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Prakash Chandran: This Healthy Takeout COVID-19 podcast was recorded on September 14th, 2020. Since the start of COVID-19 many have compared Coronavirus to the flu causing discrepancy and confusion about both illnesses. Fortunately medical professionals can thoroughly inform us on the primary differences and similarities to give clarity and help prioritize our safety and wellness. We're going to talk about it today with Dr. Amy Jaworek, an Infectious Disease Specialist and Dr. Gennady Gelman, Family Medicine Physician, both at Harrington Hospital. This is Healthy Takeout, the podcast from Harrington hospital. I'm Prakash Chandran. So Dr. Jaworek, we're going to go ahead and start with you. What exactly are the main differences between the flu and COVID-19?

Dr. Jaworek: There are more symptoms that are similar than different, unfortunately, which makes things quite confusing. Especially as we enter flu season, both illnesses, feature fever, chills, cough, shortness of breath, fatigue, and muscle and body aches. However, there are two differences that I see that are of some importance that may help. One is only a few known to have exposure to either illness. The flu is usually quicker onset, one to four days and COVID may take about four to 10 days to come about. The second is with regards to symptoms. While I mentioned initially the symptoms that are similar to both illnesses COVID specifically can affect the taste and smell, and that can be fairly early on. So if you have noticed that you cannot smell or taste as you have, you may very well have COVID and should get checked.

Dr. Gelman: And at Harrington we have a great site built out at harringtonhospital.org/flu or /Coronavirus. And you can go there for more of these symptoms to check things there's a symptom checker and some other tools to use as well. If you think you may have one or the other.

Host: Yeah. That's very helpful. And it's good to introduce that resource. You know, I'm curious Dr. Gelman, what do you see as one of the most common misconceptions about the flu and Coronavirus similarities?

Dr. Gelman: One is that they're going to be mild. And I think patients are not taking it as seriously as they should either one. And yes, a lot of the data showing that a lot of the younger population, maybe it has a mild illness, but we do live in a society with a lot of patients with different illnesses and different ages. And, you know, in a family group setting, you are always going to be encountering maybe somebody who's older, maybe somebody who is sick. So I think all of us are at a risk of exposing somebody else to something. We talk about it in the offices in primary care, often that the week after a laboratory documented flu, there's an uptake in strokes and even heart attacks. So we're not just talking about being ill. We're talking about these other illnesses that may happen after you've been exposed to something. So I think taking the symptoms seriously and really preventing it, fortunately with the flu, we have a vaccine, unfortunately with Coronavirus, currently there is no vaccine and there's no prevention at this time.

Host: I'd like to talk a little bit about how the flu spreads versus how COVID-19 spreads. We've heard a little bit about how, you know, COVID can basically spread over the air. And I've also heard of the concept of super spreaders before, but some people don't spread it as easily. So Dr. Jaworek, could you potentially spread some light into how COVID spreads and how that's different than how the flu spreads?

Dr. Jaworek: There are more similarities once again, then differences, but the COVID virus seems to be more contagious. There is more spread through personal contact with talking, speaking, there's been cases where singing has spread and there may be over a larger surface area through air. There may be some instances where they've found that there's live virus in an airborne setting, several meters away. They have not proven that necessarily individuals have been sick from certain exposures that are at a distance, but we aren't sure. So we do tend to make an estimate of the six feet away, but there may be actual virus that's viable, further distances. Therefore I think the mask is quite the help in keeping people free as possible of contact with COVID. Flu can spread through close personal contact, but it doesn't seem to be as contagious as COVID is surfaces of desks and chairs tend to be very minimal if any source of contact, however, handshakes where people touch their face or nose, maybe sources of contact and acquisition of illness.

Host: And Dr. Gelman moving on to you. One of the things that you hear about you basically hear about two statistics. One is the infection rate and the other is the death rate. And I often times hear people in the news and in the media saying that sometimes the flu can be just as deadly. You actually hear both things. So can you talk a little bit more about which one of these diseases can be more deadly?

Dr. Gelman: I think that's a tough question. It's hard to compare the two. I think they're different in the way they're presenting in the US right now, as I mentioned before, we have a vaccine for the flu and last year, despite that there's estimates that are up to 62,000 Americans have died due to the fluid just last year and every year there's about, I would say, 30 to 60 or sometimes get as high as 80,000 Americans who die. And that's with having treatment that's with having prevention that's with knowing what we're dealing with, obviously right now, we're dealing with something that whole virus, we don't know what it's going to do when the winter months, we don't know how to prevent it. I guess we don't have a way of preventing it yet, other than masking and social distancing. And hand-washing. Last year, I think the CDC also estimates like something like 50 million Americans had the flu as an illness. So when we talk about those, those are huge numbers. So I don't like to compare them and say like one is deadlier than the other. I think that we should be considering them both concerning both dangerous, and we should be treating them with caution equally. And I'd like to add that. I'm hoping we get to a point that we have a vaccine and we can actually start treating COVID more like the flu, where we can say, okay, you know, a lot of people in society have it.

