Transcription:

Melanie Cole (Host): Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family.

Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine. I'm Melanie Cole. And today, we're discussing preparing for flu season. Joining me in this panel are Dr. Lisa Kalik, she's an assistant attending physician at New York Presbyterian Hospital and an Assistant Professor of Clinical Medicine at Weill Cornell Medical College Cornell University; and Alphonso Scotti, he's a physician's assistant at Weill Cornell Medicine South Hampton.

I'm so glad to have you both with us. As we get into this flu season and we've been dealing with this pandemic, it's really a lot. And I know that it's more for you healthcare providers than it is for those of us, but we're all kind of going through this together, right? So, Dr. Kalik, I'd like to start with you. Since we've had the vaccine and since people are going maskless and concerts and football games and things have started up again, have you seen an uptick in RSV or other respiratory illnesses as physical distancing, masks and such start kind of going by the wayside?

Dr Lisa Kalik: Yes. I definitely have seen that in my practice. The common cold is making a comeback for sure. And of course in that setting, we are always ruling out COVID just in case because sometimes there are mild symptoms, particularly in vaccinated individuals. I don't really see this cause I only see adults, but RSV, especially in children, especially over the summer, there's a huge uptick in that. And it hadn't really been seen when it typically is during the winter. But this summer, there was a huge increase in that especially in young children. So it was sort of interesting that it happened out of season. So we'll see how that progresses as we get into flu season.

Melanie Cole (Host): Well, that's always really the concern as we come into flu season, is what's going to happen with this year's flu season, and we're going to get into that. But Alphonso, before we do, can you tell us the differences as Dr. Kalik just mentioned. Even if someone comes in with cold symptoms, you're testing them for COVID because we just don't know. Can you tell us the similarities and some of the differences between some of these respiratory viruses, flu and COVID?

Alphonso Scotti: That's definitely an issue. Generally, classic symptoms of COVID and flu are quite similar. We can see general upper respiratory symptoms, fever, GI symptoms, body aches. Both can cause pneumonia with shortness of breath and difficulty breathing when severe. Flu though classically presents with a sudden onset of fever, body aches, fatigue, upper respiratory symptoms, that I-just-got-hit-by-a-truck-type-of-feeling. Whereas COVID, although often similar is a bit slower to evolve. Loss of taste and smell are also symptoms that we see with COVID, but not with flu.

RSV, categorized by lots and lots of mucus production generally begins with a runny nose and congestion and can progress to cough and reactive airway symptoms in like the three to five-day area generally. This is generally seen most severely in kids under two and can still be dangerous in the elderly and immunocompromised. Those are some of the similarities and differences that we'll see.

Melanie Cole (Host): Well, thank you for clearing that up because I know they do all have similar symptoms, but you described the differences really, really well. So let's get into flu. Well, we don't want to get into flu, but Dr. Kalik, how would you characterize the upcoming flu season? Tell us what's changed in the vaccinations, what's changed as far as this year's flu vaccine. I understand mist is back. Tell us a little bit about what's going on.

Dr Lisa Kalik: Sure. Well, we're just going to be starting to get into flu season. So some of this is based on our sort of scientific hypothesis. But we are concerned that the flu season is going to be more severe this year, mainly because very few people got the flu last year because of masking, social distancing, working from home, et cetera. So our normal natural and herd immunity that we may have developed did not happen last year. So we are concerned that there's going to be more flu and potentially more severe flu.

So the vaccine this year, basically every flu vaccine is quadrivalent, meaning it covers four different strains of flu. So there's two B strains and two A strains. And the difference between this year's flu vaccine and last year's flu vaccine is that there's two new A strains that they're covering. And the nasal mist, the live flu vaccine is available. That's limited to only healthy people, people between the ages of 2 and 49. There's other restrictions. You can't be pregnant. There's certain asthma conditions that you can't have to receive that one. But it is available for a specific population of people. And everyone should be vaccinated. If you're over six months of age, unless you have a very specific allergy or contraindication to getting the flu shot. But the great, great majority of people can be safely vaccinated. And I recommend that to everybody.

Alphonso Scotti: Yes, if I could add. I agree, there's also interesting jet injector option this year, which is a high pressure narrow stream of fluid that penetrates the skin instead of a needle. This might be a good option for some needle-phobic folks out there. And that's available for ages 18 to 64 as well.

