Flu vs. COVID-19: What to Know as Flu Season Approaches

Podcast Transcript

Deanna Pogorelc:  Welcome to the Health Essentials Podcast, brought to you by Cleveland Clinic. I'm your host, Deanna Pogorelc. We're now several months into the coronavirus pandemic, and we're also fast-approaching peak season for yet another infectious disease, influenza. Here to explain everything we need to know, heading into this flu season, is infectious disease specialist, Dr. Kristin Englund. Hi, Dr. Englund. Thanks for being here.

Dr. Kristin Englund:  Good morning, Deanna.

Deanna Pogorelc:  For our listeners, please remember that this is for informational purposes only and is not intended to replace your own physician's advice. So Dr. Englund, one thing I keep hearing over and over again by some people during this pandemic, is that coronavirus is just another flu and it's not a big deal, and why are we making such a big deal about it. So can you start by talking a little bit about what differentiates these viruses and how the flu is different from the coronavirus?

Dr. Kristin Englund:  Well, certainly. First of all, they're caused by two completely separate viruses. Influenza has been around for many, many, many years, and we're aware of the two types, influenza A and influenza B. Each year, there are going to be different variants of the influenzas. So that's why we have a vaccine that we need to get every year for those. SARS-CoV-2 is a brand-new virus. We've had coronaviruses in the past, but this is a brand-new variant of it. So this is something that we've not seen before. None of us have ever seen it. So none of us have any form of immunity against it. And that's why it's able to spread so worldwide and so rapidly is because nobody has immunity. Nobody is protected against it at this point. Unfortunately, we have no way to protect people against it either, in the form of a vaccine. There's no vaccine available for the new COVID-19. However, we do have influenza vaccines that are available.

Deanna Pogorelc:  And what do we know about how infectious the coronavirus is? Is it more contagious than the flu, less contagious?

Dr. Kristin Englund:  So certainly, coronavirus is spread similarly to the way that influenza is spread. It's spread through respiratory droplets. So if somebody is coughing, if somebody is sneezing, if somebody is talking, singing around you, those droplets can be passed back and forth. And those droplets can carry a number of infections, including influenza and including the SARS-CoV-2. So the question is whether we can get it, if we're more likely, if we get exposed to flu versus if we're more likely to get COVID-19. So they're roughly about similarly infectious. Although, what we're seeing is more likely these super spreading events when we talk about COVID-19. So if somebody is going, say, out to a meeting, to a choir practice, to a party, and they have COVID-19 but don't necessarily have symptoms, they can be super spreading at that point in time, meaning more and more people around them are more likely to get exposed to and infected than, say, somebody if they were to have just the flu.

Deanna Pogorelc:  I see. And so we know we've heard that most people who get COVID-19 get either no symptoms or mild symptoms and can kind of recover at home, but what do we know about the rate of people who get it and become very sick and need to be hospitalized?

Dr. Kristin Englund:  Certainly. So we're seeing, certainly, our hospitals in certain areas filling up with patients who are very, very ill with COVID-19. So you're right. While the majority of people are only going to be having mild symptoms, about 20% of people who have symptoms are going to be having more severe symptoms and possibly even requiring hospitalization. So for those who are more likely to get ill and require hospitalization, they're under usually certain categories of folks who either are older, over the age of 65, as far as COVID goes. That's also the same as flu. People who have underlying illnesses, such as underlying lung disease, like COPD, or asthma. People who have diabetes or high blood pressure. People who also are morbidly obese. So who have a weight or a body mass index that we see that's higher than about 40.

Deanna Pogorelc:  And as you all, as medical professionals, have learned more about COVID-19 over the past few months, have you gotten a better idea of how to treat people who get it, even though there's not necessarily one treatment per se, specifically for COVID-19?

