirus at their doctor’s office.
“It’s kind of a funny trend that people feel comfortable to go to Walmart and Home Depot and all these big chain stores, and they are afraid to come to the doctor,” he said.
Kerkering said there were 9,600 confirmed flu cases in the Roanoke City and Alleghany Health Districts last season.
So far, there have been about 2,600 confirmed cases of COVID-19 in the districts. Both viruses are highly contagious. Both call for measures to reduce spread.
“We are looking at what is going on in the Southern Hemisphere right now. It is their winter, so it is their influenza season. Interestingly enough, influenza has not been a big problem,” Kerkering said. “One has to wonder if that’s not due to the masking and social distancing and hand washing, because all of those are the recommendations for influenza as well.
“So I’m hoping with the mitigation we are using for COVID, plus the fact that we have an influenza vaccine, we hopefully will not have to deal with influenza this year as we have in years past. But I’m saying that while knocking on wood and crossing my fingers.”
The messaging is the same from the governor to public health officials to private practitioners.
“I can’t predict how things will go. I will say this, as a physician, perhaps as a bit of a silver lining as we go into the fall, is we are paying attention to keeping our hands clean and wearing our masks. And if we get our flu shots, which again I highly recommend all of you do, then perhaps the flu season won’t be as impactful as it was in the past,” Northam said. “But if we get a bad flu season on top of COVID-19, we’re going to have some real challenges.”