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Flu

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After a November and December in which realities like a “tridemic” of viral threats sickened residents throughout Suffolk County, the new year has started off with fewer illnesses and cautious optimism among health care professionals.

“The numbers are coming down now,” said Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. The overall threat is “less” and “we’re in the take-a-deep-breath phase.”

Indeed, the frequency of cases of several viruses is lower.

“Flu and RSV (respiratory syncytial virus) are down,” Dr. Adrian Popp, chair of Infection Control at Huntington Hospital/Northwell Health and associate professor of medicine at Hofstra School of Medicine, explained in an email.

At the Catholic Health hospitals, including Port Jefferson-based St. Charles and Smithtown-based St. Catherine of Siena Hospital, the emergency room visits are down around 10% from a few weeks ago, said Dr. Jeffrey Wheeler, medical director of the Emergency Department at St. Charles.

In between too busy and too quiet, the hospital is in the “sweet spot” where health care providers have enough to do without frantically racing from one emergency to another, Wheeler said.

Among those visiting St. Charles, Wheeler added that health care providers are seeing a smattering of illnesses.

At the same time, the vaccine for the flu has proven to be a “good match” for the current strain, Nachman said. “Amongst those who did the flu shot, they have tended to not get sick enough to go to the doctor.”

According to New York State Department of Health figures, the overall numbers across the state have been declining for the flu. For the week ending Jan. 14, the number of infections was cut in half.

Suffolk County saw a slightly larger drop, falling 59% for the same week, to 571.

This year, people who were going to get the flu vaccine may have helped themselves and their families by getting the shot earlier, rather than dragging out the process of boosting their immune systems over the course of months. Nachman said.

Cases of monkeypox continue to be on the lower side, in part because of the number of vaccines people in the area have received.

To be sure, health care workers are still helping people overcome a range of infections circulating in the county.

“We are still seeing a smorgasbord of flu, COVID and RSV,” said Nachman. Of the people admitted to Stony Brook Hospital, most of them have a comorbidity.

At Huntington Hospital, admissions are “high,” and the hospital census remains high, Popp added.

Health care workers are diagnosing viruses like the flu and COVID-19 and have used available treatments to reduce the symptoms and the spread of these viruses.

New COVID vaccine approach

Earlier this week, the Food and Drug Administration posted documents online that reflected a possible future change in its approach to COVID-19 vaccinations.

Instead of recommending bivalent boosters or a range of ongoing vaccinations to provide protection against circulating strains, the FDA plans to approach COVID-19 vaccinations in the same way as the flu.

Each year, people who are otherwise healthy and may not have high risks may get a single dose of a vaccine based on the strains the administration anticipates may circulate, particularly during the colder winter months.

Health care professionals welcomed this approach.

Nachman and Popp thought a single shot would be “great” and appreciated how the annual vaccine would simplify the process while reducing inoculation fatigue.

“The simplest messages with the simplest strategy often wins,” Nachman said.

Bivalent booster concern

Addressing concerns raised by the Centers for Disease Control and Prevention about a potential link between the bivalent booster and stroke, Nachman suggested that was one data point among many.

Israel has used the Pfizer bivalent booster exclusively and hasn’t seen any such evidence linking the booster to stroke.

The CDC data is “one of multiple data points that we use to look at safety events,” she said. “Not a single other one has shown any relationship with stroke among the elderly in the first 21 days.”

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People are waiting once again for COVID-19 and other tests at local urgent care centers. File photo by Lina Weingarten

Around this time of year, parking lots are often full.

That’s true of the mall parking lot, as people go out to shop for holiday gifts for their friends and family, but it’s also true, especially this year, for hospitals and urgent care centers.

With the so-called “tridemic,” which is a combination of viruses that typically affect the lungs, including COVID-19, the flu and respiratory syncytial virus (or RSV), infecting people of all ages, the need for health care and medical attention has been high in the weeks leading up to the holidays.

When Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital, arrives at work at 7 a.m., she drives past urgent center parking lots that are “full for a reason. It’s because people are sick” and need medical attention at the start of the day.

Indeed, the combination of the three viruses, as well as other viruses and bacteria in the community such as adenovirus and enterovirus, has made it difficult for some children to attend schools and for adults to go to work.

For the week ending Dec. 10, which is the most recent period for which data is available, Suffolk County reported 3,936 cases of the flu, which is up 35% just from the prior week. The week ending Dec. 10 alone represents more than half of all flu cases for the entire 2019-2020 season, according to data from the New York State Department of Health.

