With Infectious Disease Specialist Dr. Manuel Gordillo & ER Director Lisa Collins-Brown

The annual flu season is officially under way. Unlike years past, Flu Season 2020 has the added health threat of intersecting the ongoing COVID-19 pandemic. 

Currently, flu cases in our area are very low, but what can our community expect this winter? Will there be a potential flu-COVID “twindemic”? What should we do if we get sick? What can we do to stay healthy?

To find out — and to learn more about Pfizer Inc.’s recently announced COVID-19 vaccine — we asked the experts: Dr. Manuel Gordillo, who leads Sarasota Memorial’s infectious disease team, and SMH Emergency Services Director Lisa Collins-Brown, RN.

Ask An Expert Q&A

 

Should the Suncoast be concerned about a possible “twindemic” with flu and COVID-19?

 

Dr. Gordillo: Influenza is unpredictable. We don't know what the effect of both viruses will be, so we don't know what's going to happen in our community.

The best-case scenario would be something like what happened in March in the U.S.: When the COVID virus came, influenza nearly disappeared. One of the most likely reasons for this was because people started physical distancing, washing their hands a lot and staying home more. Even when there was not yet widespread mask use, the other precautions were enough to halt flu virus transmission. 

The same thing happened in the Southern Hemisphere last season. Health officials there reported historically low flu transmission and very few instances of viruses other than COVID-19. That also was attributed to physical distancing, hand hygiene and mask use, and those countries also promoted flu shots a lot.

If we continue taking these precautions and people get their flu shots, we likely would see such a best-case scenario locally and would have a very attenuated flu season. 

We need to prepare for the worst and hope for the best. 

Is it possible to get flu and COVID-19 at the same time? 

 

Dr. Gordillo: Yes, but based on last flu season, it’s not common. We're hoping flu and COVID tend not to occur together, but we need more data in order to make a more definitive assessment. Flu and COVID are very different antigenically. The antibodies for one virus do not protect you against the other.

Multiple illnesses make their rounds in the winter — flu, norovirus, bronchitis, strep throat — and now, there’s COVID. How can we tell them apart?

Dr. Gordillo: Because the symptoms are so similar, it's very difficult to tell them apart unless you test for them. That's why we’re hopeful that flu shots and preventative interventions for these viruses will be effective. 

When you go to healthcare centers — hospitals, ERs, urgent care centers — we can test you for viruses, but if you’re at home, it's going to be very difficult to tell the difference between them. You would need to be evaluated by a healthcare provider to determine which virus is making you sick.

What tests are available to diagnose viruses? Who should get tested?

 

Dr. Gordillo: The testing supply chain is still limited. Even now, 10 months into this pandemic, we have limitations on when we can use our best tests for all these viruses — molecular tests, including the PCR test, the NP swabs and nasal swabs, and some oral swabs. We need to reserve these for people who are going to be admitted to the hospital. 

We do have some tests for viruses that are more widely available. The influenza antigen test, for example, and similar technologies used for outpatient COVID testing. These point-of-care tests can be done quickly, with results in 15 to 20 minutes, but they are not as sensitive as molecular tests, and may result in missing a few cases. We have to be very mindful of when and how we use them. 

We are not seeing many influenza cases here yet, so there really isn’t a reason to widely test for it yet. We need to test when it's going to make a difference: in the very young (age 5 or younger), in the very old, in the immunocompromised or if it's going to make a difference in infection control or public health decisions. Deciding when to test is an ongoing discussion among physicians and other clinical staff in the hospital, urgent care centers and the ERs.

If I have flu or COVID symptoms, where should I seek medical care? 

 

Collins-Brown: If you’re having symptoms, first reach out to your personal physician — if you have one and they’re available. Sarasota Memorial also has 6 urgent care centers, where you can go (open 8 am to 8 pm daily).

But for anything life threatening — shortness of breath, dizziness, chest pain, chest pressure, ongoing fever, severe cough — you need to come to the Emergency Department. 

Since we're not going to know what you have until you’re tested, anybody with those type of symptoms — flu and COVID symptoms are a lot alike — will be given a mask, foam hand sanitizer and will be separated from others.

We’ve seen that people are delaying care or avoiding the ER because of concerns about COVID, but it actually is very safe to come here.

