(upbeat music) - 18 million cases of the flu in the United States so far this season, making it the worst flu season in almost 30 years.

Next on "Health Matters," we're looking at how our region is impacted, plus, what you can do to stay healthy.

(upbeat music continues) Good evening, I'm Aaron Luna.

Washington and Idaho rank in the high and very high ranges for flu cases.

That data, as of January 10th, from the CDC.

With the number of cases in Spokane County, we've crossed the acute respiratory threshold and triggered policy changes at local hospitals.

Joining us tonight, Dr.

Joanna Breems, infectious disease expert with Washington State University.

Dr.

Brian Simmerman, a pediatrician with Providence.

Kayla Myers, the program director for immunization assessment and Promotion at Spokane Regional Health District.

And Dr.

Sarah d'Hulst, medical director for MultiCare Rockwood Primary Care.

Dr.

d'Hulst, let's start with you.

Can you walk us through the acute respiratory illness threshold?

What does that mean and who sets that threshold?

- So in 2020 there was a group of hospital systems in this area called the Northwest Health Response Network, and they decided, together, that above a certain threshold, 13.4% of ER visits, hospitalizations, for folks with respiratory illness, if they pass that 13.4% positive for the flu, that we would take certain steps and we have surpassed that threshold at this point.

- And once we hit this threshold, specific policy changes are triggered at area hospitals and also clinics, Dr.

d'Hulst and Dr.

Simmerman, what does this look like for MultiCare and Providence locations?

- So at MultiCare what it means is that your providers in the clinic or in the hospital are masked and we're recommending that patients mask as well if they're comfortable doing that, just so we can help decrease that spread of infection a little bit.

- Similar for our experience at Providence as well.

We'll have all of our caregivers wearing masks.

We'll have our patients, when they're symptomatic, if they're comfortable wearing masks, also wearing masks, in those other shared spaces with other patients.

It also creates some changes for the hospitals and specifically for like our children's hospital, you start to have a limitation on the number of visitors within some of those sensitive units like kids units and younger patients being able to come visit with certain exceptions that are made for that.

- And how long does this continue on until that threshold number goes down?

How often do you check or what's the trigger?

- Yeah, so that threshold is monitored pretty consistently about every week.

And usually when we're about two weeks past that threshold, then we lift those restrictions, typically right around spring break.

- Gotcha.

And how often does this usually occur?

Is this something we are seeing commonly from year to year or does it kind of come and go?

- Yeah, since the pandemic really this, since this network came together, we've reached that threshold every year.

And this year actually we got to mask a little bit later and that meant the flu had not really passed that threshold until a little bit later.

But usually by this time of year, we're in the throes of flu season.

- Well, let's take a moment to medically define the flu.

Most of us have a general sense of what it means to have the flu, how it feels to have the flu.

But Dr.

Breems, what is the virus doing to our bodies?

- So the influenza virus is a respiratory virus and when you get it, it gets into your respiratory tract.

It actually infects those cells and causes damage to those cells.

It can cause the immune system to respond.

And the immune immune system does a good job of responding, which gives you those fevers, and the muscle aches, and the feeling really run down.

And those are the common, most common presentations of the influenza and what we call the flu, which differentiates it from some of the other common conditions.

But it's that real body aches, fevers, and then cough is a common, is the most common presentations.

- Does it present itself in that order or do those just kind of?

- Usually they go together.

So often people will say they feel like they got hit by a truck and that is how it is.

It's not the like, oh, I woke up with a scratchy throat and now it's a little worse.

It's like, ugh.

I just, now I feel miserable.

And tightness in the chest, maybe cough.

So primarily in the chest and the lungs, more so than starting in the throat with the sinuses and congestion.

- So you get the all at once coming together?

- Commonly, yeah.

Some patients won't have that.

So the older patients, persons with maybe underlying, you know, advanced immunocompromised or other diseases may not have the whole whole gamut of all of those signs and symptoms.

- And Dr.

Simmerman, how does the flu differ from the common cold or even a stomach bug?

- Yeah, so flu is worse than the common cold.

And the common cold can make you miserable.

But influenza, and that's exactly how I've heard it described.

You feel like you got hit by a truck.

But in our younger kids sometimes it can have some other symptoms that go along with it.

Like they just may, won't drink very well.

They can sometimes put themselves at risk for being dehydrated because they just don't keep up with what they should be doing with fluids because they feel so miserable.

Some kids occasionally can actually have some associated gastrointestinal symptoms, and it is not a GI bug, but some kids will actually, because of their fevers or other things, be nauseated and sometimes vomiting and things like that as well.