At the same time, COVID and RSV numbers have climbed.

“We almost doubled our COVID census over the last three to four weeks,” Dr. Michael Khlat, chief medical officer at St. Catherine of Siena Hospital in Smithtown, explained in an email. St. Catherine currently has almost 60 COVID-positive patients. Nearly a third of those patients are admitted for COVID and are receiving intravenous remdesivir, while the others are incidental findings in the context of other medical needs.

“What is special about this surge is that it is inclusive of COVID, influenza, rhinovirus as well as RSV,” Khlat wrote. “The symptoms are very similar, and treatments are all supportive at this time.”

Family gatherings at Thanksgiving contributed to the increase, adding “extra turbocharging to the current respiratory viruses,” Nachman said.

The most vulnerable patients are the immunocompromised, patients with diabetes, chronic lung and cardiac disease, obese residents and patients with chronic liver and kidney disease, Khlat added.

Demand for beds

The influx of patients has meant that St. Catherine has had to increase its capacity of staffing using nursing agencies to meet the needs of the community for “seamless, high-quality care,” Khlat explained.

St. Catherine has also added more providers on the medical wards to care for patients and has load balanced patients with their Catholic services partner St. Charles Hospital and other Catholic Health facilities.

Nachman urged residents to see their primary care doctor if they have routine viral symptoms. Coming directly to the emergency room slows the process of delivering urgent care.

To be sure, Nachman urged anyone with chest pains or stroke-like symptoms should head directly to the emergency room.

Nachman said Stony Brook Children’s Hospital is transitioning to a model in which they triage patients who walk into the ER to assess the need for services.

As people prepare for family gatherings, Nachman suggested that they evaluate the risks of interacting with others.

People with an immune deficiency might want to wear masks or speak outside with others, particularly if someone in the group had one of the respiratory viruses.

Viruses like RSV are generally contagious for about three to eight days, according to the Centers for Disease Control and Prevention.

RSV spreads through close contact, which means that passing someone in a supermarket won’t likely spread the virus, while sitting and doing homework or eating a meal next to someone could.

As for COVID, Nachman continued to urge people to get the bivalent booster shot.

Every study, she said, shows that the booster drastically reduces the risk of being hospitalized with COVID.

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Doctors suggest getting immunized before the holiday gathering season begin. Stock photo from Metro

This fall and winter, several infections have their sights set on your lungs.

Amid threats from diseases that affect other organ systems, three of them — COVID-19, the flu and respiratory syncytial virus — can and often do attack the lungs.

While the current strain of COVID isn’t as lethal as the original, the virus continues to mutate, leading to new strains and, potentially, to different strains later this fall.

At the same time, the flu and RSV have been waiting for an opening after COVID protections like masks also kept them at bay during 2020 and 2021.

“How bad is the winter going to be?” asked Dr. Sharon Nachman, chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “It will be based on more [COVID] variants coming through, with a strong flu season, which is never something you want to see.”

The number of cases of respiratory illnesses like RSV and the flu has been lower in the last few years. The lack of exposure to those viruses, however, may give them an opening for a stronger return in the population.

These viruses “didn’t paddle along for a while,” Nachman said. “Now, they are paddling furiously. Everyone is seeing them.”

People’s immune systems may not be prepared for the threat from these recurring viruses.

When people arrive at the hospital, health care officials often see the same symptoms, with coughing and sneezing.

“It could be one, two or three” causes at the same time, Nachman said.

The combination of contracting more than one virus at the same time could lead to prolonged and painful illnesses.

COVID reality

Much as people would like to return to a pre-pandemic reality, the SARS-CoV2 virus not only continues to infect people, but it also remains something of an evasive target, with mutations leading to new variants.

While area hospitals don’t test for the specific COVID strain when patients are sick, doctors expect that some of the people who have contracted the disease have the modern variants.

“Undoubtedly, many cases that are coming to our Emergency Department are due to the new Omicron sub-variants,” said Dr. Sunil Dhuper, chief medical officer at Port Jefferson’s St. Charles Hospital. “Information from the Centers for Disease Control and Prevention has shown that Omicron BA.5 cases are trending downwards and the cases due to the sub-variants are on the rise.”

“The purpose of the vaccine is to attenuate the symptoms from the virus and reduce the severity of illness, hospitalizations and/or death.”