Our ER has many protocols in place to ensure patients can safely seek treatment, including: 

• Waiting room chairs are safely distanced.
• A screener at the entrance checks temperatures.
• Every single person who walks through the door is required to wear a face mask.
• We're also using a lot of sanitation protocols, wiping down surfaces and using the Tru-D germ-killing robot.

And we're going to continue to do these things for the foreseeable future. 

Dr. Gordillo: If you are not sick enough to go to the ER or an urgent care center, ask your doctor for a telehealth consultation, and they can decide right there whether you need medication, testing or some other intervention. 

Antiviral medications like Tamiflu won't help with COVID, but they can obviously help with influenza, if taken early (within 48 hours of symptoms appearing).

When should I seek emergency care for COVID or flu? 

 

Collins-Brown: If you’re unable to care for yourself, you really need to come on into the ER.

Other signs that indicate urgent or emergent care are persistent symptoms or experiencing:

• Difficulty breathing.
• Shortness of breath.
• Chest pain.
• Dizziness.
• Ongoing vomiting, diarrhea or anything that could cause dehydration. 

If you experience any of these, contact a doctor. Your doctor may advise you to go to the ER.

Dr. Gordillo: Another sign it’s time for emergency care is confusion. We've seen it a lot — especially with severe COVID but it can also happen with severe influenza — particularly among the elderly. Confusion may be a sign of hypoxia (absence of enough oxygen) or just a part of the disease. 

We recommend that seniors and the elderly buy a pulse oximeter to use at home for oxygen self-checks. If you get low oxygen readings, you probably belong in the Emergency Room or an urgent care center.

What are the red-flag symptoms to look for in children?

 

Collins-Brown: The signs that indicate urgent or emergent care would be the same for children. Children can compensate for quite a while before they decompensate, but when they decompensate, it's usually quickly.  

With COVID in kids, we’re seeing more cough and fever, shortness of breath. Contact their pediatrician or a healthcare provider immediately if a child is experiencing: 

• Ongoing shortness of breath.
• Difficulty breathing.
• Any kind of pain or pressure in their chest.
• Confusion.
• Lethargy.
• Inability to drink or eat.

How long should people isolate or stay home if they're sick?

 

Dr. Gordillo: Contact your doctor or other healthcare provider for guidance, if you’re sick. The physician needs to make an assessment on what they think is going on: Do you have COVID or do you have influenza-like illness?

If you’re sick with COVID, stay isolated for 10 days. As long as you're feeling better at day 10 and you don’t have any fever, you can go back to the world. When you come into the hospital and you've got severe disease, it could be a little different; sometimes we go up to 20 days. 

If you’ve been exposed to COVID but don’t have symptoms, you’ll need to isolate for 14 days. This is a little counterintuitive, but it’s what we recommend because that's the duration of the incubation period. You can become ill up to 14 days after exposure.

For influenza and other flu-like illnesses, we continue to recommend staying home until you are fever-free for 24 hours without taking fever-reducing medication (Tylenol, ibuprofen, naproxen, etc.). 

Can you provide an update on where we stand with a potential COVID-19 vaccine?

 

Dr. Gordillo: Pharmaceutical company Pfizer Inc. announced Nov. 8 that its vaccine looked to be more effective than anyone anticipated. While the data is rather preliminary, it's solid. 

Having a vaccine that is more than 90% effective on preliminary data is better than anybody expected. We still have to wait probably until the third or fourth week of November to see the safety data. 

The next step — overcoming peoples’ opposition to vaccines — is the difficult part. An effective vaccine sitting on a shelf doesn't do anyone any good. We need to do a better job in explaining how this vaccine is safe, how it has been developed using the best technology, the best science. It's not just the distribution of that vaccine, but also getting people to accept it. 

Pfizer has not yet filed for Emergency Use Authorization (EUA); if the Centers for Disease Control (CDC) and Federal Drug Administration (FDA) approve the EUA, administration of the vaccine will begin. But there's no timeline for all of this yet.

Right now, our best tools to fight this pandemic and influenza are the common-sense interventions we’ve been using since the pandemic began: social distancing, mask wearing, hand hygiene, etc.

If we all do all of that — and then on top of that, we have a COVID-19 vaccine, and the vaccine is accepted — we’ll finally be able to turn the corner. A few months from now, we may be able to return to some sense of normality, which all of us are longing for.
 

** The above video was recorded Nov. 9, 2020, and the content was published Nov. 10, 2020. For the most up to date information on COVID-19, please also visit smh.com/COVID19 as well as the CDC’s website.