So sometimes, for our younger patients, you really have to kind of tease through a little bit.

But generally speaking, from my perspective, when you look at a kiddo with flu, they really do look miserable.

- [Aaron] Yeah.

- They just look miserable and they feel terrible.

But when I grew up, we kind of, I remember in my family having kind of a misnomer for calling flu gastroenteritis, right?

So like we always thought like when I had the flu, it really meant a GI bug.

But really that's not a correct terminology that should be used for that.

That's really more of a GI bug that we would call, I would call it gastroenteritis.

Now the patients, I would say you have a stomach bug or something like that, but that's more of a vomiting and diarrheal illness that's somewhat different really than this respiratory infection that you get with influenza.

- And you're talking about people looking miserable.

Do you have levels to the flu, like a flu that hits like maybe at a level 10, one that hits kind of a lower at a three?

Or does it all kind of level out?

- That's a good question.

I don't personally have a level that I say you're a level five influenza patient, but as a physician I will make an assessment on how severely ill I think you are.

- [Aaron] Okay.

- And so are you a kid who really hasn't been drinking and you're gonna get dehydrated?

Are you a kid who has for some reason some respiratory distress and some other things that may indicate more complications of your respiratory system?

So I'll be looking at those kind of things to see like, are you gonna be the quote, average flu cases that's miserable but gets through this?

Are you gonna be a kiddo that's at risk for more significant complications?

- [Joanna] Yeah.

- Dr.

Breems, how does the flu spread?

- Primarily through respiratory secretions.

So we saw this with COVID and other respiratory viruses.

So when people cough or you know, touch their mouth, their face, things like that, and touch other doorknobs, tables, that sort of things, the virus can, for short periods of time, survive in those surfaces.

But primarily it's close contact.

And so, we tend to see things arise in these fall and winter months.

People are, especially after the holidays, with a lot of socialization, a lot of close contact indoors.

We tend to see these respiratory illnesses climb.

- You're hugging a lot of family members - [Joanna] Yeah.

- During the holidays.

- Yeah, and aunties are kissing you and that's a problem.

What are some common misconceptions about how the flu spreads?

And it'll kind of open up to the panel as well.

- I think folks feel like sometimes I got the vaccine and then I got the flu.

And so we have a lot of conversations about how the flu vaccine doesn't actually give you the flu.

It can't, it doesn't have all the components.

It's not really the whole entire virus.

Some folks can feel a little bit miserable, either because they got a sore muscle, they just feel a little bit run down as their immune system builds some antibodies or because it takes the flu shot a couple of weeks to really build up antibodies.

You got the flu during cold and flu season sometimes.

You caught something else, typically.

- What if a couple is living in a home, one of 'em gets the flu, someone's relegated to the basement bed.

Is that a good enough barrier?

We're talking close contact.

Is that still close enough to really spread that virus?

- I mean you, you do have to be in close contact, but oftentimes by the time somebody's clearly sick with the flu and diagnosed with the flu, there has been close contact that has happened already.

So that's some of the difficulty in avoiding it inside the household.

But certainly limiting exposure after somebody's been diagnosed is helpful.

For persons who are at really high risk for severe complications, there are prophylaxis medications that we might use to say, oh, you've been exposed to flu, someone in your house has the flu.

There are medications to take to try to prevent getting the flu or getting severely sick from it.

- The flu season runs from October through May, with December and January claiming the spot as the months with the most cases.

So far, this flu season across the US there's been a 21% decrease in adults getting their flu vaccine compared to 2019, 2020 data.

That is from the CDC.

Kayla, are we seeing the past events with COVID playing a role in people's perceptions of the validity of vaccines?

- I think vaccinations can be confusing to people sometimes.

There's some vaccines we only need once in our lives and there's some vaccines we need every year, right?

So when information was coming out about the COVID vaccine, it was a new vaccine.

So when things and statements were made, I think people felt like they shouldn't have been getting COVID.

I think as a society we've learned a lot from that and know that now you get the vaccine to reduce the severity of the illness or to keep you out of the hospital, right?

So it's not meant to keep you from ever getting the illness.

And even vaccines that are lifetime protection have a little percentage where you can still get that disease.

So I think a better understanding of how vaccines are meant to protect you will help bring back some trust in the validity of the vaccine.

- And what are some of those conversations sounding like in the office with people you come in contact with?

- Not that dissimilar from what she just shared.

So sometimes we will say, 'cause families will share, "Well, hey, we all got flu vaccines last year and you know, two or three of us got sick, like what's the deal?"

And you're like, "Yeah, it's not our most effective vaccine at preventing ever getting influenza, but it does decrease severity."

