It’s Back: Covid and Flu, what should you do?
October 8, 2024 | Episode 26
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Lindsey Gordon, Dr. Buller, Marcus Thorpe
Marcus Thorpe 00:14
The weather has changed along with the leaves, but we are certainly seeing some familiar things back in our homes and our workplaces and in our schools, covid and the flu are popping up and hitting some of us pretty hard. Welcome to the wellness conversation, an OhioHealth Podcast. I'm Marcus Thorpe.
Lindsey Gordon 00:29
And I'm Lindsay Gordon. You know the basics, keep those hands washed, stay home when you're sick, and cover your cough. But there is so much more to lead us through this really important time of year. Is OhioHealth physician group. Dr. Megan Buller, it's good to see you. Dr. Buller, thanks for being here.
Dr. Buller 00:45
Hi. Good morning, guys. Thanks for having me.
Marcus Thorpe 00:47
Absolutely, so I do want to start with covid, because it is one of those things that I think a lot of people are one hearing about but should be thinking about. I know we all hope that we'd be completely past this, but as we heard time and time again, it's not going away, but some of the severity that we've generally seen has kind of ratcheted back. What are you seeing, and what should we be thinking about when it comes to covid this time of the year?
Dr. Buller 01:11
Yeah, no, I think unfortunately, this is here to stay, and it's turned into more of a respiratory virus that we see, like other coronaviruses, influenza, RSV, which are other viruses we hear about, but we are seeing much less severity of illness overall, much less hospitalizations due to covid primarily. We do see trends, kind of bumps, you know, we're just getting through right now, our summer surge. I think people are calling it So, seeing more cases, a few more hospitalizations, but again, not anywhere near the numbers we were seeing back in 2020, even 2021.
Lindsey Gordon 01:48
Gotcha. So, of course, the vaccines have evolved and changed a lot over the last few years when it comes to getting vaccinated to protect against covid-19. What are the options now, I went to Walgreens to get mine a couple days ago, and I was surprised. I forgot that you don't need, like, a two-shot series anymore. They just had the one and it was just one and done. And so, what are the options for people who are considering this?
Dr. Buller 02:15
Yeah, so, you know, we're starting to get that time of year. We hear flu shots, and I think covid vaccines are going to be right along with that. So, recommendations are for anybody over the age of six months to be vaccinated with a yearly vaccine. These aren't, quote on quote, boosters, really. They're vaccines like influenza vaccines with a yearly specific one kind of trying to trend the strains that are most commonly circulating. So we know that the FDA just released approval on three different vaccines, two of the mRNA vaccines, the Pfizer and the Moderna, which we're both very familiar with, and then the Novavax, which is a protein drive vaccine as well. So, options for people and should be available at any of your local retail pharmacies. I imagine some primary care offices are going to be getting those through as well.
Marcus Thorpe 03:05
Well, we talk about changes with covid people once they test positive, or if they start to feel those symptoms and they're pretty sure they're positive, maybe they don't go through the full testing. What's the recommendation for people, and when should they be steering clear of folks and isolating or do we not have to do that anymore? I just kind of want to level set for people, because maybe you haven't thought about that in a while.
Dr. Buller 03:29
Yeah, I think you know, it's a smart idea in general, anytime you have a cold or other respiratory illness, to try to minimize contact and interaction with other people, just to prevent transmission of these viral infections, because we know they're all of them are pretty readily passed from person to person. So you know, the guidelines have changed significantly since we, you know, first found out about covid and so still, recommendations are if you test positive, are pretty sure you have covid and some people may find they don't test positive right away, but on repeat testing, you know, 24-48 hours later they do. You know, trying to steer clear of especially high-risk peoples, the general population return to work. Criteria is, is similar for other respiratory viruses. You know, we'd like to see improvement in symptoms, going fever free for at least 24 hours, without any need for Tylenol or Ibuprofen to lower that temperature. And then, you know, just good common sense, good hand washing, avoiding high risk peoples, even wearing a mask too for the next few days, may be helpful. I do think for return to work, it is a little dependent. In return to school, it is dependent on your workplace and the school. So always check with our policy as well.
