a guide to tolerating the flu season while under pressure of covid

1. Sakhile Ndlalane
Levy Mwanawasa medical university teaching hospital
COVID-19 testing during this season facts

2. RESPIRATORY VIRUSES
• Respiratory viruses are the most frequent causative agents of
disease in humans, with significant impact on morbidity and
mortality worldwide.
• There are many types of respiratory viruses that circulate in all
continents as endemic or epidemic agents.
• The risk of a large outbreak becomes higher, during the autumn
and winter seasons, especially on viruses that cause:
SARS-CoV-2 (COVID-19),
Influenza virus (flu),
Respiratory syncytial virus (RSV)

3. Covid, Flu, and RSV: what are the differences?
These virus cause different contagious respiratory illnesses
• COVID
 caused by infection with SARS-CoV-2
 There is one type, but several variants, of SARS-CoV-2, such as Alpha, Beta, Delta, Gamma, Mu, and others.
 seems to spread more easily than flu
 can cause more serious illness in some people than flu
 symptoms can take longer to show up
 People can be contagious longer with COVID-19
• Flu
 Caused by infection with influenza viruses
 It can cause mild to severe illness, and at times can lead to death.
 There are four types of flu viruses: A, B, C, and D
 – Human influenza A and B viruses cause seasonal epidemics of disease (known as flu season)
• RSV
 There are two subtypes of RSV: A and B
 usually causes mild, cold-like symptoms.
 Most people recover in a week or two.
 Serious infections with RSV can cause bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of
the lungs) especially for infants and older adults
For all these viruses, the incubation period and duration of contagiousness varies

4. COVID, FLU, and RSV: what are the similarities?
All three are respiratory RNA viruses that are easily transmitted via:
 Direct contact and droplets
 Indirect spread and aerosols
Shared symptoms include
 Fever/chills
 Cough
 Runny nose/congestion
 Shortness of breath
These viruses mutate and change over time
They can show results ranging from asymptomatic cases, mild, severe disease or even death.

5. Importance of testing
You might have already realized that, due to the nature of clinical presentation of the viruses, its very hard to tell one from the other right?.
Would you rather have your doctor start treating you on a guessing game technique, or would you rather know which one of the viruses is
affecting you? No brainer, isn’t it?
Multiplex technology allows for simultaneous testing of multiple viruses and coinfections
“All patients with acute respiratory symptoms in hospitals and other health care settings, and all specimens from sentinel primary care
surveillance, should be tested for both SARS-CoV-2 and influenza during the influenza season to monitor incidence and trends over time.”
“Given overlapping symptoms, routine multi-pathogen testing for SARS-CoV-2, and influenza (and possibly other respiratory infections) is
important for surveillance, treatment decisions (such as timely use of antivirals for influenza), minimizing isolation times, and avoiding and
reducing rates of transmission.
It is nearly impossible to diagnose an infection based on symptoms alone. Given overlapping symptoms, routine multi-pathogen testing for
SARS-CoV-2, influenza virus, and RSV is essential for providers, patients, and health officials to help manage flu season during the COVID-19
pandemic via:
– Higher through put for surveillance and monitoring
– Minimizing isolation times
– Avoiding and reducing rates of transmission
– Savings in resources (cost, reagents, personnel, and time) compared to single tests
– Deciding on best treatment choice in time.

6. Importance of vaccinating
Vaccines save millions of lives a year, but what exactly is a vaccine and what goes into making one? And how do we know
they are safe?
All vaccines contain active ingredients called “antigens” that trigger an immune response to viruses, bacteria and other
pathogens. But in order to work well, it is important that they also contain other key ingredients to keep them safe and
effective. The main ingredient in most vaccines is water. They also contain emulsifiers and stabilizers to ensure that the
other ingredients remain suspended in the solution and are protected against the effects of temperature changes during
transportation or storage.
Vaccines differ from other medical drugs in two important ways.
 The first is that they are designed to prevent disease, rather than treat it.
They do this by priming a person’s immune system to recognize a specific disease-causing bacteria, virus or other pathogen. This
“memory” can last weeks, months or even years, or in some cases for life, which is why vaccination can be so effective, stopping
people from getting sick rather than waiting until the actual disease occurs.
 The second is that vaccines by their nature tend to be biological products, rather than chemical like most drugs.
This means that the processes involved in making them are more complex and expensive, and they tend to be less stable than
chemicals and more vulnerable to temperature changes. So due to this, vaccines normally need to be refrigerated to keep them
within a specific temperature range. The type of vaccine will determine how low a temperature the vaccine needs to be stored at.
Most vaccines need to be kept refrigerated or frozen, but intranasal vaccines are now being developed that can be stored at room
temperature.
 Vaccines are available for SARS-CoV-2 and flu, but not for RSV, so it is advisable that people should vaccinate against these viruses
which are potentially life threatening.