Dr. Kristin Englund:  Absolutely. I think we have to give a lot of credit to our intensivists, so those of our physicians and respiratory therapists who are working in the intensive care units. Where we've seen numbers in other countries as far as 40% of people who were in the intensive care unit in, say, Italy who were passing away if they had to be intubated in the intensive care unit, we're seeing numbers much better than that here in the United States. So I think our intensivists have learned a lot about how to manage the ventilators, specifically in patients with this disease. We're also learning how to manage medications, such as steroids, in using those in patients who have very severe disease.

We're also offering trials that were not available right off the bat. So we're trying new medications under guidance of the FDA and under clear clinical trials, with medications such as Remdesivir. So we're finding out more and more about the best ways to treat patients, and offering better hopes that even if you get in the intensive care unit, or need to be intubated, there's a greater likelihood that you'll survive.

Deanna Pogorelc:  Yeah. And I want to ask you about symptoms, because I know when this all started, there was a lot of talk about how it's very hard to differentiate COVID-19 from the flu because the symptoms tend to be very similar. So how has our knowledge of symptoms evolved since then?

Dr. Kristin Englund:  Well, as we're heading into the flu season, this is one thing that we're concerned about because there are a lot of similarities between influenza, or the flu, and COVID-19. So patients will often present with either, one, with a cough, feeling short of breath, having a fever, also presenting with muscle aches or overall soreness, fatigue. People get very tired with both of those disease processes. Some of the differences that we're seeing a little bit more is diarrheal illnesses or nausea and vomiting in patients with COVID, although children with influenza can have those symptoms as well. And a very different symptom that we're seeing is a loss of sense of taste and sense of smell in patients with COVID-19. Headaches can be seen in both of them, although the problems that we're seeing with COVID-19 are that people are getting blood clots. So headaches in somebody with COVID-19 can be very concerning because it could indicate the potential for a stroke, or a bleed.

Deanna Pogorelc:  And what about the kind of traditional upper respiratory symptoms, like a runny nose, or more like cold symptoms. Are those common at all?

Dr. Kristin Englund:  So while we see those listed as people having sneezing, watery eyes, runny nose, they can be seen in COVID-19 patients, but there's certainly much less. I would suspect that mostly that's going to be your typical cold-type symptoms. If you're not showing other symptoms such as more of a shortness of breath, cough, potentially fevers, it's less likely to be COVID-19, or the flu.

Deanna Pogorelc:  Okay. So as we are heading into cold and flu season and have all of these things on our mind, can you talk a little bit about when does flu season really begin and what kind of flu season are we expecting this year?

Dr. Kristin Englund:  Sure. Great question. So our flu season, we'll typically see starting in roughly October. It really differs every year. Sometimes we're not seeing influenza rearing its head until January, February, but some years it's as early as October. So this year we're recommending that people get a flu vaccine in September and October so that we're prepared for the beginning parts of the flu season, and we have everybody protected as best as we can at this point in time.

So what are we expecting from a flu season this year? A lot of times we can predict our flu season based upon what they see in the Southern Hemisphere. So say in Australia. What we're seeing so far is that they're having a lighter flu season than usual, which is a blessing at this point. We don't necessarily want to be fighting these two off at the same time. However, it's not a hundred percent accurate. So we're hoping for a lighter flu season. Some of it may be a lighter flu season because they've also been following a lot of COVID-19 precautions. And we know that the way that we can prevent ourselves from getting exposed to influenza and getting sick from influenza are a lot of the same things that we're recommending that you use to keep yourself from getting exposed to, and getting ill from COVID-19.

Deanna Pogorelc:  Why do we tend to see the flu peak during the winter months?

Dr. Kristin Englund:  So we see it a lot during the winter months because that's also a time when, as it's getting colder here, we're starting to see people congregating indoors more. So the flu is more likely to be spread amongst people as you're in your home, as you're in enclosed environments. You're not spending as much time outside, riding your bike, going for long walks. So people are in a lot closer environments.

Deanna Pogorelc:  And I'm curious, as we're kind of navigating this, figuring out how kids are going to go back to school, could that potentially be a factor in how good or bad the flu season is?