Lindsey Gordon 04:49
I know this time of year too, my allergies are horrible, and so I'm caught in that camp of people that's like, what is it? You know, like, spin the wheel, flu, covid, or the allergy, right? And so are there any telltale signs that can point you in the right direction of what you might have besides, if you know, of course, take a covid test. But is there anything that's completely different that separates covid from allergies?
Dr. Buller 05:16
I think fever is going to be the biggest thing. Yeah, obviously fever shouldn't be related to allergies. So that should push you in the camp of some sort of viral infection, be it influenza or covid. Unfortunately, there is going to be a lot of overlap in the remaining symptoms, the nasal congestion, the runny nose, even the cough, sometimes can be an overlap. So, I think having a kind of index of suspicion, if you will. You know, hey, my roommate, neighbor, family member, just tested positive, and I've been around them in very close quarters, maybe more likely to be covid.
Marcus Thorpe 05:49
We should have had this podcast a couple weeks ago when all the allergies were flaring up because we were taking covid tests like every day. This has to be covid, right?
Lindsey Gordon 05:56
I canceled plans because I thought I had covid and it was just allergies.
Marcus Thorpe 06:01
We, I guess the question is, you know, this round we talked about the severity being quite a bit lower than what we saw 2020-2021 and some points even after that. Why is that? Why are we seeing people not be impacted to the severity level that we have before? Are we getting to a point where so many people have had it or your immunity is boosted. Explain, from an expert's perspective, why the severity seems a bit lower.
Dr. Buller 06:27
Well, I think that's exactly it is because we now have immunity, either via vaccination or from having had covid infection or both. And so we know that provides some baseline immunity there, which we didn't have prior to 2020 and that's why so many people got ill so quickly. Now people have antibodies that rev into action that can help protect them and help minimize the severity of illness.
Lindsey Gordon 06:50
Yeah, makes a lot of sense. I just can't believe how far we've come since 2020, March of 2020 my son's birthday is around this time of year, and he was my pre pandemic baby, and I look at him now, this little five-year-old, and I'm like, Oh my gosh, the whole beginning of your life was a pandemic. And now we're getting the questions of, what's a pandemic? What's covid? Why did we stay home? Why did we wear masks? Why is Mommy wearing a mask in all these pictures? It's really, really interesting. So, let's talk about, you mentioned, hospitalizations are down. The number of deaths related to covid, 19 are down. What should, what are, what should our level of worry be, our concern with this? You know, do we still need to have that strong arm out to take measures to be, you know, to protect loved ones who might have compromised immune systems?
Dr. Buller 07:42
I would definitely say still, the patients that we are seeing come into the hospital with covid infection, who are ill in general and who are severely ill are those who are elderly and those who are immunocompromised. And so really continuing to make sure we're protecting those people, people who can't mount an immune response to vaccinations or to natural infections. Recently, I was with a group of residents, and we had a very ill patient with covid, and they were on medications that that were immunosuppressive, and they were like, I don't know why they're so sick. And I had to explain to them, This is what covid looked like three four years ago. This is what people look like when they were ill. So that's still happening. And so really making sure that we're taking care for our immunocompromised, friends, family, coworkers.
Marcus Thorpe 08:34
All right, I want to close the book on covid with this question, and then we'll move into flu, which I know a lot of people have questions about and are worried about and those kinds of things. How about treatment options for covid? You know, it's ride it out. But I think of those marketing geniuses when it's covid, Paxlovid, holy cow. That sticks in my brain. But so, what? What should you do? What treatment options do you have if you do have covid?
Dr. Buller 08:56
Yeah, so you mentioned Paxlovid. So that is an antiviral medication, oral antiviral medication that's available for outpatient treatment of covid infections and I would recommend this primarily in our again, high risk patients, hopefully help decrease the severity of illness, decrease duration of illness, and especially those who maybe don't have as robust of an immune response, can help clear that virus and Get them through their illness. The other oral one is Molnupiravir, that's also available. And then we do have an intravenous antiviral medication as well that's available to patients who are in the hospital. Not all of these being antiviral medications are going to be most effective if taken within the first five to seven days of illness, because that's when the highest rate of viral replication is.