And that's been shown clearly over years of research, that hey, you were unfortunate and you got it, but you probably weren't as sick as you would've been if you had not had that.

So there's still was some marginal benefit, which may be for some patients enough that, as you said, like keeps them outta the hospital and that's a big deal for those particular patients.

- Yeah, I'll often talk to my patients about their individual risk, which I think is important too.

When my patients are adults and so many of them have comorbidities, diabetes, or heart disease, or emphysema, and those patients, I talk to them about, you know, here's the real risk for you and here's what we know about the vaccine in your situation and what it can help protect against.

And maybe it's not influenza but it is hospitalization and if hospitalization happens for you, this is a problem and here's what that might look like.

And that usually goes a long way.

So individualizing the recommendations.

- I would add to that, sometimes the conversations we have include individual risk in the sense of who's in your home?

Does grandma and grandpa help take care of you?

And they have cardiac issues or lung issues.

Is mom expecting her next one?

Pregnant women are at high risk for the flu.

Did you have a little baby in the last six months?

And they're too young to get the flu.

So the big kids who go to school get the vaccine in hopes that if they get sick, or maybe they won't catch it as severely, and pass it on to baby who has higher risk of complications.

- And I think, I don't work in a clinical setting, but I do work out in the community at like community centers and shelters and things.

And to backtrack, a lot of times it'll start the conversation of, you know, "Did you get your flu vaccine this year?"

And they'll say, "No, I got it last year and it gave me the flu."

And so it's a lot of those conversations of, "Well can you describe a little bit more about that for me?"

And they'll say, you know, "I felt really terrible."

And I say, "Well for how many days?"

And they say, "One or two."

And I say, "That is your body making an immune response.

It's not the flu itself.

And imagine that for one to two weeks how you felt and probably more severe."

- [Aaron] A big difference.

- [Kayla] Yeah.

- Historically, do low vaccine rates impact the duration of flu season?

- I mean, I will say that if more people were vaccinated, we would see less transmission.

But as we covered, it doesn't keep you from getting the flu itself all the time.

But if we had more people vaccinated, we would have slower transmission.

- And Dr.

Breems, does this also affect the intensity of flu symptoms?

- The vaccine, vaccinations, definitely.

So vaccination, as she said it, you know, they report vaccine efficacy each year with the flu vaccine that's recommended.

And that efficacy, you know, often they're referring to whether or not you get influenza, and sometimes that efficacy is not very high.

And those are numbers we tolerate because the efficacy of preventing hospitalization and preventing death is much, much higher.

And those are the outcomes we really care about the most.

And absolutely the vaccine is by far and away the most effective way we have for limiting the severity and morbidity, mortality related to influenza.

- Dr.

d'Hulst, are there any long term effects of the flu?

Several years ago we were in introduced to long COVID.

Can we see anything like that with the flu?

- Yeah, there are certain populations of people.

Sometimes we know ahead of time, sometimes we don't know who's gonna have long-term effects.

And so some of those things are things you've maybe not really ever heard of.

There's something called Guillain-Barre syndrome, which is a type of paralysis that is somewhat transient, but incredibly debilitating and typically an intensive care stay.

There are folks that will have cardiac complications later.

And our asthmatics, their lungs are already not perfect.

And then if we add flu and other respiratory illnesses on top of that, those are when we see a lot more ER visits, hospitalizations throughout that particular season.

- And it's not just adults with low vaccine rates.

So far, only 42% of children in the US were vaccinated for the flu this season.

That's down 11% from 2019, 2020 stats.

Now Dr.

Simmerman, what are the risks of the flu for children and do they differ from adults?

- The risk for the illness of influenza?

So, some of the things we've mentioned earlier, that you can have a relatively tolerable illness where you're, you know, achy, febrile, coughing, and you get through it or you can develop complications.

So again, some kids may develop more significant lower respiratory symptoms.

They can develop a secondary pneumonia, they may have other complications like that that puts 'em at risk for hospitalization, particularly in our youngest kiddos.

So kiddos less than age two.

And then in kiddos that also have other comorbidities, they have other illnesses that put 'em at risk, they have a history of asthma or they have a history of diabetes or other things like that.

And it can make you sick enough, on occasion, to hospitalize you.

And then for some kids, sadly, in the ICU and some kids occasionally actually may pass away from complications related to influenza.

- But we are well into flu season.

We're in the heart of the flu season.

Kayla, is it too late to get your flu shot?

- So as we kind of discussed earlier, we are seeing the uptick after the season of gathering, right?

So it is not too late.

And as Dr.

d'Hulst said, it takes about a couple weeks for it to work.

