Thoughts on Coronavirus and Influenza

By: Lori B. Gaylor, PA-C, MPAS, DFAAPA

Picture yourself in line at the grocery store, the hardware store, a fast-food restaurant, or on a plane. Someone next to you coughs or sneezes. You envision a green fog swirling from that petri dish of plague filled germs floating in the air and moving towards you. You may actually take a step back to distance yourself from this danger. Is this an overreaction, or are you just being smart? The answer may surprise you. You should definitely step back.

Coronavirus (COVID-19) is currently in the news and is likely what generates the most fear when a cough or sneeze is noticed in a crowded room. It is new, it is novel, it causes anxiety, and it makes a great news story. However, there is currently another viral epidemic impacting countries around the world, and it is much more likely to cause serious illness or fatality. This disease is something that has become so familiar we have become complacent to it. It is commonly known as the Flu (Influenza). There is panic and media frenzy whenever there is a new outbreak, but pandemic disease is not something new. There is history.

The 1918 Pandemic of H1N1 virus was the most severe pandemic in recent history. According to the CDC, it was caused by H1N1 virus of avian origin and spread worldwide during 1918-1919 (only 100 years ago). It infected over 500 million people in the world (one-third of the world’s population at that time), and it killed at least 50 million people worldwide, with 675,000 deaths in the US alone. Why are we not more afraid of Influenza?
Influenza, despite its severity, is a familiar commodity. It is both predictable and expected. We have become complacent. Every year there is a flu season, and every year cases rise and fall in a pattern. In October, cases rise, and as Spring comes around, Influenza cases decline. February is peak season for Influenza, and it is preventable. We have a vaccine against Influenza. We even have an effective antiviral medication for Influenza. Yet the numbers are still frightening. It is baffling why this does not garner more media attention.

Influenza worldwide has reached an estimated 1 billion cases, with up to 646,000 deaths worldwide in a season. In the US alone, Influenza has caused approximately 26 million illnesses, 250,000 hospitalizations, and 14,000 deaths so far this season (just since October), and up to 61,000 deaths in past seasons. (CDC).

Coronavirus (COVID-19), has caused over 75,000 illnesses, and over 2,000 deaths, primarily so far in mainland China. 35 cases are confirmed to date in the US, more with the cruise ship passengers back, with 0 US deaths to date.

Both seasonal flu viruses and COVID-19 are contagious viruses that cause respiratory illnesses. Influenza symptoms typically include sudden onset of fever, aches, cough, sore throat, headaches, runny/stuffy nose, fatigue, and occasionally vomiting and diarrhea. Complications can include pneumonia, sepsis, and death.

COVID-19 most commonly exhibits fever, cough, and shortness of breath, with an occasional sore throat, runny nose, diarrhea, nausea, and vomiting. Complications can include pneumonia, sepsis, and death.

Influenza can spread person to person even before symptoms begin. The first 3-4 days of illness are the most contagious, but healthy adults may be able to infect others a day or so before symptoms begin, and up to 5-7 days after the illness begins. Young children and those with weakened immune systems may be able to infect others for an even longer time.

Coronavirus appears to be spread in a similar manner and has been shown to spread person to person even before symptoms begin. This is still being investigated. One possible difference, however, that has been noted is that COVID-19 may be spread through the respiratory route, and not just by the droplet route. This means COVID-19 may be spread by droplets remaining in the air even after the ill person is no longer in the vicinity.
Most cases of Coronavirus are not life-threatening, which is one of the reasons it is difficult to contain. It is effective in its spread, and it is not highly fatal. This will create a near-perfect scenario for pandemic illness (pandemic meaning the worldwide spread of a new disease). Severe illnesses such as H5N1, SARS, MERS, and Ebola are highly fatal to humans, and mild or asymptomatic cases were rare. Basically, the virus killed its host too quickly to spread itself. At the time of their emergence, those diseases were big news, but they faded away and were contained quickly. In COVID-19, it can make people sick, but not too sick to survive and spread the virus. A host can test positive for the virus despite feeling fine, with no symptoms at all. This is what makes it more dangerous and more capable of widespread infection. This is also why such dramatic containment measures are in place to attempt to halt the current outbreak. Several epidemiologists have cautiously been quoted as saying the likely outcome is that this virus ultimately will not be containable.

There is a vaccine in development for Coronavirus. Phase 1 clinical trials for a potential vaccine should begin within the next few months.
There is a vaccine already available for Influenza. It is safe, and it is effective. There are numerous articles and studies supporting the safety and effectiveness of the flu shot, too many to reference here. The flu vaccine prevents some of the most dangerous types of Influenza and is shown to reduce the severity of flu, even if not a perfect match for the strain. Those not worried about contracting Influenza themselves should consider vaccination to protect others close to them. There is a phenomenon known as “herd immunity,” which refers to the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination. Only around 50% of US adults got their flu shot this year. Stop for a second and ask everyone in the room around you if they got their flu shot this year. You’ll be surprised.
So, to reiterate the original answer to our question, the answer is yes, you would be smart to distance yourself. Distancing yourself from others who are ill is a good idea! Both Coronavirus (COVID-19) and Influenza are spread in respiratory droplets, and these can spread up to 6 feet in the air. Even smarter: get your flu shot and follow CDC guidelines for disease prevention.

Go to CDC.gov for even more information, but in general, the CDC recommends the following to prevent the spread of respiratory viruses, which include both Coronaviruses and Influenza viruses: Wash your hands often with soap and water for at least 20 seconds (sing the happy birthday song, or ABCs); avoid touching your eyes, nose, and mouth with unwashed hands; avoid close contact with people who are sick; move away from people before coughing or sneezing; stay home when you are sick and keep sick children out of school or daycare; cough and sneeze into a tissue then throw it away, or cough and sneeze into your upper shirt sleeve, completely covering your mouth and nose; clean and disinfect frequently touched objects and surfaces.

So yes, be smart, do what the CDC recommends to stay well, and to prevent the spread of disease. That’s their job. It is, after all, named the CDC (Centers for Disease Control and Prevention) for a reason.

 

See Lori B. Gaylor, PA-C, MPAS, DFAAPA speak at the GAPA 2020 Summer Conference in Sandestin, Florida July 13-17.

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