Lindsey Gordon 09:41
Can you still have co infections of both flu and covid at the same time?
Dr. Buller 09:45
It's possible, like we see co infections with other viral, viral illnesses too.
Lindsey Gordon 09:49
Gotcha, I remember that was a big thing right at the beginning. It was like, Whoa, because you were testing positive for the flu, but you maybe also had covid. Let's switch gears and talk about the flu. When is the best time to get your flu shot? I know it can take what two weeks to be effective, like the covid vaccines, but when is that best time to get the shot we have? You know, back to school. People are getting ready for holiday planning. You have homecomings, reunions, all these things that people want to be healthy for. You know, you hear people nowadays say, I just got to get through this week without getting covid. You know, I can't cancel these plans, but for the flu, when's the most effective time to get your flu shot?
Dr. Buller 10:29
Yeah, we're right kind of in the beginning of flu vaccine season. As you mentioned, it does take about two weeks to really develop those antibodies, which we rely on to help, again, shorten duration of illness, or even prevent illness, so making sure you're doing it before any major family gatherings, travel plans, especially if you don't want to be ill during that time. I typically tend to get my flu shot somewhere right around October-ish is kind of my goal. So, we really have peak immunity during the highest flu activity.
Marcus Thorpe 10:59
Dr. Megan Buller is our guest here, infectious disease specialist at OhioHealth physician group. The fact that I hear this a lot from people, they say, Well, I don't know if I'm going to get a flu shot this year. Last year, I got a flu shot. I still got the flu can you educate folks on what a flu shot actually does. It doesn't mean you're not going to get the flu.
Dr. Buller 11:23
Yeah, so there's a couple things I want to touch on there. The first one is, what is a vaccine? So, the flu vaccine, the majority of our formulations that you will get and see in the injections are what we call inactivated virus. So, it's either a killed virus or a protein part of the virus, but not the full active virus. So, there is no way to get the flu from the flu vaccine itself. What people feel at the time they get the flu vaccine? Maybe one. Maybe you were developing the flu or other respiratory illness around the same time and it overlapped, or your body's immune response to that vaccine, and that's actually, for me, quite reassuring, because that's telling me the body is doing what it's supposed to do in making these antibodies. And we know the flu vaccination is not 100% effective in protecting against illness, but what it does do is decrease the severity of illness, prevent hospitalizations, prevent severe illness and prevent death. We know that it does that quite effectively.
Marcus Thorpe 12:25
Yeah. So if you're sick, your severity of that illness could be decreased quite a bit if you had the flu shot and then you're back on your feet and back to normal in a day or two, versus maybe a week or two
Dr. Buller 12:36
Exactly. Not to downplay flu in the setting of covid, because we still do see people admitted to the hospital, admitted to the intensive care unit, even dying from influenza every year.
Lindsey Gordon 12:46
All right, I know it's really shocking too, because we think all the flu, it's been here forever, you know, it'll be fine, but some cases, you just never know. I sort of already asked this question, but I want to ask it under the space of the flu as well. I have two littles at home, two little kids who go to childcare, and so they bring home everything, right, like Hand, Foot and Mouth, croup, RSV, like you name it, right. How do you know when, like, it's the flu and do I need to put them through the process of getting tested for the flu or covid?
Dr. Buller 13:26
I think part of the answer to that latter half of your question is, it may depend on what your school daycares policy is as far as coming to school or to daycare. Yeah, you know, I think things to look for similar symptoms is that we're going to see, and unfortunately, you're right. There's a lot of other viruses too that overlap, but the flu and covid We tend to see, causing more fevers, chills, body aches, just feeling really rundown, fatigue. You have those respiratory symptoms as well, including cough. They're really hard to clinically differentiate. So I think depending on, as we talked about earlier, kind of the general what is the return to work, return to school, return to daycare policy, I think it's helpful, especially if you know they're going to be around somebody who is a high risk patient. You may want to take extra precautions and test them. But you're right. It's hard to know, when do we do the testing versus not? Because I have two small children as well. We're just going to get into every other week, probably some other respiratory illness, and it's a challenge, for sure.
Lindsey Gordon 14:35
Absolutely.