So if you haven't gotten it yet, you should go get it right now.

- We can't go back in time, but what is the prime time to get a flu shot or is there a prime time?

Can you get it in the summer and just be really proactive?

- Well it's not gonna be a very, it's not gonna help you much in the summer because we know the influenza virus likes cold temperatures.

So it's more so we like to say, you know, get it before you go trick or treating.

So if you haven't gotten your flu shot by the time your kids are dressing up or you see kids trick or treating, you should go get it.

- October's a good month.

- [Kayla] Yes.

- I will say for some families that are in earlier and they don't think they're gonna come back and get it or they're not gonna go somewhere else, and I'm like, it's better just to get it now than to not get it at all.

- Thank you, perfect.

- Studies looking at how long does that immunity last after the vaccine, and most of the data suggests about six months you get good protection for the six months after your vaccine.

So that covers the flu season pretty well, even if you get it a little earlier.

But in the summer, by the time six months is up, you might be right in the middle.

- [Kayla] Yes.

- Good to know.

And the flu changes every year, so you have to get a different shot.

Just explain that to me real quick.

So there are surveillance sites all throughout the world and so whenever a positive flu test comes in, they will send it to that site to see if it is actually of a, I mean, to see what strain it is.

And so once we kind of compare data of what strains we're seeing circulating, usually in the southern hemisphere, we can kind of predict what we will see in our flu season in the northern hemisphere.

And so that's how the CDC, FDA and WHO, the World Health Organization, determine what strains to add in the annual flu vaccine.

- Well, we've talked about ways to prevent the flu, how to identify it, that it's actually a flu.

Dr.

Simmerman, what's the first thing we should do when we realize we're sick?

Besides call into work.

- That's a good thing to start with, right, yeah.

So specifically for some patients, and it was mentioned earlier, there are treatments that can, if diagnosed early enough, may be helpful at minimizing the symptoms.

And if you look at the indications for these anti-flu or antiviral influenza medications, in my world, in the pediatric world, it's usually the young patients like less than five, but especially less than two, and those with comorbid conditions.

But there's always something else that may be going on in that family.

It may be a family member, as you mentioned, that might be at higher risk.

So you wanna make sure you're trying to minimize that risk.

Or sometimes for older kids that may not have other things, but they have big things happening in their lives, like they're about to go do some big concert and they need to be able to sing or something like that in a week.

And so there are ways to, for us, if we can diagnose early, to try to give anti-flu medications.

That doesn't really cure it, but it mitigates it.

It sort of makes it less bad and you might get better a little bit sooner and you might be able to return to your normal life activities a little bit sooner.

And so usually finding out early is an important thing, not only for the individual, but potentially for the family.

- And no one likes to be stuck home sick for a extended period of time.

Dr.

d'Hulst, there are ways, proven ways, to shorten the duration of the flu.

Talk about, you know, family remedies that have been passed down.

- Right.

Is there anything you recommend?

- Yeah, there are a couple of things that folks can do.

I'll second what Dr.

Simmerman said as well.

I think one good thing that came from the pandemic was that we can purchase tests at any grocery store for the flu and COVID.

And so if you know you have the flu, certainly if you might be a high risk person, you call into your doctor's office, but some natural remedies are elderberry.

Sometimes can make a difference for folks and help them feel better with the flu.

And then for young kids, especially under the age of six, we love honey.

It helps coat your throat and as effective as most over the counter cold medicines.

And so we really like that to help treat cough.

- Nice.

Anyone else have anything I should know about some secret weapons they're not sharing?

- I would just reiterate the staying home.

- [Aaron] yeah, - Your body needs rest.

Your body needs to recover.

So staying hydrated, eating healthy foods.

These can go a long way to shortening the duration and ensuring you don't end up with some of those worst complications and get back to work or life sooner.

But slowing down and taking care of yourself.

- Now I've been told by people close to me, I'm not naming names, that if you take medication for your cold or flu, it takes longer to recover.

It's a theory that may be in the same vein as if you don't tough it out, you don't get stronger.

And Dr.

Breems, is that how viruses interact with treatment?

- No, no.

The antiviral medicines that we mentioned are specific to the virus.

They interfere with like molecular mechanisms of the virus replicating or infecting new cells.

So it shuts down those processes.

Your body has already seen it.

It's producing its immune response.

Is, you know, fighting it off and the medicines just sort of help out.

But there's no glory for suffering with this one.

So things that help you feel better, you know, the medicines for fever, medicines for your aches, and pains, those are fine and don't change the duration of illness.

- And Dr.