Dr Lisa Kalik: One other point is that none of the flu shots this year were made in the egg medium, that some people have been concerned about because of egg allergies. So none of the flu shots have any egg in them. So even when they do, it's not really a concern unless you have a severe egg allergy. But this year in particular, it is not an issue.

Melanie Cole (Host): Wow. Thank you both for those great points. A lot of things I didn't know and I'm sure many of our listeners didn't know that either. So when you hear about myths, people who won't get the vaccine, and this goes across all vaccines, you know, initiatives really. Alphonso, speak about some things. When they hear you're a physician's assistant and here we are talking about flu. What do they say to you, some of the myths that they say to you, and then you debunk them?

Alphonso Scotti: There's a couple that I think I hear the most. I would say the first one is "I could get the flu from the flu shot." And this is one we hear all the time. And I think it's clear that an influenza vaccine can not give you the flu. The viral strains of the injectable flu vaccines are inactivated and not infectious. Even the live attenuated vaccines, the nasal spray vaccines are weakened form of the virus that will not cause influenza illness.

The other one that I hear quite a bit is getting sick with the flu is not that serious. This couldn't be further from the truth. Millions of people get the flu every year. Hundreds of thousands of people are hospitalized. Thousands to tens of thousands of people die from flu-related causes every year. Even if you're not one of the unlucky hospitalized patients, flu symptoms can disrupt your work, school and social activities for weeks.

Melanie Cole (Host): Oh, 100%. It's really uncomfortable. I don't know if anyone listening has had the flu, but it's like you said, it feels like you got hit by a truck. So Dr. Kalik, how do you work with people that have said some of the myths that Alphonso was just talking about or if they're vaccine-hesitant? I mean, we want people to get this flu vaccine this year, right? Because there's that co-infection that could possibly be present in this season. Speak about how you talk to your patients about this.

Dr Lisa Kalik: Sure. Absolutely. I spend a lot of time educating my patients and debunking these myths that Alphonso mentioned that the flu isn't serious, which it can be; that the flu vaccine can't give you the flu. And also the other thing people are worried about is side effects, which is another myth that people think there can be very severe side effects, which it's not really a myth. It's true, but it's extremely, extremely rare to have a serious side effect. Most people have a sore arm and maybe a low-grade fever for a day, but most people just have a sore arm.

And some of the rare side effects that people hear about such as Guillain-Barré syndrome, which is an extremely serious neurologic condition that can result from the flu shot is one in a million people. So it's extremely rare. And the flu itself can give you a Guillain-Barré syndrome. So it's not really a reason not to get the vaccine. And some people will say, you know, "I never got the flu, so why should I get the vaccine?" And to me, that's just they've had good luck so far. It's not a good reason.

So I try to go through all of that education with patients and in particular, this year, I am talking about how we are concerned that this flu season may be more severe. So, it is something that I spend a lot of time with every patient and every visit right now. And if patients are hesitant, I also always leave the door open if they change their mind to come back, to go to a pharmacy. I mean, it's so easy to get a flu shot and quite frankly, a COVID vaccine now, fortunately, that I just bring it up every time even if they come in for something completely different. It's just a big priority for every visit at this time of year.

Melanie Cole (Host): Well, I just got my flu shot and my first shingles shot too. And I went to my local drugstore now. So Alphonso, that's a question that I would like to ask you. What is the best place to get the shot? If we get it from Weill Cornell Medicine, from our internal medicine specialists, then it's really in our medical records, right? I mean, we can get them from the pharmacies. But when we get it from our primary care providers, then it's a part of our records.

Alphonso Scotti: Right. Agreed. To piggyback on what Dr. Kalik said, I agree. At all of our visits this time of year, where we can really review vaccination history and make sure that our patients are getting the influenza vaccine, and certainly being offered the influenza vaccine. Ideally, they would get it on their office visits and we try and make it as easy as possible to set up a nurse visit that is really just minutes out of their day to come in, stop by, get your flu vaccine and you're done.

Luckily, with our kind of integrated electronic medical record, a lot of our patients that get their vaccines at some of the pharmacies actually populate into our medical record, which is a nice feature as well. So I say wherever you can get it, just get it. I will not be offended if you do not get it in my office.