Marcus Thorpe 14:36
I think the cool part about these podcasts is that you learn so much, and hearing both of your stories, I've learned that you both need to scoot over a little bit away from me, because you both have little kids that are just like illnesses.
Lindsey Gordon 14:49
I know, oh my gosh, it's all right. We check in with our pediatrician quite often this time of year. And what's great too, is sometimes a phone call, right? Is, is so great I can. Call and talk to a nurse on the phone. She'll ask, you know, what are the symptoms? What are we seeing? Do we really need to see your child today? Or can we wait a little bit, wait a day or two, see what happens? I never hesitate to call.
Dr. Buller 15:13
Exactly and I think vaccinating our children as well, making sure they're up to date on flu and covid, vaccines will help protect them against these illnesses as well.
Marcus Thorpe 15:21
You know, it's hard to point out a whole lot of positive things that came out of the covid pandemic space, but I think one of the things that I've noticed people do more and more of is one hopefully washing their hands. But when people are coughing or sneezing, just that ability to cover your cough, we it was so ingrained in what we needed to do. Maybe that will help some of the flu spread go down a little bit, maybe this time of the year than we've seen even in past years. Have you noticed some of that, that some of our hygiene and the things that we do have improved?
Dr. Buller 15:53
I think so. And I think people are more cognizant. You see more people wearing masks when they're out, you know, when they have some sort of respiratory illness, I know in the hospital, even pre covid, you know, if we were feeling sick, had any respiratory symptoms we were supposed to be masking anyway. But I think you see more and more people just out in the community doing that as well, maybe refraining from being in high population density settings around, you know, and trying to keep others healthy.
Marcus Thorpe 16:20
How about medications for the flu? You know, we always say, get as get as much fluid as you can in your body, and do all those things. But are there things we can take to help lessen post vaccination and those kind of things?
Dr. Buller 16:33
You know, I think the primarily, what I would recommend is just what we call supportive care, so taking Tylenol, ibuprofen for fevers and body aches over the counter, cough, cold, congestion, medications, as you know, as directed by medication instructions may help some of those symptoms, and for the flu, specifically, there are some antiviral medications as well. Probably the most common one people are familiar with is Tamiflu, and this is something, again, maybe most beneficial in those high risk patients, and does, again, the recommendations are to take within 48 hours of symptom onset, so making sure we're hitting the illness early enough where it's actually going to be effective.
Lindsey Gordon 17:16
Why is it that, I mean, the answers, I think, may be obvious, but why is it that everyone seems to get covid when they travel? Like, I feel like that's been the theme over the last few weeks, where, if you go on a trip, you're doomed. You're getting covid When you come back. You know, like, is there a way to avoid that? Should we be wearing a mask on an airplane?
Dr. Buller 17:34
I think it's a lot of being in, maybe situation, scenarios you're around just more people in general than you may be in your regular day to day life out exploring, going on tours, going to museums, going to crowded places, where you're just going to be breathing in a lot of air that other people are breathing. You know, are, you know, at home, and here you're kind of aware of what your friends and family are feeling doing and what kind of measures they're taking to prevent illness, but out again, when traveling, you may not be aware of what other people are doing. And there's different levels of covid flu activity in different states, different parts of the world as well. So while we may be seeing less cases here in Ohio, in Europe, they may be seeing a higher surge too, so more risk for exposure.
Marcus Thorpe 18:24
And we're going to be inside more as things get a little colder, which means you're going to be shoulder to shoulder with aunts and uncles and people that are coming from different places. So just something to keep in mind as we kind of push through the rest of this year. Well, Dr Bower, this has been great information, very helpful for our listeners. We're very thankful for you and your expertise with that, we always like to finish our podcast with a little fun a little get to know you round. Are you okay with that?
Dr. Buller 18:48
Sure.
Marcus Thorpe 18:48
All right, everybody has like, their go to comfort food when you're feeling down, or you've got a cold, or you need something, you know, I would imagine for you, there's got to be something that you turn to whenever you're just not feeling great. What is it?
Dr. Buller 19:02
I'm just probably everything that's bad for you. I want my comfort food. I want the pizza. I want the mac and cheese. I want the grilled cheese and tomato soup. I want my ice cream and yeah, so a lot of that.