Dr. Kristin Englund:  Well, I think a lot of it's going to depend upon how well we're able to encourage social distancing, hand-washing, masking, even while our kids are in school. We can certainly see that for influenza, some of our youngest children can get sick more often than our middle-aged folks. So we do worry about influenza in the very youngest children. But as we look at children, say, that are more of the school age time, they're at risk for a certain infection called the Multisystem Inflammatory Syndrome in children. And that's a very rare but very severe illness that we can see in school-aged children. So going back to school is not completely safe, but it is something that certainly many people are going to discuss the risks and benefits of that. And I think our school systems and our parents and our teachers are going to have to make decisions based upon that.

Deanna Pogorelc:  So I want to ask what we can all be doing to kind of prepare ourselves to stay healthy this flu season. And you talk a little bit about that, but maybe you can reiterate a few of the really important things that we need to be doing.

Dr. Kristin Englund:  Absolutely. So we do know that there are ways that you can protect yourself from getting either influenza or COVID. And they're pretty simple. So when you're going out in public, it's really important that you wear a mask. That not only protects you, but it also protects those that are around you. So if you are coughing, if you're at a time when you're feeling well, but you do have the virus and you could potentially spread it to someone else, then the mask is going to catch that virus and catch those droplets and keep you from being able to spread them to someone else.

So masking is terribly important. We do know that masks are not a hundred percent effective. So it's important, even if you're wearing a mask, to maintain that social distancing. And what that means is that you're going to be standing six feet away from somebody else. So that if a little bit of droplets are able to get out through and that virus is able to penetrate out that mask, it's not going to be able to travel as far and potentially infect someone else.

The other thing that we do know is that the virus can sometimes live on other objects. So if you're touching a handle, say, on a grocery cart or on a door handle, you can get virus on your hand. And then as we all normally do, it's just so easy to touch your face, or touch your eyes, or rub your nose, and rub your eyes. The virus can then get into your eyes, or your nose, or your mouth. So if you're out in public, it's really important to make sure that after you touched something, to use hand sanitizer, or go to the bathroom and wash your hands for 20 seconds.

Deanna Pogorelc:  Okay. And if someone does develop some of those flu-like symptoms that we talked about earlier that could possibly be flu, could possibly be COVID-19, what are the best steps for them to take at that point?

Dr. Kristin Englund:  Well, I think the most important thing for you to do is make sure that you call your physician's office, or call one of the Urgent Cares or Express Care Online models so that you can get in contact with a provider and talk through with them about what your symptoms are. Sometimes the symptoms can be easily managed at home. Sometimes you may need a test looking for flu, or looking for COVID-19, and the person on the other end of the phone can direct you to where you can most appropriately be getting a test.

Sometimes those symptoms may be more concerning. Like you're having a bit more shortness of breath when you're trying to climb the stairs than you could before, or your temperature's high, higher than we would like to see, or you may be having some chest pain. Those may be indicators that the provider on the other end of the phone is going to direct you then to the emergency room. We'd rather you not just show up at your primary care doctor's office without giving them a call ahead of time, because it's going to be really important that we make sure that we keep our doctor's offices safe for all people who are coming in for visits. So if we get a heads-up and we know that somebody is having some of these symptoms, we can either direct you to a different location, or we can make sure that we're getting you into a room appropriately and not having you sitting in a waiting room.

Deanna Pogorelc:  Do we know anything about a potential interaction between the coronavirus and a flu virus? Have we seen any cases where people have both?

Dr. Kristin Englund:  It's certainly not impossible for people to have both, since they are two different viruses. There's no reason why you can't get exposed to both of them at the same time. We're not seeing a lot of people who are having viruses, the two viruses together. There aren't any clear cases that we've had of that, but it is certainly possible. And if you were to get exposed to both of them, that could be quite devastating.

Deanna Pogorelc:  So for those of us who are preparing for cold and flu season, is there anything that we should be stocking our medicine cabinets with, anything that we should really have on hand in case we were to get sick with either the flu, or with COVID-19, or even just a cold?