Dr Lisa Kalik: I use that same line. I won't be offended. Get it sooner rather than later. No need to wait to come in. And patients can always inform us when they come in that they got it already and we can enter it in manually if it doesn't auto-populate. But more and more, it is auto-populating from the pharmacies. So it usually works fine.

Melanie Cole (Host): One of the questions that I've heard so much over the last year, for sure, can you get COVID if you've had the vaccine? Well, with flu and we've been talking about flu for so many years, Dr. Kalik, can you get flu if you've had the vaccine? I mean, I assume that we can even still get it because nothing is 100% except for maybe like smallpox was or polio or something. I would like you to speak about that, but also suppose we do get flu, what are some of the treatments? What do we do? Is there anything that can help make us feel better?

Dr Lisa Kalik: Yeah. So for certain people with certain medical conditions, there are antiviral treatments such as Tamiflu, which is readily available that ideally we would start within 48 hours of onset of symptoms. It's not necessarily needed for everybody. It depends on your underlying medical conditions, your age, whether or not you live with anyone else who has underlying medical conditions and the real benefit of Tamiflu in those cases is it shortens the course of disease and prevents hopefully more serious disease in that setting. But many people will get better on their own without Tamiflu. And there's not a lot of benefit if you give it after the 48 hours for most people, unless they're very sick or older or immunocompromised.

Additionally, for treatment of the flu at home, fluids, resting, Tylenol or Advil to treat fever, sort of the home remedies will help with the symptom management and definitely staying at home until you have had no fever for about 24 hours is sort of the general rule we give people in terms of preventing transmission to others.

Alphonso Scotti: I like to add to my patients now who are used to masking, if they do have to leave the house, be sure that they're wearing a mask as another layer of helping protect the public.

Melanie Cole (Host): That's a great message. You may be asymptomatic with COVID or have mild symptoms, but if you've got the flu, you don't want to leave the house. You don't want to pick your head up off the pillow. So it's not one of those fun days off of work, right? It's really, really not. It's not like, "Yay. I get off work today." This is not a fun one. So I'd like to give you each a chance for a final thought, because nobody wants to get the flu. And the vaccine is out now, it's available. So Alphonso, why don't you start? Best advice here for people that may be hesitant, maybe have never gotten a flu shot before and what you would like them to know about getting their flu shot and really discussing with their primary care providers if they have questions.

Alphonso Scotti: I think you nailed it. I mean, our first and strongest recommendation is to get vaccinated. I think that's clear. Our vaccines are generally quite effective even though they change yearly. But studies after studies has shown that even people vaccinated and who get influenza are shown to have a reduced severity of the illness.

So if you do get vaccinated and you still get the flu, it's likely it will be a less severe case. We have data that shows that amongst adults, we are seeing a 26% lower risk of ICU admission, a 31% lower risk of death from the flu as compared to those who were unvaccinated. So there's just data upon data discussing the benefits of being vaccinated.

Melanie Cole (Host): And Dr. Kalik, last word to you. I'd like you to wrap this up for us and summarize who should be vaccinated. And the best way to protect those that are medically vulnerable in our society from the flu. There are some people that really cannot receive the flu vaccine, but not that many of them. So can you kind of go over those guidelines and offer your best advice as well?

Dr Lisa Kalik: In general, anyone over the age of six months can receive the flu vaccine unless there's an allergy or certain autoimmune conditions or a few medical conditions that would be a contraindication to doing so. So really the great majority of the population is eligible for what is a very safe vaccine and relatively effective, if not completely preventing the flu, reducing the severity of it should you get it.

And really the more people that get vaccinated, the more we protect each other in the community, because it creates less people to transmit the flu the more the people that get vaccinated. So that's really the key and that's generally true for all vaccines and it's the same for the flu vaccine. So the more people that get it, the better off we are. And in addition, it does protect people who can't get the vaccine, which really the big number of people who can't get the vaccine is very young babies who would be very vulnerable to the flu should they get it. So I vote for almost everyone to get it.

Melanie Cole (Host): Well, I vote for that too. And so what great information. And like we said, it is no fun. And so everybody get out there and get your flu vaccine. They're available now. And you can read more about them at weillcornell.org/primarycare to schedule your vaccine appointment.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. Thank you both so much for joining us today and giving us such great information.

And that concludes today's episode of Back To Health. We'd like to invite our audience to download, subscribe, rate and review Back To Health on Apple Podcasts, Spotify and Google Podcast. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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