Lindsey Gordon 19:15
I love that. The cheeses, the dairies, you know, oh so good. When you were deciding what you wanted to do as a physician, how did you land on infectious disease?
Dr. Buller 19:26
So, great question I get asked a lot, because not a lot of people know what an infectious diseases specialists do. But for me, it was the variety of cases I got to see the ability to still have to be on top of a lot of internal medicine. You know, we interact with patients who have heart problems, kidney problems, lung problems, liver problems, and so we have to have still retain a lot of basic information and knowledge about that. And it's just, it's a fun specialty, if you're kind of into the detective work and kind of putting the pieces together and trying to find out the answer to why a patient's coming in with months of fever or a rash.
Marcus Thorpe 20:06
I bet you never, in your strangest, wildest dreams, would have ever imagined being on the ground floor during a pandemic, though. I mean for you, that must have just been just the most wild time, right?
Dr. Buller 20:19
Yeah, no, it was definitely nothing I had anticipated and nothing I would necessarily want to do again, but I think it was a for what. It was a good learning experience for me and my colleagues, and I think it definitely brought us closer together and with our colleagues in the hospital trying to figure out, how do we process all this information while trying to help keep patients healthy and alive and not having any prior knowledge of you know what this infection was.
Marcus Thorpe 20:46
Thank goodness we had you and your teams to lead us through. I mean, it was, I know, every day something new, and our infectious disease team was our source of truth. I mean, literally, the people we would turn to every day and be like, what's going on? Tell me this, tell me that. And we're so thankful that we had so many good people that were helping and leading it was, it was really impressive.
Lindsey Gordon 21:07
Like drinking from a fire hose every day, right? All this information, all this knowledge, how do you know what's true, what's false? And I really think the infectious disease team at OhioHealth really led the way with guiding us through all that.
Marcus Thorpe 21:21
All right, so you've done infectious diseases. What's the strangest thing you've heard over the years of, hey, I do this to treat the flu, or I do this to treat a cold. What's one thing where you're like, shaking your head going, I can't believe I just heard that.
Dr. Buller 21:32
That's actually a really good question. I feel like people don't even want to offer that up to me. They know I'll kind of look at them strangely. I don't know. Have you guys heard any fun?
Lindsey Gordon 21:42
I saw something the other day, and I was like, This is so perfect, and I'm going to save it for this moment. Here it is. I saw someone cutting up an onion, putting it in the plastic bag, and then putting their foot in the plastic bag and like, like, yeah, you know what I'm saying.
Dr. Buller 21:57
Yeah. No. Actually, my sister was mentioning that to me as well. I didn't even she sent me a link, and I haven't even read I've never heard of that before, but apparently that's a new fad. We'll have to get back to you guys on that.
Lindsey Gordon 22:07
Yeah, stay tuned.
Marcus Thorpe 22:08
It's bizarre.
Lindsey Gordon 22:09
I saw it. I was like, this is a great one for Dr baller, because I've heard of people putting, like, essential oils on the bottoms of their feet, right?
Marcus Thorpe 22:17
We've done that with our kids. I don't know if it works. But my wife was like, what kind of witchcraft is this?
Lindsey Gordon 22:19
And then, like, a pedicure can solve everything in my book. So, like, there's that. But then I saw the onions in the bag, and I was like, Oh, I don't know. I couldn't cook with onions for like, a whole week aft er I saw that.
Dr. Buller 22:35
Maybe somebody will try it out and get back to us.
Marcus Thorpe 22:38
Lindsay will be the one. This has been great. Thank you so much for your time, for your information. I know this will be one of those. You know, we don't want to hear about covid, but we need to hear about covid, and certainly the flu is something we can always use a little refresher, and I think you've really helped us with that. So, thanks for your time and for your information, of course, and we thank you for joining us for this episode of the wellness conversation in OhioHealth podcast. Before we wrap up, we do invite you to follow us on all major social channels, making sure you stay up to date on any new episodes and other health and wellness topics. If you're looking for more information on OhioHealth services, including infectious diseases and any locations you can go to ohiohealth.com.
Lindsey Gordon 23:15
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