Dr. Jaworek: The estimated 25 to 70,000 deaths last year from flu. And so far, we're up to 180 to closer to 200,000 deaths from COVID unfortunately we should be remised. If we don't touch on the racial and ethnic variations, black individuals have higher proportion and communities are hit to up to 50% positivity in some parts of the country. And there's a study that shows just a couple of days ago in JAMA, which is the Journal American Medical Association, that there are some differences in nasal gene expression, which means that there are differences in the way that the nasal cells respond to COVID. And that, for instance, there may be some more easy access to COVID to enter the body and the nose in black individuals than other ethnic groups.

Host: Yeah. Thank you so much for that clarity and Dr. Jaworek, I want to stick with you for a second here. You know, you hear so many things about COVID-19 in the media. I'm curious as to, if you've heard any myths that you'd like to address or debunk about COVID-19 or even the flu?

Dr. Jaworek: Unfortunately, just the ones the President helped to propagate. And I know this has been politicized to a crazy extent, but do not inject any hydrogen peroxide in your body or take any other substances other than what your doctor has recommended.

Dr. Gelman: If I may add that hydroxyl chloroquin, when actually lost its emergency use permission to the FDA initially did release it's no longer even listed as such. And as far as vaccines, my big thing is this year, we're trying to make sure everybody's getting vaccinated for the flu, and there's a lot of concerns about the flu shot and the flu shot cannot make you sick. There's no live virus in there that can make you ill. You know, the autism concern that we hear, unfortunately, we still hear as much as the data has been retracted and there's never been evidence of anything like that, but that still prevents some patients from getting vaccines in childhood. We think all kids starting at age six months or older should be vaccinated. And it goes on into adulthood.

Host: Yeah, I think that is very good advice. And just as we close here, Dr. Gelman, I'd like to stick with you here for a moment. There's a lot of concern and apprehension around coming to the hospital and getting treated due to COVID concerns. So what advice might you have to those that are experiencing flu or COVID-19 symptoms, but they're just not sure how to navigate it during these times?

Dr. Gelman: It's really important to seek care. The sites are open. The Harrington sites are open. The Harrington Hospital is open or Harrington Urgent care is open. We've taken on new ways of cleaning the rooms. We've taken spacing in the waiting rooms. In the emergency room, we even have a way for you to wait in your car until it's your turn. So we're trying to do as much of this social listening and masking and prevention of spread as much as we can at the same time, it's really important to seek care. There's a lot of cases we saw, especially in like the months of April when patients were not coming in to see the emergency room that they've had other medical issues that they weren't addressing. For other cases, if somebody that was feeling really uncomfortable, is feeling really sick. The government has now made it easier to have telehealth appointments. And want to say most, if not all clinicians at Harrington are able to do a telehealth visit with your so if your primary care, and you're not sure you can do that. We've learned that we can actually do a lot more through telehealth than we thought possible before. Patients are really working with us to do their own exams a little bit to give us information, if you want to make sure you have a thermometer. So that's one thing I would say, if you don't have one yet before flu season cold season starts, if we do get one. So when you call us, we can have more information to work with.

Host: And Dr. Jaworek, did you want to add anything else before we close here today?

Dr. Jaworek: No, I think that's great. Don't give up on your masks.

Host: Yeah. And just one more thing about that, because you've actually heard so many different things around people saying that the masks aren't effective and it's not helped by what we hear in the media, because sometimes you hear, you know, you should wear your masks everywhere and it really protects you. But then other people say, well, then you go to sit down at a restaurant and then you take it off, which is strange because the virus doesn't care if you're sitting down at a restaurant or not, whether you have it on or not. So Dr. Jaworek, can you maybe just tell our audience a little bit more about why wearing a mask is important?

Dr. Jaworek: Sure. Actually wearing a mask helps from spreading viruses as well. When you exhale and inhale particles come out of your nose or become inhaled into your nose that can contain virus. And as I had mentioned earlier, this is a very contagious virus. It's appearing to be more contagious than the flu. And there's a recent study that just came out that was more of a study, but more of a random poll of individuals. And the only positive thought in the, in this poll was that people who had entered a restaurant took off the mask and ate without a mask and inside a restaurant or twice as likely to have reported positive COVID tests. The individuals who went about their business and other places of business, such as hairdresser salons and shopping mall. So I think that would really point to the effectiveness of the mask to my vision at this point.

Dr. Gelman: And I wanted to add, and maybe you can expand on this is that the Southern hemisphere is having declining cases in other viral illnesses being spread because of the precautions that we're currently taking it worldwide or globally for Coronavirus wearing masks and social distancing.

Dr. Jaworek: Right. I believe both of those as well as hand-washing are very important in helping get us through this. 
And don't give up prematurely, keep doing the same things that are keeping you healthy to date.

Host: Well that's right. I once heard this phrase. It's one of my favorites. The price of peace is eternal vigilance. So keep washing your hands, you know, social distance properly and definitely wear that mask. So thank you so much for your time, both of you today. I truly appreciate it. This has been hugely informative. That's Dr. Amy Jaworek, infectious disease specialist and Dr. Gennady Gelman, family medicine physician, both at Harrington Hospital. Thanks for checking out this episode of Healthy Takeout. For more information, please visit Harringtonhospital.org/coronavirus. To get connected with Dr. Jaworek or Dr. Gennady Gelman, or another provider, head to Harringtonhospital.org. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks. And we'll talk next time.