Dr. Kristin Englund:  Sure. So I think, number one, the best thing that you can do to prepare for this viral season is to make sure that you're getting your flu vaccine. As I said before, we don't have a vaccine for COVID-19, so let's protect ourselves against the one thing that you can protect yourself from. And that's the flu vaccine. So everyone should be getting a flu vaccine, regardless of whether you see yourself in a risk category or not. It not only protects you, but it protects all the loved ones around you. So in my case, if I'm 55 years old and I don't necessarily fall into a risk category, I need to get the flu vaccine so that I can protect my parents.

The other thing that we should have in our cabinet, certainly fevers can go along with any of these syndromes. So having some Tylenol at home is a good idea to be able to take care of any of the fevers. Some ibuprofen in case you're having more of the kind of muscle aches. Having a cough syrup at home certainly is a good thing to have. Having a thermometer, making sure that you have a thermometer around, and a good thermometer, one that you can rely upon.

And then one other thing to consider is a machine that is very simple. You just put it on your finger, and it's called a pulse oximeter. And that is one that you can use to make sure that the oxygen level, if you're feeling a little short of breath, that your oxygen level is staying in a healthy range. And a healthy range that we want to see is above 94%. So as long as you're maintaining your oxygen above 94%, you're doing just fine. If it starts to fall below that, or when you're exercising, walking up stairs, walking into the kitchen, you see it falling below that, that's an indicator that you want to call your doctor or call one of the Urgent Care or Express Care lines.

Deanna Pogorelc:  Okay. So if we do get sick, and you mentioned being in close contact with your doctor, we know if we're saying at home, kind of resting, treating ourselves at home, how long can we expect symptoms of either the flu or COVID to last, and how do we know that it's safe to go out into the world again and not be contagious?

Dr. Kristin Englund:  Absolutely. So we certainly want to make sure that we're feeling well, but also that we're not infecting others. So we know that with influenza, you can be shedding the virus, or possibly spreading the virus to somebody else for about a day before you're even having symptoms. Typically, symptoms of influenza or the flu are going to be lasting about four or five days, maybe even up to seven days. So typically, for about a week, if you have the flu, it's a good idea to kind of hunker down at home and make sure that you're not going out and potentially spreading the disease to other people.

For COVID-19, it tends to last a little bit longer than that. So people can be infected and show symptoms anywhere from two days to 14 days later. But we also know that if you've been infected, before you start to show symptoms, you can be passing the virus on for a good two to three days even before you're showing any symptoms. The symptoms of coronavirus, or COVID-19, can last for about 10 days, so longer than influenza. So it's really important that you're staying away from everybody else. And again, just staying down on your couch, staying in your bedroom, really isolating yourself away from other people for at least 10 days.

Deanna Pogorelc:  Well, great. That was all great information. Is there anything else we didn't talk about that you think is important to leave our listeners with?

Dr. Kristin Englund:  I'm afraid we're not going to be seeing a vaccine for COVID-19 for some time. I think we're going to have to get very comfortable with practicing all of these preventative measures for certainly flu, but also for COVID-19. So it is something really important that we need to be able to embrace, and understand that we're not only protecting ourselves, we're protecting all of those around us. And that if we want to get back to more of a normal life, being able to go out to movie theaters, being able to again go back to school safely for our kids, and go out shopping, we're going to need to practice all of these preventative measures to make sure that we are keeping ourselves safe and being able to move back into a bit more normalcy.

Deanna Pogorelc:  Absolutely. Well, thank you so much for your time today.

Dr. Kristin Englund:  Thank you.

Deanna Pogorelc:  And to our listeners, for the latest information on coronavirus, or to schedule a virtual visit or appointment, you can visit Clevelandclinic.org/coronavirus. You can also find more podcasts with our Cleveland Clinic experts at clevelandclinic.org/hepodcast, or wherever you get your podcasts. You can also follow us on Twitter, Instagram, and Facebook, Clevelandclinic, one word. Thanks for joining us.