COVID May Lead to Under/Over Treatment of Flu, Antiviral Resistance
Flu season begins in the coming weeks, and with COVID cases continuing to spike throughout the country, medical providers will need to discern if one has COVID or flu to administer proper treatment.
However, millions of Americans are seeing medical providers virtually, using telemedicine platforms and although this allows much needed access during a pandemic that encourages isolating at home, it unfortunately leads to diagnoses over the phone/computer that are not definitive.
If one has the flu, we treat the patient within 48 hours with an antiviral such as Tamiflu, to lessen the severity and shorten the course. Complications of the flu include pneumonia, heart attack, myocarditis (inflammation of the heart muscle), stroke, multi-organ failure and more.
So those with flu need to be identified early and treatment instituted without delay. However, if virtually a provider cannot test a patient what will they do?
Flu vs COVID – How To Tell The Difference
Some providers may suggest getting tested, some might feel the symptoms are COVID-related and miss a possible influenza illness, or some may play it safe and treat presumptively for flu, giving an antiviral that might not be needed.
Prescribing medications to those who don’t need them leads to resistance.
Medications currently FDA-approved to treat influenza include:
- osteltamivir phosphate (Tamiflu)
- zanamivir (Relenza)
- peramivir (Rapivab)
- baloxavir marboxil (Xofluza)
However, that’s it. Unlike antibiotics, our trove of antivirals for flu holds just a few medications. If these are overused, resistance can set it. Or if they are overprescribed, shortages can ensue.
In 2005, there were widespread shortages of antivirals as American began hoarding prescriptions in fear of the H5N1 Avian flu that had been affecting Southeast Asia and China.
Antiviral resistance and shortages can wreak havoc on already deadly flu seasons, notorious for causing 20K-80K deaths in the US each year.
Although the symptoms of flu and COVID-19 overlap:
- Fever
- Body Aches
- Cough
- Sneezing
- Sore Throat
- Shortness of Breath
- Fatigue
- Headache
- Nausea
- Vomiting
- Diarrhea
- Rash -seen in children
…there are some subtle differences. These are:
- Symptoms may come on more abruptly with flu. Many can tell their medical provider the exact time of day they began feeling ill, whereas with COVID-19 (similar to other cold type viral illnesses) the symptoms may come on more gradually over the course of 12 -24 hours.
- Fever appears to spike higher in the flu. Many with flu will spike a fever going into 103-104. COVID-19 can also cause high fevers but many patients oftentimes cite temperatures between 99-102.
- Fever may come on earlier in flu than COVID-19. Oftentimes flu will present with a fever on the first day or two. Many with COVID report their fever to come later.
- Fever with flu resolves quicker. Most flu-related fevers resolve after a few days (unless a secondary infection such as pneumonia is occurring). With COVID-19, some cite the fever lasts for weeks.
- Flu resolves most commonly between 5-7 days. Those with COVID sometimes report having symptoms for much longer.
This year’s flu season is predicted to be slightly less severe if masks and social distancing guidelines are followed strictly. However, since many do not wear fresh clean masks, maintain them in proper position over their nose and mouth, social distance or receive the flu vaccine, our optimism for a mild flu year wanes by the day. And if flu gets misdiagnosed as COVID, it could be even more problematic.
The solution? At home flu testing. Rapid flu tests at home will allow telemedicine health care providers to make an accurate decision on whether one needs to be treated for flu while undergoing testing for COVID. Even though it is believed one can get the flu and COVID concurrently, we healthcare providers need to as early as possible institute treatment if the former is suspected while at the same time recommending isolation to all patients exhibiting both flu or COVID-like symptoms.
Daliah Wachs, MD, FAAFP is a nationally syndicated radio personality on KDWN, GCN Network, iHeart Radio and Board Certified Family Physician