— Dr. Sunil Dhuper

Symptoms of the newer variants are similar to others, with fever, chills, cough, runny nose, fatigue, muscle or body aches, shortness of breath, loss of smell or taste, sore throat, nausea or vomiting and diarrhea, Dhuper explained.

Doctors said it was difficult to gauge how effective the new bivalent COVID vaccines are against the latest strains.

The latest booster may “not be active against all the coming variants,” explained Dr. Phillip Nizza, attending infectious disease physician at St. Charles Hospital.

The new booster was designed to enhance the reaction to the BA.4 and BA.5 variants.

“We don’t have enough data” to determine the effectiveness of the booster against current and future threats, Nachman said. “How effective it will be depends” on differences between the booster and the strain someone contracts.

Still, the vaccine is likely to provide some benefits, doctors said.

“The purpose of the vaccine is to attenuate the symptoms from the virus and reduce the severity of illness, hospitalizations and/or death,” Dhuper wrote. “And I think the vaccines would be very successful in accomplishing that objective.”

Even for people who have been infected recently with COVID, Nachman urged people to get a booster.

The combination of an infection and a booster “Is always better than not getting a vaccine,” Nachman said. “You should get a vaccine. The timing is tricky” and could involve getting a dose two weeks after contracting the virus or waiting.

The viral threat during the December holidays, in particular, is higher, so Nachman urges being as immunized as possible before then.

With people not wearing masks and not even testing for the virus even when they get sick, Nachman suggested that it’s “highly likely” the country will see new variants by the spring.

Nachman urged people to take steps to protect themselves, which includes eating well, exercising, receiving the latest vaccination and limiting exposure, particularly for those who might be vulnerable.

“Take care of yourself,” Nachman urged.

At Stony Brook University Hospital, the wards are busy, with a steady stream of patients coming in, receiving treatment and getting discharged, Nachman said.

“We’re seeing a lot of other viral illnesses,” she added.

She sees a ramp-up in RSV, which she doesn’t expect to peak until Thanksgiving.

Dhuper remains concerned about viral threats this fall and winter.

“We do anticipate a worse flu season this year as the herd immunity is at a lower level,” he wrote. “People should get their flu shots sooner rather than later as that is the only primary protection we have to offer. People with comorbidities should particularly be concerned as the likelihood of severe illness, hospitalization and even death could be higher without the protection from the vaccine.”

While Nizza hasn’t seen any major spike in the flu yet, he suggested in an email that “now would be a good time to get vaccinated.”

Got all that? Good, now, when you’re outside, far from other people and you want to give your lungs a break, take a deep, cleansing breath. Other times? Protect your health and the health of your family and community.

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Get a flu shot now. 

While timing a flu shot can seem like timing the stock market — buying or selling a stock now might mean missing out on gains later — it’s not. A flu shot generally provides immunological coverage against the flu from about four weeks after the shot until six months later.

With a flu season that doesn’t follow a yearly calendar, residents sometimes try to balance between minimizing the possible effect of exposure to the flu in the next few weeks with exposure to the flu in the middle of the spring.

“It makes most health professionals very uncomfortable when people [suggest holding off on protection through the spring] as a reason to delay immunization, as it takes four weeks for protective antibodies to mature,” said Michael Grosso, Chief Medical Officer at Huntington Hospital. Influenza season can begin as early as November and sometimes earlier, so “any time now would be the right time.”

Medical professionals urged people to be even more proactive about getting a flu shot this year, as the pandemic continues to lurk in the shadows, on door knobs, and within six feet of an infected individual.

When people contract the flu along with other respiratory illnesses, the combination, as people might expect, can cause significant sickness.

“The novel coronavirus is just that, it’s novel,” Grosso said. “We don’t know exactly how it will interact with influenza. We do have significant prior experience with concurrent infections with other respiratory viruses. Individuals coinfected with one or more serious respiratory viruses frequently get sicker.”

That’s the case for both children and adults, Grosso added.

Getting an influenza vaccine could also reduce the confusion that will occur if people experience flu-like symptoms, which are also a hallmark of COVID-19 cases.

“Getting as much of the population immunized as possible is even more important than at other times,” Grosso said.

Each year, somewhere between 150,000 to 180,000 people are hospitalized from the flu and the death toll can range between 12,000 to 61,000 people per year in the U.S.

Doctors recommended that people who are 65 and older get a quadrivalent flu shot, which includes an additional influenza B strain.

