Is there anything unusual about the symptoms you are seeing with this strain?
The headaches and body aches seem to be worse, and this one is causing some gastrointestinal symptoms as well, with many patients experiencing vomiting and diarrhea. So for patients trying to control symptoms – drinking broth, tea, juice to stay hydrated – this is making it harder, and people are feeling a little bit worse symptomatically. So I think we're seeing some of those impacts. If people are feeling worse, then they tend to seek medical care.
Tell us more about the patients you are hospitalizing.
Transplant patients, cancer patients, the elderly, young children, and patients with lung disease and other underlying medical conditions are really the ones that get hit hard. Occasionally, you will have a younger, otherwise healthy person that gets just such a severe manifestation of the flu – and usually it's a massive inflammatory reaction that their body has – that they get admitted. But that’s a much, much smaller group than those with these underlying conditions.
Who’s at risk of complications?
- People aged 65 years and older.
- Those with certain chronic medical conditions, such as asthma, diabetes and heart disease.
- Pregnant women.
- Children younger than 5 years old.
This predominant flu strain is not covered by this season’s flu shot. Does having the vaccine still seem to be making any difference?
A lot of the time, those who get the yearly flu shot have less severe symptoms. There's going to be some immune response to it regardless of if the vaccine covers the predominate circulating strain. So even if it's not perfect in preventing the flu, if I have underlying medical conditions, it's helpful if I've been vaccinated because, more than likely, it’s not going to be as severe and will prevent hospitalization.
How have the holidays affected the situation, and what is the incubation period? Are you still bracing for more holiday fallout?
This seems to have a pretty fast incubation period, so a couple of days. I'm hoping the worst is over. But the holidays are always interesting, especially during viral season. You take a bunch of people, and maybe one or two of them has the flu, and then you fly them all over and mix them together. That is the perfect recipe for a fast spread.
One positive of this flu is that it does seem to be a pretty short course of illness. While the symptoms start out quite severe, it doesn't seem to be a long drawn-out, multi-week thing for most patients. There's always going to be exceptions, but it seems to be three to four days of feeling pretty bad and then getting better.
Estimated U.S. cases
- A subtype of the influenza A H3N2 strain, subclade K, is responsible for 90% of current flu cases in the country, according to the Centers for Disease Control and Prevention.
- U.S. cases have topped 15 million already this season, resulting in over 180,000 hospitalizations and 7,400 deaths (as of Jan. 9)
- Colorado has reported one pediatric death in a school aged child.
How can people know they should see a healthcare provider; can you touch on those cases when someone thinks they are better, and then they suddenly get very sick again?
If you come into the ED, and you say you've had symptoms for a day or two, most likely that's going to be caused by a virus. What happens is that this virus can weaken your immune system and make you more susceptible to a secondary bacterial infection, such as bacterial pneumonias. This is the group that may need antibiotics and possibly further care.
When else should people seek care for flu?
If you're ever concerned, and if your symptoms are really, really severe, we want to see you. If it goes on for a long period of time, if you have comorbidities, you're pregnant, you have lung disease, those people may need to get checked out a little bit earlier.
If you have mild symptoms that are controlled (staying hydrated, breathing well) – and I think that's really important to emphasize – you may feel bad, but if your symptoms are controlled and manageable and you're otherwise a healthy person, nothing I'm going to do in an emergency department is going to completely alleviate your symptoms. Unfortunately, with these viruses, they're going to have to take their course. They do not respond to antibiotics.
What’s your advice for home care?
The best thing you can do at home for yourself is sleep, stay hydrated and control symptoms. You can take over-the-counter anti-fever, pain and cough medications. Cold and cough medications will help with symptoms, but by no means are they going to eliminate all of your symptoms. But they might help you be able to sleep and be able to recover.
Are the antivirals effective against these strains, and do you recommend them?
In a healthy person, they may shorten just slightly the duration of symptoms and maybe the severity. The people that we worry about and that we really emphasize using these antivirals with – oseltamivir is the big one – is those with comorbidities that may lead to severe illness and hospitalization. That's the population we target, such as pregnant women in later stages of pregnancy.
We now have a home test that can tell us if it's flu or COVID. Is this something we should do if we start to feel sick?
At this point – and we're talking generally healthy, mildly symptomatic people – it doesn't matter what virus you have, because there is no cure. More than likely, you're not going to be hospitalized or have severe illness. Some people really feel like they need that, testing to know, so I'm not going to speak against the home test. But unless you're in that comorbidities or really symptomatic category, we're not going to do anything differently medically.
Do you test everyone who comes through your ED doors?
No. We don't test everybody that comes into the emergency department because it doesn't change the impact on the patients, and it doesn't change their course as long as they are not severe cases or hospitalized.
I think that's really important, because people are worried about strain on the emergency department, strain on the hospital. Over testing means you put strain on your laboratory and other clinical resources. So if we are sending these tests down to the lab, that's more volume they have to process, more work for the nurses and other healthcare workers. In addition, it is an expense to the patient. We know healthcare is expensive, insurance is getting more expensive. We know these are going to increase cost without benefit to you, the patient, which is what we care about as physicians.
Is there anything else you would like to add?
Focus on the tried-and-true basics of taking care of yourself, not on the “super flu” piece of this. It goes back to the basics: minimizing exposure; taking caring of yourself; treating your symptoms at home when you can. Stay away from the hype and focus on the basics of staying healthy.
How can I lower risk of infection?
- Stay home when sick and limit exposure to others who are symptomatic.
- Cover your nose and mouth when you cough or sneeze.
- Wash or sanitize your hands frequently; both soap and water and alcohol-based sanitizers work against flu.
- Avoid touching your face.
- Wear a mask in crowded or high-risk places.
- Prioritize healthy habits such as adequate sleep and good nutrition.
