Biologic Treatment Considerations for Asthma During the COVID-19 Pandemic and the Upcoming Flu Season - Episode 15
Stanley Goldstein, MD: We know that we’re talking about the coronavirus pandemic overlapping with the flu season. First of all, on a clinical presentation, do they differ in how they would present to help us differentiate them? We could do rapid testing now for coronavirus, you could do a test for the flu. That’s been available for years. But clinically, could you determind if there is a difference from person who has the flu or a person who has coronavirus when it comes to their symptoms?
Shahzad Mustafa, MD: Acutely, up front, it would be very difficult to clinically differentiate between the two infections. These are respiratory viruses, very different families of respiratory viruses, but they’re going to present very similarly in my opinion with potentially fever, upper respiratory symptoms, myalgias, things like that. Over time certainly, coronavirus and influenza are not the same, we know that, they are very different. They have a different time course, whereas you might be thinking you’re going to be getting better with influenza after several days, and with coronavirus infection, there may be a second worsening right after several days. But initially it’s going to be difficult to determine the difference.
As was said, there is the ability to test. But if there’s any change in clinical status, coughing, fever, certainly increased nasal symptoms, upper respiratory symptoms, I think many symptoms have the option to test hopefully in America now for coronavirus, but also at the same time test for influenza as well, because you would like to know that because it would certainly change your management. We always say we’re the allergists, we’re immunologists, we believe in vaccination. But if ever before, vaccination with influenza vaccine this year is more important than ever. This global pandemic has got me down, too, but I like to be the eternal optimist. We just saw Australia go through their flu season, and for the first time in decades, they had the lowest rate of hospitalization for influenza in Australia. That gives me hope that there is a way to do this right, where if we do this with masking, social distancing, all the precautions we should be taking, we may actually see better outcomes with other infectious diseases like influenza that we typically do in the winter. It’s very important that there’s an opportunity here to do better.
Stanley Goldstein, MD: Very true. Talking about the flu vaccine, what are you seeing when it comes to patients coming in for the flu vaccine? I know in my own patient population; they are coming by the droves for their flu vaccine. It’s never been this high in my own patient population. I think they’re totally aware of the crossover between the flu symptoms and the coronavirus symptoms, and they are hearing the message. Shahzad, you mentioned hearing the message about wearing masks and social distancing. That would be nice, but that’s one of the problems that’s ongoing. Are you seeing the same thing with patients requesting flu vaccine?
Shahzad Mustafa, MD:We always offer influenza vaccine to every patient that comes in that qualifies, which is nearly everyone. We haven’t given many. Because they’ve already all gotten it. It’s even one more step than you. It’s only middle of October and that’s great, but many of my patients have already received their influenza vaccine. Anecdotally, I think, more people are being vaccinated locally, at least that’s my opinion. Sorry, Giselle, to cut you off.
Giselle Mosnaim, MD, MS: Not at all. I also am seeing that patients are being much more proactive about getting their flu shots this year. I’ve been doing a number of telemedicine visits as well; many colleges are requiring that students that are on campus get the flu shot. I am having my young asthmatics that are in college, they’re being very proactive about getting their flu shots as well. I think college campuses across the country are being proactive about the flu shot, locally the message to patients about getting their flu shots is definitely being heard.
Shahzad Mustafa, MD: I’ll just take this opportunity, I know this is an asthma talk, but I think it’s important as allergists, and there’s still this misconception in the community, we still hear it, that there are very few reasons not to get the flu shot. An egg allergy, which still comes up, especially in our pediatric population, is not a reason for the kid not to get the flu shot. Even if you have egg allergy, a severe egg allergy, a severe reaction, it is safe and recommended you get your flu shot. I just want to add that. There are very few reasons not to get your flu shot. If you think there is a good reason not to get your flu shot and you are interested in it, please reach out to an allergist, your primary care doctor, a provider who can counsel you and talk you through the risks, because again the importance has never been higher.
Stanley Goldstein, MD: Thank you for that important health care informative message. Doctors, thank you both. I think the discussion has been great. It’s been an informative discussion both for myself, I’m sure for you guys, and for the audience that will be viewing it. Before we conclude, maybe you already gave me your final thoughts, but any other final thoughts that you would like to add? Now’s your chance. Giselle, anything?
Giselle Mosnaim, MD, MS: The final thought is that we’re all in this together, this coronavirus pandemic. I think that we are all trying to get back to a functioning society. For our patients with asthma, again keep doing what you’re doing, getting your flu shot, optimizing your management of your asthma, taking your controller medications. If you are on a biologic, continue to take your biologic. We’re just trying to make sure that we take the best possible care of our patients.
Stanley Goldstein, MD: Shahzad, anything additional?
Shahzad Mustafa, MD: I echo everything that was just said. We are really in this together. We will get through this together. But this is difficult, and I think it’s okay to say that this is really difficult for many people on many levels. But as health care providers, we have tools for our asthmatics to control outcomes, have good outcomes. We as a community have tools get through this with the appropriate precautions. If you have questions or concerns about how to best get through the global pandemic, how to take care of your asthma during this, please reach out to us.
It is safe and appropriate to get health care, whether it’s in person, whether it’s with telemedicine. It sounds like all of us are doing a little bit of that and we will continue to. Your providers are here for you. We have some good information on how to get through this, whether it’s asthma or other chronic conditions or just the global pandemic itself. Thank you for the discussion today, I really enjoyed it and I learned a lot from both of you.
Stanley Goldstein, MD: Thanks. I’d like to sum it up in one phrase. It may be the worst of times in the sense that people are getting sick with flu and coronavirus, but, in a way, as has just been pointed out both by Shahzad and Giselle, it may be the best of times. People coming in for their flu immunization vaccines, people wearing masks, people social distancing, and they have the opportunity, as mentioned, to reach out to your physician in your environment, in your area, your specialist physicians, allergists or pulmonologists, and knowing what to do and how to move forward.
Stanley Goldstein, MD: Thank you for watching this HCPLive Peer Exchange. If you enjoyed the content, please subscribe to our newsletters to receive upcoming peer exchange and other great content right in your inbox.
Transcript Edited for Clarity