Transcription:
Preventing the Spread of a Cold and the Flu

Melanie Cole (Host): Influenza is a serious disease that can lead to hospitalization and sometimes, even death. Every flu season is different, and according to the Centers for Disease Control and Prevention, this year’s flu season is off to a fast start, and early indications suggest it may be more severe than previous seasons. My guest today, is Dr. Adam Leicher. He’s an experienced Emergency Medicine Physician and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show, Dr. Leicher. Explain a little bit about influenza and the devastating effect that it can have around the globe.

Dr. Adam Leicher (Guest): Sure, I’m happy to be here. Influenza is a serious illness that we see. It’s a viral illness that tends to occur more heavily in the winter months. It’s spread person to person by what we call droplet mechanisms where coughing, sneezing, even hand contamination from person to person can infect another and really cause a fairly serious illness ranging from fever, body aches, fatigue, to more concerning complications – pneumonia, and dehydration, and the need for hospitalization and pretty intensive care. It’s something we really take very seriously and look out for year to year.

Melanie Cole: Tell us about this year’s flu expectations and what’s changed in the vaccination recommendations?

Dr. Leicher: Well, the vaccination recommendations primarily have changed from last year in that the CDC is recommending the vaccine only be administered by injection rather than any intranasal spray. In past years, there was a nasal availability or mechanism, but that is no longer recommended this year. The CDC is recommending that everybody who is in what’s considered a high-risk population or who does not have what we say is a contraindication or reason to not receive the vaccination, be given the injection this year. It’s what’s called a quadrivalent, meaning it has four different types of influenza protection as opposed to previous years – primarily -- where there were three different types.

Melanie Cole: So, how do they figure out every year – the CDC, and this year you said it was a quadrivalent – how do they figure out how to make this vaccine?

Dr. Leicher: Well, mostly that’s done based on historical data with some projections for the coming year. The CDC and similar epidemiologic bodies from across the globe look at the variants or the strains of flu that have been most active across the globe in previous years. Some of the data is collected based on looking at the summer hemisphere because they experience their flu season six months before we do. Say, they look at Australia and try to figure out what type of flu is the most active within a given year, and from that, project which of the strains of this virus are going to most likely be prevalent among the community. So they, using these projections, create a vaccine that will most likely be effective in preventing illness, but again, some of that is guesswork and projection based on historical models and doesn’t always play out to be one-for-one protective.

Melanie Cole: Who should be vaccinated, and what’s the best way to protect young children that are too young to receive the vaccine?

Dr. Leicher: Sure, so recommendations from the Centers for Disease Control really encourage that children over 6-months are vaccinated, any adults who are over 50-years-old are vaccinated, and then anyone within what we consider a higher-risk group be vaccinated. This includes people who have chronic medical conditions, such as heart disease, or COPD, chronic lung issues, kidney disorders, anyone who is immunocompromised with conditions such as HIV or Hepatitis, women who are pregnant or who may become pregnant during the flu season, and anyone who is residing in an assisted care or a long-term care facility. That being said, there are special populations who cannot be vaccinated, notably young infants under 6-months old. Recommendations to protect these very special populations are that everyone around them be vaccinated, first and foremost. New parents with neonates at home should be vaccinated. Any caregivers who are coming into and out of the house should make sure that they are vaccinated. This extends to people who are working in long-term care or residential care facilities or people who are coming into contact with these high-risk populations. Beyond vaccination, we ask that people take general precautions, such as covering their cough or sneeze, frequent handwashing, even wearing a mask to prevent the spread of illness.

Melanie Cole: Can you still get the flu if you’ve been vaccinated?

Dr. Leicher: Yes, unfortunately, the vaccine is created using some guesswork and sometimes, the projections for the type of virus most active or prevalent is off. And then, there’s even natural evolution and mutation that the virus can undergo, and so you can get the flu. The flu has many different variants and strains, and there are active strains of flu out there in the population that are not accounted for or protected for by the vaccine. Just because someone has had the vaccination, does not mean that they are inherently protected against getting the flu in any given year.

Melanie Cole: And we’re going to talk about the difference between the cold and the flu, but if you do get the flu and you suspect that’s what you’ve got, what is the treatment? Do you go to Urgent Care? Do you call your doctor or your pediatrician, if it’s your child? And are there some treatments to help slow the progression or make it a little bit less serious?

Dr. Leicher: Sure. I think the first important thing to consider is, am I having a life-threatening emergency? Whether it’s the flu or any other illness, if somebody is struggling very hard to breathe, they’re experiencing severe chest pain, they’re difficult to arouse or seem confused, or really have any kind of condition that seems to be life-threatening, we recommend calling 9-1-1 or coming to the Emergency Department.

Beyond that, for people who are experiencing early signs of flu – fever, cough, headache, general fatigue – I would say first ask are you in one of our higher risk or special populations? Are you elderly and debilitated? Are you very young? Are you immunocompromised for any reason, such as receiving chemotherapy? These populations, I would say, should be in contact with at least their primary care physician earlier rather than later to ask about recommendations.

