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Tag: Respiratory illnesses

  • Tested positive for flu during the holidays? Here’s what you should do

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    (CNN) — As millions of Americans hit the road or take to the skies for the holidays, another seasonal traveler is picking up speed: influenza.

    Flu activity is already rising across the country. In the week ending December 13, roughly 4% of visits to health care providers were for respiratory illnesses, and nearly 10,000 patients were hospitalized with influenza, according to the latest data from the US Centers for Disease Control and Prevention, released Friday. So far, three children already have died from flu-related causes this flu season.

    Those numbers mean the virus may be closer to home than many families realize. Holiday gatherings could include someone just recovering from the flu, or someone beginning to feel sick. Should they still show up to open presents on Christmas morning? How long should a visit be postponed before heading to grandma’s to bake cookies?

    As flu cases climb, here are the flu-related rules families should know this holiday season.

    If I’m having symptoms, when should I take a flu test?

    There are several over-the-counter flu tests available in the United States, and they can be taken at home as a nasal swab, similar to Covid-19 tests.

    Many doctors recommend taking a test as soon as you experience symptoms.

    “Particularly if you’re a person in a high-risk group,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center.

    “Those persons are people who are age 65 and older, anyone who has a chronic underlying medical condition, if you’re immune compromised, if you’re a pregnant person and very young children,” he said. “Those are all people who are in high-risk, and once they have symptoms, that’s the time to get tested, because we would have antivirals available to help keep you out of the hospital.”

    Flu symptoms usually start suddenly with fever, chills, headache, body aches and fatigue, Dr. Pamela Lindor, a pediatrician at Bluebird Kids Health in Jacksonville, Florida, said in an email.

    While you should quickly start treatment and avoid exposing others when you test positive for flu, “if the over the counter test is negative but your symptoms are severe, consider getting a more accurate test from your doctor or urgent care center,” she said.

    Testing is key because once it is determined which respiratory illness you have, you can then receive appropriate treatment, Schaffner said.

    “Flu is not the only illness we’re concerned about. Maybe you have Covid, and if you have Covid, we have another medication that could help keep you out of the hospital,” he said.

    At what point should I take antiviral medications for flu?

    Flu antiviral drugs, such as Tamiflu or Xofluza, are prescription medications, and they work best when started early, ideally within two days after flu symptoms begin.

    “For the flu, if you are ill, the sooner you begin the antiviral, the more effective it is,” Schaffner said. “There is the 48-hour rule. That is, for it to be maximally effective, you have to initiate treatment within the first 48 hours after you get symptoms. But even after 48 hours – and this is especially true for high-risk people – you can still have some modulating effect of the antivirals.”

    As soon as someone starts to show symptoms, they should stay home and avoid contact with other people to not spread the virus.

    “You’re capable of transmitting the influenza virus the day before you get symptoms,” Schaffner said. “But nonetheless, wear a mask and avoid other people in your family as much as possible until your symptoms start to abate and you’ve had no fever for 24 hours without using Tylenol.”

    According to the CDC, people can return to their normal activities when, for at least 24 hours, they have not had a fever without using fever-reduction medication, and their overall symptoms are improving.

    “This will usually be at least 4-5 days,” Lindor said. “Flu is most contagious starting the day before symptoms develop and continuing for about one week.”

    If I’m wearing a mask, can I still be around people for gatherings?

    Some people who have symptoms or fever might be tempted to still visit family or open Christmas gifts with loved ones, as long as they wear a mask, but Schaffner still warned against it.

    “If you’ve developed symptoms, I think you’ve got to stay home,” Schaffner said.

    “Even if you say, ‘Well, I have these symptoms, but I’ll wear a mask.’ Yes, that will reduce the chance of spreading but not reduce it to zero. And guess what? It’s very hard to eat and drink with a mask on,” he said. “So, you will indeed be exposing people. And when you get to family members, even when you wear that mask, they’ll be hugging and kissing. These are very close circumstances, so you’ve got to restrain yourself and separate yourself, otherwise you are very much in danger of becoming a dreaded spreader.”

    What should household members do if someone else in the home tests positive?

