flu season

Experts Predict a Severe Flu Season, So Get Vaccinated Now

If you hear the word “vaccine” and automatically think of COVID-19, our concierge primary care doctors in Jupiter don’t blame you. But there’s another virus lurking on our shores: the annual influenza outbreak, which deserves our attention now.

You can be forgiven for thinking we no longer had to worry about the flu because, for the last two years, it all but disappeared. This is largely due to all the hand washing, social distancing, and mask-wearing we practiced during the pandemic.

But unfortunately, those sensible health precautions are pretty much behind us now, and all signs point to a worse-than-normal flu season. In fact, we’ve already seen scattered reports of cases around the country. And remember that many cases go unreported because people typically recover at home without being officially tested and recorded.

Ominous Signs

The reason experts are expecting a more severe 2022-23 flu season is that they’re looking to Australia, which undergoes its flu season before ours. 

That country is just concluding its worst season in five years, with cases reported to be three times higher than normal. Their season also began two months sooner than it typically does, meaning it is expected to arrive sooner than usual here, as well.

“The Southern Hemisphere has had a pretty bad flu season, and it came on early,” Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Bloomberg News late last month.

“Influenza, as we all have experienced over many years, can be a serious disease,” he added, “particularly when you have a bad season.”

Dr. Frank Esper, a pediatric infectious disease specialist at the Cleveland Clinic, echoed those warnings.

“This year we expect it to be a very big flu season and that the flu season [will be] even worse in the younger groups [than] it was in years past,” he told Cleveland’s Fox8. 

We’re Not Prepared

For the last two years, we have rightly been focused on avoiding COVID-19, which has killed well over one million Americans to date. But influenza also presents a danger, especially to very young, pregnant women, those with chronic conditions, and the elderly.

In 2019, the last year that we actually had a notable flu season, nearly 61,000 Americans died from the flu, including 129 children. There were approximately 42.9 million cases of the flu, with 647,000 of those requiring hospitalizations. And that was considered a mild season (although it was the longest season in a decade, beginning in October and ending in May).

In addition, because of the demise of COVID-19 restrictions in general, we could get hit even harder.

“The thought is when the COVID pandemic hit, we started masking up and everyone started socially distancing, schools were closed for a whole year,” Esper said.

“Flu just nose-dived. It almost got to the point where there was no flu.” 

But because we haven’t been exposed to it lately, we are even more vulnerable to its effects, making it harder to fight off.

“Usually, we see the flu every year. Our immune systems are ready for it. When you haven’t seen the flu in two or three years, that means our immune systems may be a little slower,” he explained.

Double Whammy?

Then there’s the possibility of a “twindemic,” or a severe flu season that strikes at the same time as an uptick in coronavirus activity. This is a distinct possibility because both viruses tend to increase circulation when people spend more time indoors in the colder months, and immunity from earlier vaccinations or infections is beginning to wane, especially in those who haven’t had a recent coronavirus booster.

In fact, we’ve already seen an increase in COVID-19 cases across the country in the last two weeks, according to data provided by the Mayo Clinic.

So the Centers for Disease Control and Prevention (CDC) reports that getting a flu shot this year is recommended as “the first and most important step in protecting against flu viruses,” while at the same time reducing the burden of flu hospitalizations and deaths.

“An influx of hospitalizations from COVID-19 and the flu could stress the healthcare system and impact staffing if any healthcare workers are out sick,” Soniya Gandhi, associate chief medical officer at Cedars-Sinai, told Cedars-Sinai Newsroom.

The Time is Now

Because of all the signs that the flu season here could start early, it’s important to receive your vaccine as soon as possible, since it takes at least two weeks to achieve full immunity.

“The bottom line is that you don’t want to wait until you’re already going to be at risk of getting influenza to get vaccinated,” Dr. Albert Ko, an infectious disease physician and professor of public health, epidemiology, and medicine at Yale School of Public Health, told NBC’s TODAY.

And we’ve seen with COVID-19 that vaccines work to reduce the severity of such illnesses, not only in individuals but also in those around them who either can’t receive the vaccine or who don’t respond well to it.

Remember that if you haven’t yet received your omicron booster, you can get both shots at the same time, one in each arm.

“The flu and COVID-19 vaccinations are important on a personal level, and they’re critical from a public health standpoint,” Gandhi said.

Coronavirus Pandemic

New Guidance on COVID-19 Can Be Confusing

Sometimes it seems as though we need a spreadsheet to keep track of all the changing information and recommendations on COVID-19.

  • Masks/no masks?
  • Boosters? Maybe not, maybe now, maybe later.
  • Quarantine? Yes, no, who, and how long?