Simmerman and, and Dr.

d'Hulst, we, you know, we kind of talked about the honey, the elderberry, are there things, maybe supplements, that you can take going into a flu season to kind of boost your immune immunity and kind of build up some resistance to it beforehand?

- Yeah, one of the things that you can do is take probiotics.

Probiotics are starting to be shown to help with certain respiratory illnesses, GI illnesses, things like that.

The other thing I stock at my house is zinc.

And so the very thought of a scratchy throat or a sniffle, we take zinc at our house.

Zinc is shown to reduce the length and severity, somewhat, of the common cold.

And so when it usually starts and you have that little tickle, is it COVID, is it the common cold, is it influenza?

It's hard to tell and the zinc isn't going to hurt.

- Okay.

So maybe something like vitamin C, extra vitamin C or airborne?

What's that stuff you take on before you go on a plane?

- I think it's mostly vitamin C, but there's some other things in there.

So sadly they've done some nice studies looking at vitamin C. And taking super therapeutic levels of vitamin C does not seem to make a huge impact on your illness or the length of your illness or severity of your illness.

I wish it did because.

- Interestingly enough, it might for the extreme athletes.

- -[Brian] Oh okay.

- You're an ultra marathoner, vitamin C might be helpful in preventing respiratory illnesses.

- I was hoping it wasn't that extreme.

Maybe a person who plays pickleball once a week might be.

- No, unfortunately not for most of us.

- In that category.

- But just to recap, we can always reduce the severity if you go and get vaccinated before you even have any symptoms.

- [Joanna] Yeah, absolutely.

- And do all these other things too.

- I stay pretty basic when with my patients younger that are suffering.

I'll usually just say like, look, you gotta keep 'em hydrated, keep 'em hydrated.

So let's find things that they wanna drink and I don't care what it is, well, I do, but milk, water, juice, whatever, I'm not gonna be too picky when they're sick.

And same thing for the nutrition.

Some nutrition helps you fight illness and when kids feel miserable, let's not be too picky about whatever, let's find something that they want to eat so they can eat something.

And keep that going until they're feeling better.

- And we've been kind of talking about, you know, toughing it out, that doesn't really do anything for you.

Someone who has that mentality, what are some of the symptoms that you need to be aware of to say, okay, now it's kind of gotten outta my control or this might be leading to something bigger.

I need to seek like professional help.

- So certainly worsening.

I sort of say like by three days.

If three days in it's getting worse and not better, that's that's a maybe a red flag.

Shortness of breath.

So inability to really catch your breath.

Maybe with, you know, maybe some minor activities around the house.

That is a red flag.

Worsening after getting better is another one.

So we mentioned pneumonia.

So influenza actually increases the risk for bacterial pneumonias and what that often looks like is influenza.

You feel miserable but you start getting better.

But then several days later, fever, shortness of breath, cough, it all comes back worse.

Those are also red flags for a potential complication.

- So let's say you get that tickle, you start feeling like you got hit by a truck.

Does getting the vaccine immediately help in any capacity?

- [Kayla] Yeah, it's a little too late at that point.

- Too late at that point.

- [Kayla] Honestly.

Yeah.

- And we're talking about, you know, going to the hospital when you see those symptoms.

What are some of the common comorbidities or common things that people have that kind of trigger those doctor visits?

- So in the adults age over 65, it does increase the risk.

Other comorbidities, like I mentioned, diabetes, heart disease, emphysema or other lung disease, chronic renal or kidney disease, all of those can, and then immunosuppression of any kind can increase the risks.

One of the things I think that isn't talked about a lot is the risk for, you mentioned cardiac complications, but we see a big increase in heart attacks after somebody has had influenza.

So persons who are at risk for heart disease, influenza, can increase that risk quite dramatically in the 30 days following an influenza infection.

- Yeah, we're running outta time, but I want to talk real quickly, where can people go to get a flu vaccine?

- Always start with your provider or your local pharmacy.

Like some people have certain insurances where you have to go to Kaiser, I'm one of them.

Or if you don't have access to vaccines, you can always check out for free community clinics.

On our website at srhd.org, we try to post any public ones so that people can get access if they don't have luck elsewhere.

Also, Range Community Clinic is a great resource.

They have the ability to work with any insurance and if you're uninsured as well.

- Great, and that's all the time we have for tonight.

Thank you all for being here to walk us through this important topic.

And remember, there's still time to get your flu shot.

Talk to your doctor or local pharmacist.

You can share this episode with friends and family.

Just go to ksps.org.

Stay healthy and goodnight.

(soft music) - [Narrator] "Health Matters" is proudly supported by MultiCare.

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