7. Treatment
SARS-CoV-2 variants or influenza virus types do not influence each method of treatment, such as which antibodies or
antivirals are used.
 Most people with flu have mild illness and do not need medical care or antiviral drugs. If you get sick with flu
symptoms, in most cases, you should stay home and avoid contact with other people except to get medical care. If,
however, you have symptoms of flu and are at increased risk for complications, are very sick or worried about your
illness, contact your health care provider.
Antiviral drugs can help treat flu illness:
 Antiviral drugs are different from antibiotics. Flu antivirals are prescription medicines (pills, liquid, intravenous
solution, or an inhaled powder) and are not available over the counter.
 Antiviral drugs can make illness milder and shorten the time you are sick. They might also prevent serious flu
complications, like pneumonia, when treatment is started early.
NB: It’s very important that antiviral drugs be started early after symptoms begin to treat people who are very sick with
flu (for example, people who are in the hospital) and people who are sick with flu and have a greater chance of getting
serious flu complications, either because of their age or because they have a higher risk medical condition.
Most otherwise-healthy people who get flu, however, do not need to be treated with antiviral drugs.

8. There is no specific treatment for RSV infection, so fluids and rest are the best advice for mild symptoms.
If you have COPD or asthma, be sure to maintain use of prescribed medications to reduce breathing difficulties and speak with
your healthcare provider if you think your medications might need to be adjusted.
Most RSV infections go away on their own in a week or two.
There is no specific treatment for RSV infection, though researchers are working to develop vaccines and antivirals (medicines that fight
viruses).
Take steps to relieve symptoms
 Manage fever and pain with over-the-counter fever reducers and pain relievers, such as acetaminophen or ibuprofen. (Never give
aspirin to children.)
 Drink enough fluids. It is important for people with RSV infection to drink enough fluids to prevent dehydration (loss of body fluids).
 Talk to your healthcare provider before giving your child nonprescription cold medicines. Some medicines contain ingredients that are
not good for children.
Its important to visit your healthcare Centre to rule out covid or other types of colds and flu before following the steps as directed above.
If you are reading this and you are not a healthcare provider, please do not try to guess the nature of sickness by gauging the severity of
symptoms.
The golden rule is : “its better to be safe than sorry”
Treatment continue….

9. Treatment continue….
People who are more likely to get very sick include older adults (ages 50 years or more, with risk increasing with age), people
who are unvaccinated, and people with certain medical conditions, such as chronic lung disease, heart disease, or a weakened
immune system.
This group of people need to visit their nearest healthcare facility even if their flu seems mild, in order to rule out covid-19 or
any other virulent strains of flu, so that treatment can be started immediately.
COVID-19, treatments are available that can reduce your chances of being hospitalized or dying from the disease. Medications
to treat COVID-19 must be prescribed by a healthcare provider and started as soon as possible after diagnosis to be effective.

10. References:
• 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149556.
• 2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7120591/.
• 3. https://pubmed.ncbi.nlm.nih.gov/33647033/.
• 4. https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00364-7/fulltext.
• 5. https://www.cdc.gov/coronavirus/2019-ncov/variants/variant-info.html.
• 6. https://www.cdc.gov/flu/about/viruses/types.htm.
• 7. https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm.
• 8. https://www.cdc.gov/dotw/rsv.
• 9. https://www.cdc.gov/rsv/about/symptoms.html.
• 10. https://asm.org/Articles/2020/July/COVID-19-and-the-Flu.
• 11. https://www.cdc.gov/rsv/index.html.
• 12. https://acmedsci.ac.uk/file-download/4747802
• 13. https://files.covid19treatmentguidelines.nih.gov/guidelines/covid19treatmentguidelines.pdf.
• 14. https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm.
• 15. https://www.ecdc.europa.eu/en/publications-data/covid-19-testing-strategies-and-objectives.