Article

Managing the flu season during the COVID-19 pandemic

Roche is committed to providing innovative solutions for treatment and diagnostic tests for the management of respiratory viral infections.

During flu season, reliable diagnostic solutions can help differentiate between the SARS-CoV-2 and influenza A/B viruses so that healthcare providers can make informed decisions on which treatments are appropriate, help improve patient outcomes, and return to a normal life.

Characteristics of influenza and COVID-19

Influenza and COVID-19 are respiratory illnesses that are caused by different viruses. COVID-19 along with emerging variants, results from the novel coronavirus, known as SARS-CoV-2, while the flu is caused by influenza viruses.¹ Both viruses spread between people in close contact through droplets that come from coughing, sneezing, talking, or sharing eating utensils or drinks. Each can be transmitted between individuals even before symptoms are noticeable and People can experience a range of symptoms -- from no symptoms (asymptomatic) to severe symptoms.

Symptoms from the flu and COVID-19 can overlap and may be difficult to discern. Symptoms for both include:¹

Fever/chill
Cough
Shortness of breath or difficulty breathing
Fatigue
Sore throat
Runny or stuffy nose
Muscle pain or body aches
Headache
Vomiting and diarrhea

According to the Centers for Disease Control and Prevention (CDC), the main difference between the diseases is that COVID-19 seems to be more contagious than the flu and can spread more quickly.¹ Additionally, people with COVID-19 may be more contagious for a longer time versus the flu. Due to these differences in the length of contagiousness, seeking a diagnosis is an important first step to help play a part in limiting the spread of both influenza and COVID-19.

For the flu, a person can develop symptoms one to four days after infection. For COVID-19, an individual can develop symptoms, on average, five days after infection but can also show signs as early as two days or as late as 14 days after infection. Another issue related to COVID-19 and the flu is that an individual can be completely asymptomatic but still spread the virus.

Additionally, individuals with other underlying medical issues, including diabetes and heart disease, are at higher risk for developing more severe illness from the flu and COVID-19 virus.^2,3

Management and treatment for flu and COVID-19

Flu

Influenza is a serious health concern and places a significant burden on healthcare systems worldwide. Furthermore, during an ongoing pandemic, flu infection may be confused with covid infection and hamper individuals ability to return to normal life while exhibiting flu-like symptoms. According to the World Health Organization (WHO), there are an estimated 1 billion cases, 3-5 million severe cases, and 290,000 to 650,000 influenza-related respiratory deaths worldwide each year.⁴

The CDC is urging individuals to get the flu vaccine as soon as possible to reduce the risk of becoming sick.¹ Vaccination, treatment with antiviral drugs for the flu and quarantining when necessary are important measures that can help save lives as well as valuable medical resources that healthcare workers need.

While vaccinations play a critical role in battling influenza, they are not always employed, and there are gaps in coverage for millions of people at risk, increasing the need for other interventions like therapeutics.^5,6 The CDC recommends prompt treatment for people who have flu or suspected flu who are at higher risk of serious flu complications, such as people with asthma, diabetes, or heart disease.⁷

COVID-19

As of November 2021, there have been over 250 million positive COVID-19 cases in the world and over 5 million deaths.⁸ Together, we can work towards returning to normal lifestyles. Following guidances from healthcare agencies and public health officials can help prevent the spread of COVID-19 through various measures that include:

Wearing a mask
Keeping a distance of at least 6 feet
Washing your hands or using alcohol-based hand sanitizer

These same measures can also help reduce the spread of influenza. The National Institutes of Health (NIH) have put out guidelines for the treatment of COVID-19.⁹ Several therapeutic agents and prevention strategies, including various treatments, monoclonal antibodies, and vaccines have been evaluated to battle the disease.^10,11 Appropriate prevention strategies will play an important role as we work together to return to normal. As the effectiveness of vaccines may change over time, the NIH also has recommended certain monoclonal antibodies as post-exposure prevention for those who have a history of exposure to individuals with a COVID-19 infection and who are at high risk of progression to serious disease if they acquire the infection.⁸

Differentiating between influenza virus and SARS-CoV-2

As with any airborne infectious disease, everyday preventive actions such as staying away from people who are sick, covering coughs and sneezes, and frequent handwashing are always important.¹²

To help reduce the burden of COVID-19 and influenza on the economy and society, there are reliable diagnostic tests to detect both the SARS-CoV-2 and influenza A/B viruses from a single sample. Roche’s technology includes high-throughput PCR, molecular point-of-care PCR and rapid antigen tests.

It is important to reliably detect and differentiate between the two diseases to prevent transmission and provide patients with suitable care. With a high-throughput PCR test results can help determine if a patient is infected by SARS-CoV-2 and/or influenza A/B virus. Antigen testing can provide alternative solutions for decentralized testing with reliable, and rapid detection for individuals suspected of having COVID-19.

Roche’s point-of-care molecular nucleic acid test can provide fast and accurate test results differentiating SARS-CoV-2, influenza A and influenza B from a single nasal sample when results are needed quickly (20 minutes) or in emergency care situations.

What medical treatments are available?

