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Influenza Update December 15, 2020: At the Start- Very Little Influenza Testing and Treatment Approaches

By Dr. Arthur Lavin

This year’s influenza seasonal epidemic has not yet started

In contrast to COVID-19, the yearly epidemic of influenza virus is ancient and well-known, going back thousands of years to when people first began farming with animals.  Like COVID-19, the influenza virus came from animals (birds and barnyard animals), and seasonal epidemics likely began about 10,000 years ago when humanity first began domesticating animals.

Over the millennia, the appearance of the influenza virus has come to be extremely predictable.  In the continental United States, the seasonal influenza epidemic is almost always in force by this date, December 15.

So let’s take a look at the numbers.

This map shows levels of influenza virus infection in every state.  Green means no activity, red means a lot of activity.

One glance at this map shows, there really isn’t much influenza virus infecting anyone in the US, including Ohio where this is almost no influenza virus infection.

 

This graph shows the percent of visits due to influenza like illness, compared to prior years.

The red triangles show the level of such illness for the 2020-2021 season.

Notice that except for the 2015-16 season, influenza illness numbers were on their way up every year by today.

In fact, as of the last point on this graph, about 1-2 weeks ago, there really hasn’t been much uptick influenza like illness in the United States, in contrast to any other year.

To be clear, as of December 15, 2020, the influenza virus has not made a significant appearance in the United States, and certainly this is the case in Ohio.  It is too early to say whether this will remain so in the next few weeks, but we will monitor the course and begin testing for influenza once the virus appears, as outlined below.

Testing for Influenza and Treating Influenza in the Age of COVID- for children and youth

As readers of Real Answers know, treatments for influenza have very limited impact, so minimal that they do not justify the risk, which is not so trivial.  Specifically, Tamiflu, at best, only reduces the time you are ill with an influenza viral infection by 0.7 days, out of the usual 8 days, and at the same time can cause neurologic and mood disorder side effects.  For people with influenza viral infections so severe they require hospitalization, even a minor benefit could make a difference, so it can be used in such severe settings despite the real risks.

And so in the past, we have not tested for influenza for viral infections, since finding out if your viral infection was from influenza or another virus had no impact on treatment.

But this year, it does make a big difference to know if your child’s cold or flu is from COVID or not, so as you know, we test for COVID-19 for children and youth with colds.

If and when the influenza virus makes its appearance, we will be testing people with colds and flus for influenza virus infection, for several reasons unique to this year of Pandemic:

  1. Anyone with a virus should be tested for COVID-19 in any case, so a swab is being done to test for the cause of a viral infection this year of the Pandemic.
  2. If someone’s cold and flu are proven due to influenza virus by testing, and the COVID-19 test is negative, the positive influenza result makes the negative COVID-19 test more likely a true negative.
  3. And finally the testing for COVID-19 and influenza are done with one and the same swab, so it’s easy for your child.

BOTTOM LINES

  1. The 2020-2021 seasonal influenza virus epidemic has not yet begun.
  2. If it does appear, it will start later than any in the last number of years, except for 2015-16.
  3. If it does not appear, it may be the result of the Pandemic, with use of masks, distancing, and avoiding gathering having na impact, or even the SARS-CoV-2 virus blocking its spread.
  4. Tamiflu remains a drug with very disappointing performance, offering less than 1 day reduction of illness in a typically 8 day course, and exposing children to neurologic and mood disorder side effects.
  5. Since there are no treatments for influenza viral infection that offer any significant relief, we have not tested for influenza viral infection in the past.
  6. But during the era of COVID, it makes sense to test for influenza, once the virus arrives.   We are already testing for COVID-19 when your child has a cold or flu, it is only one swab to test for both COVID-19 and influenza virus, and a positive influenza virus test can bolster the credibility of a negative COVID-19 test.

We are very pleased that so many children have had their flu shots this year, it is good preparation for the influenza virus, which has not appeared yet, hopefully will not,  but very surely still may.

To your health,
Dr. Arthur Lavin

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