In a trial of 30,000 people over 65, people who received the quadrivalent shot had 24% fewer illnesses compared to those who got the standard shot, according to the Centers for Disease Control and Prevention.

Susan Donelan, Medical Director of Healthcare Epidemiology at Stony Brook Medicine, said the side effects of the flu shot include an uncomfortable arm for a few days, a low grade fever and fatigue.

“The vast majority of people can easily manage the minor side effects for a day or two with Tylenol or Ibuprofen or a cold pack on their arm,” Dr. Donelan said.

Doctors said practices such as wearing a mask, social distancing and frequent hand washing, which are designed to reduce the spread of COVID-19, are also helpful in cutting down on the transmission of the flu.

Those measures will only help if residents exercise them correctly. Masks that fall below the nose of the wearer, which may make it easier to breathe, are not as effective at reducing the spread of these viruses, Dr. Donelan said.

 

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Puppies and older dogs are especially susceptible to contracting the Canine Influenza virus. Stock photo

By Matthew Kearns, DVM

There has been a lot of media attention recently about outbreaks of the canine influenza virus (CIV), the H3N8 strain, which was first reported in racing greyhounds in Florida in 2004.  Rather than the typical respiratory infections (both viral and bacterial) that were limited to mild upper respiratory signs (coughing, sneezing, etc.), many of these dogs developed a sudden onset of severe pneumonia and death.

Later that year similar cases were documented in shelters and veterinary clinics in the New York City area. Dogs that recovered were tested at the Cornell Animal Health Diagnostic Center at Cornell University and tested positive for the  CIV H3N8 strain. In 2011, there was another outbreak in the NYC Metro area (three cases in NYC, three in Nassau County but none in Suffolk County) of the CIV H3N8 strain.

Fast forward to 2015 — an outbreak of the CIV occurred in the Chicago area that affected more than 1,000 dogs and led to eight deaths. Another outbreak shortly after the Chicago incident occurred in the Atlanta area affecting approximately 80 dogs (no deaths). In December 2015, another outbreak occurred in the Seattle area affecting approximately 80 dogs (again, no deaths).

Interestingly, none of the cases in 2015 were caused by the CIV H3N8 strain, but rather an H3N2 strain. The H3N2 strain was previously only seen in Asia (first diagnosed in 2006-2007). It is believed that this Asian strain gained entrance to the United States through Chicago’s O’Hare Airport inside a dog from Korea.

CIV is passed from dog to dog via aerosolized respiratory secretions from coughing, barking, sneezing, contaminated objects (food and water bowls, kennel surfaces) and people moving between infected and uninfected dogs. Dogs that stay at kennels, groomers, doggy day care, parks etc. are more at risk.

Approximately 80 percent of dogs exposed to CIV will show symptoms of the disease and the other 20 percent will not. This is unfortunate because this 20 percent may not show symptoms, but they can still shed virus and spread disease.  Symptoms will start three to five days after exposure and can be very mild to severe. 

Mild symptoms include a low-grade fever, runny nose and cough. Severe symptoms include pneumonia and in some cases death. Risk factors include age (the very young and very old are most severely affected), pre-existing disease or genetic susceptibility. There is no evidence at this time that CIV poses any health risk for humans.

Treatment for CIV is supportive in nature. Less severe cases where the patient is able to eat and drink are self-limiting in nature and symptoms resolve within three to seven days. More severe cases require hospitalization, IV fluids/medications, nebulization treatments and, in some cases, supplemental oxygen.

Two vaccines against the CIV H3N8 strain (the first was approved by the FDA in 2009) are available for dogs at this time. The goal of the vaccine is to expose the host (in this case dogs) to a weakened or inactivated form of the virus and stimulate the immune system to produce antibodies against it. Then, if the host is exposed to the virus naturally, the immune system will respond rapidly and fight the infection before signs of disease will occur.

At this time there is good news and bad news. The good news is there have been no reported cases of either strain of CIV in Suffolk County. The bad news is there is no evidence at this time that the vaccine currently available will protect against the new Asian strain (it may, but the veterinary community just doesn’t know at this time).

Please consult with your veterinarian as to whether your dog is at risk for the CIV virus (H3N8 or H3N2 strain) and whether vaccine is warranted for your own dog.  I will keep everyone posted through Times Beacon Record Newspapers as new information becomes available.

Dr. Kearns has been in practice for 16 years.

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