Dubai: While there has been a drastic decrease in the number and severity of COVID-19 cases in the UAE, doctors say other viral illnesses, especially Inﬂuenza, have seen a sudden spurt over the last few weeks. With holiday gatherings just around the corner for Chirstmas and New Year, doctors have urged residents to take measures to protect themselves against these infections.
There was a substantial decrease in the number of influenza cases during the height of the COVID-19 pandemic. But many fear a far higher number of flu and flu-like illnesses will present in hospitals this winter season. “Some models predict up to a five-fold increase in the number of cases for the 2022-2023 winter season,” said Dr Ruhil Badiani, family physician at Cornerstone Clinic in Dubai.
Anticipating a sharp increase in the number of influenza and other viral illnesses this year in comparison to the last two years, many hospitals have been preparing for an increase in the number of admissions.
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The uptick in the number of inﬂuenza cases has now led to most physicians keeping inﬂuenza as one of the top diagnoses in patients with fever and respiratory symptoms, said Dr Kiran Kumar, who heads the internal medicine department at Thumbay University Hospital.
Several reasons contribute to higher incidence of flu during winter.
“Usually, virus transmission is easier when the weather is cold and dry. Also, during winters, the airway mucous membranes are more susceptible to viral infections. Another important factor to note is that people tend to stay indoors during this season, which increases the chances of person-to-person transmission. Meanwhile, lack of exercise and low vitamin D have also been suggested to be responsible for increased susceptibility to ﬂu during winters,” added Dr Kumar.
Though influenza infection is most often a short-lived illness lasting a few days and resolves by itself, doctors are seeing even healthiest individuals feeling unwell for up to a week.
“The diﬀerence this time around is that the fever is lasting for longer duration, sometimes up to five to seven days, needing hospital visits and in some situations admission for IV medications,” said Dr Kumar.
Also, Dr Badiani observed that cough and symptoms of lethargy can last up to two weeks.
Doctors listed three reasons for the ﬂu season to be more severe and spreading fast and wide.
“One, the community spread and severity of COVID 19 cases has reduced and this has led to other viruses to come up. Secondly, SARS-CoV-2 was the predominant virus in the last three years and majority of the population were not exposed to and became susceptible to inﬂuenza. Thirdly, regulations around the masks and social distancing being relaxed due to the drop in COVID cases has provided a good opportunity for the flu virus to spread from person-to-person,” said Dr Kumar.
Traditionally, children, infants and elderly are considered high-risk groups for development of severe diseases due to inﬂuenza. However, it has now been seen that almost every person is equally susceptible for development of flu infection.
Yet, Dr Kumar pointed out that the current inﬂuenza virus is not leading to severe disease in terms of development of pneumonia or respiratory failure. “Most individuals are recovering with upper respiratory illness and bronchitis-like symptoms. It is still advised to take all precautions to avoid infections and seek prompt treatment.”
Dr Badiani explained that the influenza virus is spread from person to person and infected individuals are most contagious in the first three to four days after their illness begins. The symptoms typically begin about two days after the virus infects the respiratory tract.
As with all respiratory viruses, the three standard precautions hold signiﬁcance for prevention of inﬂuenza infection as well. “These include avoiding close contact with people who show respiratory illness or ﬂu-like symptoms, maintaining hand hygiene and wear a mask in crowds. Also those who have symptoms should take additional responsibility and wear masks voluntarily if going to places where close contact is possible, to prevent spread to others,” Dr Kumar reminded.
How effective is the flu vaccine?
The best protection against influenza would be vaccination, according to the doctors. The flu shot also reduces the severity of the illness and the risk of hospitalisation.
Vaccine eﬃcacy data suggests inﬂuenza vaccine reduces the risk of ﬂu illness by between 40 and 60 per cent. “In general, current ﬂu vaccines tend to work better against inﬂuenza B and inﬂuenza A (H1N1) viruses and oﬀer lower protection against inﬂuenza A (H3N2) viruses. The highest eﬃcacy is against Inﬂuenza A (H1N1) in children aged six months to 17 years which is up to 62 per cent. What is more important is the timing of vaccination which is best at the beginning of the ﬂu season. However, if missed, it can be taken any time during the season. Another point is that those who have mild illness can also take the vaccine,” said Dr Kumar.
The flu vaccine is a single shot and a second dose for inﬂuenza is usually not recommended. “But for children under the age of nine who have not previously received a flu vaccine, two doses are recommended. Babies under the age of six months are not able to get vaccinated and so it is important to protect them from infection,” said Dr Badiani.
The health authorities in the UAE are running the season flu vaccine campaign till the end of December.
Is it COVID or flu?
With a signiﬁcant overlap in the symptoms of COVID 19 and inﬂuenza, doctors say it would not be accurate to rely on symptoms alone for the differentiation between the two.
“Without testing, it is often impossible to tell the difference between influenza and COVID-19. They both cause fevers, cough, sore throat, tiredness, runny nose, muscle aches and headaches. Both viruses can also cause serious complications like pneumonia, heart attacks, and strokes to name a few. One difference is that COVID-19 can take longer to become symptomatic after infection and can be contagious for longer,” explained Dr Badiani.
In most patients, laboratory testing is necessary for diagnosis. However, Dr Kumar said, sometimes certain factors do help in making the distinction.
“We have observed more cases of inﬂuenza presenting as high grade fever up to 40 degrees Celsius both in children and adults. Headache, myalgia (muscle aches and pain) and nasal congestion are common to both viruses. COVID-19, especially the Omicron variant, causes much more severe throat pain than as compared to inﬂuenza due to its more predominant multiplication in upper respiratory tract,” he explained.
In healthy low-risk individuals, screening may not be needed and both viruses are treated symptomatically with paracetamol and/or ibuprofen, fluids, rest, and home remedies, said Dr Badiani.
“However, when [curative] treatment is required, it is absolutely necessary to distinguish between the two. Medications that treat influenza do not work with COVID-19. If antivirals are taken to wrongly treat influenza they may cause side effects and delay the correct treatment for COVID-19,” she highlighted.
What to do if you get the flu?
Dr Badiani advised people getting diagnosed with influenza to monitor for any difficulty breathing, chest pains or severe muscle pains, lack of urination, very high temperature or worsening of chronic health conditions to be seen by a doctor as soon as possible.
“Those at high risk are the very young, the elderly, or anyone with chronic health conditions. They should have a low threshold for seeking medical care. People with serious complications from influenza often need care in the hospital. Hospitalisation rates are higher for children with long-term medical conditions, babies and children younger than two years, as well as the elderly. The most common life-threatening complication is pneumonia, other complications include flare-ups of pre-existing conditions such as asthma and heart problems, acute respiratory distress syndrome, myocarditis, encephalitis, and multi-organ failure. Hence, seeking early and proper treatment is very important,” she added.
Measures to combat influenza
• Stay home if you or your family members are unwell
• Avoid contact with people who are unwell.
• Avoid touching your eyes, nose, and mouth.
• Clean and disinfect surfaces regularly.
• Wear a mask if you have symptoms
• Cough or sneeze into a tissue or your arm and discard used tissues in the bin.
• Wash hands regularly
• Eat well, be physically active, and get plenty of sleep to help you fight off infections.