    While someone with flu should take precautions to isolate themselves and not expose others, there are important steps their household members also can take to reduce their risk of getting sick.

    “Good handwashing is very important to prevent spread,” Lindor said. “Common surfaces in the house should be disinfected.”

    Can I take antivirals to prevent getting sick?

    Some doctors may prescribe antiviral medications to people who have been exposed to someone with flu, but they are not yet showing signs or symptoms themselves, especially if that person is in a high-risk group.

    “Tamiflu can be prescribed to people who have been exposed to the flu, and is usually taken for 7-10 days to prevent infection,” Lindor said. “Xofluza can also be used prophylactically, and only one dose is needed, for adults and children 5 or older.”

    For example, a 22-year-old college student may travel home for Christmas to visit their grandfather. The next day, after they have already visited their grandfather, they test positive for the flu.

    “Their grandfather is obviously in a high-risk group. Should the grandfather take Tamiflu for five days? That’s not a bad idea,” Schaffner said. “In that circumstance, it could very well avert the influenza infection.”

    When do I know whether to go to the hospital?

    It’s important to stay in contact with your doctor once you test positive for flu and experience worsening symptoms, especially if you are in a high-risk group, Schaffner said.

    And with your doctor, “have those discussions about when it is that you need to go to the hospital,” he said. “But difficulty breathing, coughing up blood, really feeling terrible, temperatures of 103 or higher – all of those things are indicators that you really need medical attention.”

    Some other “warning signs” that may require urgent medical attention include “dehydration, chest pain, lethargy, mental status changes, seizures or severe weakness,” Lindor said. “Confusion, behavior changes, or high persistent fever for over 3 days also warrant urgent medical attention.”

    Is it too late to get a flu shot?

    There is still time to receive your seasonal flu shot if you haven’t already.

    “For all those people out there who are still well, if you haven’t been vaccinated, please get the vaccine. Don’t linger,” Schaffner said.

    “That’s a holiday present to you and to everyone else around you,” he said. “There’s more than one kind of influenza virus out there, and the vaccine helps prevent serious disease due to three different types of influenza virus.”

    Lindor said that overall, the best way to avoid having the flu disrupt family gatherings during the holidays is “for all family members to get their flu vaccine early in the flu season each year.”

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    Jacqueline Howard and CNN

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  • It’s Beginning to Look a Lot Like Another COVID Surge

    It’s Beginning to Look a Lot Like Another COVID Surge

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    When I called the epidemiologist Denis Nash this week to discuss the country’s worsening COVID numbers, he was about to take a rapid test. “I came in on the subway to work this morning, and I got a text from home,” Nash, a professor at the City University of New York, told me. “My daughter tested positive for COVID.”

    Here we go again: For the first time in several months, another wave seems to be on the horizon in the United States. In the past two weeks, reported cases have increased by 53 percent, and hospitalizations have risen by 31 percent. Virus levels in wastewater, which can provide an advance warning of spread, are following a similar trajectory. After the past two years, a winter surge “was always expected,” Nash said. Respiratory illnesses thrive in colder weather, when people tend to spend more time indoors. Thanksgiving travel and gatherings were likewise predicted to drive cases, Anne Rimoin, an epidemiologist at UCLA, told me. If people were infected then, their illnesses will probably start showing up in the data around now. “We’re going to see a surge [that is] likely going to start really increasing in velocity,” she said.

    Winter has ushered in some of the pandemic’s worst moments. Last year, Omicron’s unwanted arrival led to a level of mass infection across the country that we had not previously seen. The good news this year is that the current rise will almost certainly not be as bad as last year’s. But beyond that, experts told me, we don’t know much about what will happen next. We could be in for any type of surge—big or small, long or short, national or regional. The only certain thing is that cases and hospitalizations are rising, and that’s not good.

    The pandemic numbers are ticking upward across the country, but so far the recent increases seem especially sharp in the South and West. The daily average of reported cases in Mississippi, Georgia, Texas, South Carolina, and Alabama has doubled in the past two weeks. Hospitalizations have been slower to rise, but over the same time frame, daily hospitalizations in California have jumped 57 percent and are now higher than anywhere else in the United States. Other areas of the country, such as New York City, have also seen troubling increases.