For everybody, as soon as the onset of symptoms is noted, we say begin hydrating. You can become dehydrated very quickly and easily when battling a fever and illness, so increase your water intake. There are commercial formulations of electrolytes, waters, and drinks, which can be used, though water is always the best option. Over the counter pain and fever medications, like acetaminophen -- better known as the brand name Tylenol – or ibuprofen – which is known by its brand names Motrin and Advil, among others – can be used.

There is medicine, known by its brand name, Tamiflu – Oseltamivir – which is probably the most widely prescribed anti-flu or antiviral medication. This again is indicated for use in people who are demonstrating flu-like illness, most notably again in our high-risk populations – people with chronic illness, people who are immunocompromised, older adults, younger children and pregnant women. This is a medicine that is thought to both shorten the duration of flu symptoms by one to two days, as well as decrease the chance of complications of the flu, such as pneumonia. We know that is most effective if the medication is started within one to two days of symptoms onset, so if you are in a high-risk population or feel that you are experiencing severe symptoms, asking a healthcare provider – either a primary care physician or urgent care doctor about indications for Tamiflu use are certainly reasonable. And again, we stress that the Emergency Room is really reserved for people who seem to have a life-threatening illness. People who have a mild illness and no severe, underlying medical problems really can be treated primarily through home bed rest, primary care visits, and urgent care.

Melanie Cole: How long are you contagious, and when do you tell people – whether it’s the cold or flu – that they can go back to work or school? How do we know that it’s okay to go back to your normal activities?

Dr. Leicher: Part of that I think is the obvious symptoms. If you’re still having high spiking fevers, of course, hacking cough, or stuffy nose, you’re probably still contagious. You’re projecting and spreading these droplets, which do contain the virus particles. If you’re in school or in the food service industry, or any job capacity or student capacity where you’re in contact with the public, as long as you’re still experiencing fevers, cough, congestion, or severe muscle aches and headaches, you are probably still contagious. Typically, the flu runs its course in about five to seven days, though the fatigue itself – the loss of energy can last three, four weeks even. However, once the fevers have subsided, and the cough is gone, you’re probably no longer contagious and can resume your normal activity.

Melanie Cole: So Doctor, what are the symptoms of the flu – you mentioned those, but versus a cold. How do we know the difference if we want to look into Tamiflu or we start to get some of those early symptoms, but we’re not sure if it’s just the plain old common cold, what are some of the differences?

Dr. Leicher: Sure, so, the common cold is actually an umbrella term for any number of viral illnesses that can affect somebody. Influenza is also a virus, but a particular strain of the virus, and so they share some common symptoms. Classically, both types can present with a fever, congestions, sore throat, sneezing, but the severity of these various issues can differ from common cold to influenza. In the common cold, I would say that maybe the nasal congestion and sore throat tend to predominate.

The flu typically manifests more with higher fever, extreme fatigue, very bad headaches, and a worse cough, typically. We define a fever as anything over 100.4 degrees Fahrenheit. I would expect typically that the common cold presents with more of a – what we say is a low-grade fever – somebody who has 99, 100, 101 degrees. Once somebody is experiencing a higher fever, maybe 101, 102, 103 in the adult population, we would think more along the lines of influenza, and this would also typically be seen with bad muscle aches, very low energy, very harsh, hacking cough, and typically a pounding headache. Those are signs more that somebody is suffering from influenza rather than perhaps, just slight decreased energy, nasal congestion, and a cough where we would say that’s probably not the flu.

Melanie Cole: So, to summarize, Doctor, just give us your best advice about weathering cold and flu season and this season now, what do you want people to do – to know about preventing the spread, coughing into their elbow, hand-washing, vaccinations -- wrap it all up for us, with your best advice as an Emergency Room physician.

Dr. Leicher: Sure. Prevention is always of utmost importance. We say, please speak with your primary care physician, get vaccinated against the flu because any amount of prevention is helpful. If you are in contact with someone who seems ill, or you yourself are experiencing symptoms, make sure you wash your hands, you hydrate, drink plenty of water. If you’re experiencing cough or sneeze, cough into your elbow rather than your hand to minimize spread, you can wear a mask; you can take over the counter medications. Be aware of your health status and your chronic medical issues. If you know that you experience long-term medical issues or if you reside in a medical assisted care facility, you are one of our more concerning and high-risk populations. You are somebody who we would be quicker to start on anti-flu medication, the Tamiflu when you begin to experience symptoms. And again, if you are experiencing severe symptoms, inability to breathe, severe chest pain, or anything else that appears to be life-threatening, we are always happy to see you in the Emergency Department. For many people, fighting the flu is a viral illness that will run its course typically in one to two weeks. You can treat this with hydration, over the counter medications, perhaps the Tamiflu if you’re in a special population, but be in contact with your primary care physician or if their office isn’t open, and you’re not experiencing what seems to be a life-threatening condition, urgent cares are really a wonderful resource for you.

Melanie Cole: Thank you so much, Doctor, for being with us today. You’re listening to It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, you can go to HenryMayo.com, that’s HenryMayo.com. This is Melanie Cole. Thanks, for tuning in.