Before the onset of the flu, taking the flu vaccine can reduce the odds of becoming infected.¹³ However, the effectiveness of the flu vaccine depends on a number of different factors, including your age, general health, when you get the vaccine and how well matched it is to the dominant flu strains for the current season.¹¹

It may be tempting to ask for an antibiotic to manage your viral flu infection. However, antibiotics are not an appropriate treatment as they are designed to treat bacterial infections and have no effect on viral infections.¹⁴

You may choose to use over-the-counter (OTC) medication to manage the symptoms of the flu. While OTC medication can help with reducing your fever, aches, pains and congestion they do not directly affect the course of influenza virus infection or reduce the ability to pass the infection on to others.¹⁵ If you are at risk for influenza-related complications, you should not use OTC medicines to delay seeking medical attention, but should immediately consult your doctor.¹³ People at high risk for complications include those ≥65 years of age, those with certain chronic medical conditions (such as asthma, diabetes or heart disease), pregnant women and children younger <5 years of age.¹⁶

There are also antiviral treatment options available to manage your flu infection. Flu antiviral drugs are not OTC medicines and you can only get them if you have a confirmed diagnosis of flu and a prescription from a doctor.¹³

Flu antivirals, which have been shown to not only shorten the duration of flu symptoms,^17,18 can also reduce the risk of severe illness and death,¹⁹ with the greatest benefit noted when antiviral treatment is administered as soon as possible after the onset of symptoms.²⁰

Flu antivirals can shorten the course of flu^15,16 Reduce complications of flu^21,22 and decrease risk of flu-related hospitalisations and mortality^13,23.

Together, we can regain normalcy

Together we remain steadfast in battling COVID-19, further complicated with influenza circulation, by partnering with health authorities, regulatory agencies and local communities. Accurate diagnostic solutions and effective therapeutics allow us to respond more quickly and efficiently. As a community, with various diagnostic, non-interventional measures as well as treatments in place, we can collectively help alleviate the burden on healthcare systems.

During this pandemic, it has become more important than ever that healthcare workers have the appropriate tools to differentiate between influenza and COVID-19 along with readily available treatments. Roche is proud to be a part of the solution to help individuals as well as society at large return to normal. With an extensive portfolio of resources and products, which includes 16 diagnostic tests along with therapeutics to improve patient response, we have broadened our options for managing flu in the COVID-19 environment.. Roche will ensure that patients get the care and support they deserve with reliable, consolidated and accurate testing solutions for improved clinical decisions and therapeutic options.

References

1. https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm. Accessed November 2020.

2. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed December 2020.

3. https://www.cdc.gov/flu/highrisk/chronic-conditions/index.htm#:~:text=People%20with%20asthma%2C%20heart%20disease,in%20hospitalization%20or%20even%20death. Accessed 30 Nov 2021

4. https://www.who.int/influenza/Global_Influenza_Strategy_2019_2030_Summary_English.pdf. Accessed December 2020.

5. https://www.census.gov/quickfacts/fact/table/US/PST045218. Accessed December 2020.

6. https://www.cdc.gov/flu/fluvaxview/coverage-1920estimates.htm. Accessed December 2020.

7. https://www.cdc.gov/flu/treatment/treatment.htm

8. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed 17Nov2021

9. https://www.covid19treatmentguidelines.nih.gov/whats-new/. Accessed November 2020.

10. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations-process.html. Accessed November 2020.

11. Beigel, J.H. et al. N Engl J Med. 2020 Nov 5;383(19):1813-1826.

12. Centers for Disease Control and Prevention. Key facts about influenza (flu). Available from: https://www.cdc.gov/flu/about/keyfacts.htm. (Accessed March 2020).

13. WebMD. How effective is the flu vaccine? Available from: https://www.webmd.com/vaccines/how-effective-is-flu-vaccine#1. (Accessed March 2020).

14. Imanpur S, et al. Factors associated with antibiotic prescriptions for the viral origin diseases in office-based practices, 2006–2012. JRSM Open. 2017;8(8):2054270417717668.

15. Klepser ME. Socioeconomic impact of seasonal (epidemic) influenza and the role of over-the-counter medicines. Drugs. 2014;74:1467–79.

16. Centers for Disease Control and Prevention. Flu symptoms and complications. Available from: https://www.cdc.gov/flu/symptoms/symptoms.htm. (Accessed March 2020).

17. The MIST (Management of Influenza in the Southern Hemisphere Trialists) Study Group. Randomised trial of efficacy and safety of inhaled zanamivir in treatment of influenza A and B virus infections. Lancet. 1998;352:1877–81.

18. Treanor JJ, et al. Efficacy and safety of the oral neuraminidase inhibitor oseltamivir in treating acute influenza: a randomized controlled trial. JAMA. 2000;283:1016–24.

19. Klepser ME. Socioeconomic impact of seasonal (epidemic) influenza and the role of over-the-counter medicines. Drugs. 2014;74:1467–79.

20. Centers for Disease Control and Prevention. Influenza antiviral medications: summary for clinicians. Available from: https://www.cdc.gov/flu/professionals/antivirals/summary-clinicians.htm. (Accessed July 2019).

21. Kaiser L, et al. Impact of zanamivir on antibiotic use for respiratory events following acute influenza in adolescents and adults. Arch Intern Med. 2000;160:3234–40.

22. Lalezari J, et al. Zanamivir for the treatment of influenza A and B infection in high-risk patients: a pooled analysis of randomized controlled trials. Arch Intern Med. 2001;161:212–7.

23. Gaglia MA, et al. Patient knowledge and attitudes about antiviral medication and vaccination for influenza in an internal medicine clinic. Clin Infect Dis. 2007;45:1182–8.