    Whether the nationwide spike constitutes the long-predicted winter wave, and not just an intermittent rise in cases, depends on whom you ask. “I think it will continue,” Gregory Poland, a professor of medicine at the Mayo Clinic, told me. “We will pour more gas on the fire with Christmas travel.” Others hesitated to classify the uptick as such, because it has just begun. “It’s hard to know, but the case numbers are moving in the wrong direction,” Rimoin said. Case counts are unreliable as people have turned to at-home testing (or just not testing at all), though hospitalizations and wastewater readings remain reliable, albeit imperfect, metrics. “I’ve not seen a big enough change to call it a wave,” Susan Kline, an infectious-diseases expert at the University of Minnesota Medical School, told me.

    But what to call the ongoing trend matters less than the fact that it exists. For now, what happens next is anyone’s guess. The dominant variants—the Omicron offshoots BQ.1 and BQ.1.1—are worrying, but they don’t pose the same challenges as what hit us last winter. Omicron drove that wave, taking us and our immune systems by surprise. The emergence of a completely new variant is possible this year—and would change everything—but that is considered unlikely.

    The lack of data on people’s immune status makes it especially difficult to predict the outcome of the current rise. Widespread vaccination and infection mean we have a stronger wall of immunity now compared with the previous two winters, but that protection inevitably fades with time. The problem is, people fall sick asynchronously and get boosted on their own schedules, so the timing varies for everyone. “We don’t know anything about how long ago people were [vaccinated], and we don’t know anything about hybrid immunity, so it’s impossible to predict” just how bad things could get, Nash said.

    Still, a confluence of factors has created the ideal conditions for a sustained surge with serious consequences for those who get sick. Fading immunity, frustratingly low booster uptake, and the near-total abandonment of COVID precautions create ideal conditions for the virus to spread. Meanwhile, treatments for those who do get very sick are dwindling. None of the FDA-approved monoclonal antibodies, which are especially useful for the immunocompromised, works against BQ.1 and BQ.1.1., which make up about 68 percent of cases nationwide. Paxlovid is still effective, but it’s underprescribed by providers and, by one medical director’s estimate, refused by 20 to 30 percent of patients.

    The upside is that few people who get COVID now will get very sick—fewer than in previous winters. Even if cases continue to surge, most infections will not lead to severe illness because the bulk of the population has some level of immunity from vaccination, previous infection, or both. Still, long COVID can be “devastating,” Poland said, and it can develop after mild or even asymptomatic cases. But any sort of wave would in all likelihood lead to an uptick in deaths, too. So far, the death rate has remained stable, but 90 percent of people dying now are 65 and older, and only a third of them have the latest booster. Such low uptake “just drives home the fact that we have not really done a good job of targeting the right people around the country,” Nash said.

    Even if the winter COVID wave is not ultimately a big one, it will likely be bad news for hospitals, which are already filling up with adults with flu and children with respiratory syncytial virus, or RSV. Many health-care facilities are swamped; the situation will only worsen if there is a big wave. If you need help for severe COVID—or any kind of medical issue—more than likely, “you’re not going to get the same level of care that you would have without these surges,” Poland said. Critically ill kids are routinely turned away from overflowing emergency rooms, my colleague Katherine J. Wu recently reported.

    We can do little to predict how the ongoing surge might develop other than simply wait. Soon we should have a better sense of whether this is a blip in the pandemic or something more serious, and the trends of winters past can be helpful, Kline said. Last year, the Omicron-fueled surge did not begin in earnest until mid-December. “We haven’t even gotten to January yet, so I really think we’re not going to know [how bad this surge will be] for two months,” Kline said. Until then, “we just have to stay put and watch.”

    It is maddening that, this far into the pandemic, “stay put and watch” seems to be the only option when cases start to rise. It is not, of course: Plenty of tools—masking, testing, boosters—are within our power to deploy to great effect. They could flatten the wave, if enough people use them. “We have the tools,” said Nash, whose rapid test came out negative, “but the collective will is not really there to do anything about it.”

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    Yasmin Tayag

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