Our primary care concierge doctors in Jupiter don’t mean to criticize the researchers and public officials who are responsible for keeping us healthy. The SARS-CoV-2 coronavirus is, after all, a disease we’d never seen until early in 2019. No one knew how to deal with it.

And thanks to the combined efforts of scientists around the world, we’ve made tremendous strides in the effort to combat it.

But one thing few counted on was “pandemic fatigue,” which meant many people rapidly grew tired of taking precautions and radically altering their lifestyles to help stem the spread of COVID-19.

Which may be what’s behind the latest guidance from the Centers for Disease Control and Prevention (CDC). (https://www.cdc.gov/media/releases/2022/p0811-covid-guidance.html

A new approach

This month the CDC relaxed many of its coronavirus recommendations, leaving measures to battle to limit viral spread largely up to individuals.

According to The Washington Post:

  • “No longer do schools and other institutions need to screen apparently healthy students and employees as a matter of course.
  • “The agency is putting less emphasis on social distancing—and the new guidance has dropped the ‘six-foot’ standard.
  • “The agency’s focus now is on highly vulnerable populations and how to protect them—not on the vast majority of people who at this point have some immunity against the virus and are unlikely to become severely ill.”

In releasing the new guidance, the CDC cited improved tools like vaccination, boosters, and treatments to better protect ourselves from the virus.

“We also have a better understanding of how to protect people from being exposed to the virus, like wearing high-quality masks, testing, and improved ventilation,” Greta Massetti, a CDC epidemiologist, said in a statement.

“This guidance acknowledges that the pandemic is not over, but also helps us move to a point where COVID-19 no longer severely disrupts our daily lives,” she added.

Isolation changes

In one fairly substantial shift, for example, the CDC no longer recommends quarantine if you’re up to date with your vaccines and have been exposed to COVID-19. Instead, you should mask for 10 days and get tested on Day Five.

Additional CDC guidance on isolation includes the following:

  • If you’ve tested positive and have a healthy immune system, regardless of your vaccination status, you should isolate yourself for five days. On Day Six, you can end isolation if you no longer have symptoms or have not had a fever for 24 hours and your symptoms have improved.
  • Once isolation has ended, you should wear a high-quality mask through Day 10. If you test negative on two rapid antigen tests, however, you can stop wearing your mask sooner.
  • Until Day 11 at least, you should avoid visiting or being around anyone who is more likely to have severe outcomes from COVID-19, including the elderly and people with weakened immune systems.

These changes stem from a new statistic, according to Massetti: 95 percent of the U.S. population has at least some level of immunity against the virus, either from vaccination or previous infection.

What about boosters?

As for booster shots, the U.S. Food and Drug Administration (FDA) finally decided last month against allowing adults younger than 50 to become eligible for a second booster vaccine (for a total of four mRNA shots).

Currently, only those age 50 and older and children at least 12 years old with impaired immune systems can get a second booster.

This is because the agency expects to have reformulated mRNA boosters available by next month that will contain components from both the original virus and its variants, as well as from the currently circulating (and highly contagious) omicron subvariants BA.4 and BA.5.

Meanwhile, the FDA still recommends that anyone under age 50 receive a single booster shot, and people older than 50 or those with weakened immune systems receive a second mRNA booster.

The mask question

No one likes wearing masks, especially in the heat. However, our primary care concierge doctors believe it’s better to err on the side of caution, especially if you’re immunocompromised or older than 65.

Especially given the new CDC guidance revisions, there’s no harm in wearing a mask in crowded indoor situations with poor ventilation.

It’s true that we now have effective treatments for COVID-19, but given the risk of long COVID—one recent study found that as many as one in every eight people who contracted it had lingering symptoms—what’s the point in taking unnecessary chances?

It’s up to you, of course, but in a recent interview with The Post, Ziyad Al-Aly, an epidemiologist at Washington University in St. Louis, compared the current state of the country to “the Wild West.”

“There are no public health measures at all,” he told the paper.

“We’re in a very peculiar spot, where the risk is vivid and it’s out there, but we’ve let our guard down and we’ve chosen, deliberately, to expose ourselves and make ourselves vulnerable.”

monkeypox

Why Monkeypox Is Not Like COVID-19

Last month, the World Health Organization (WHO) declared the newly spreading monkeypox virus a global health emergency.

This has prompted many to fear we’re heading into another coronavirus situation, as our concierge primary care doctors in Jupiter have found from talking with our patients.

While this is a debilitating, painful, and—occasionally—deadly virus, there are many reasons why it’s very dissimilar to the SARS-CoV-2 virus, the virus that causes COVID-19.

The history is different

Although both originated as “zoonotic” diseases—that it, they began in animals and spread to humans—we have a far longer history with monkeypox, meaning we know more about it than we did when the coronavirus first appeared.

According to the Centers for Disease Control and Prevention (CDC), monkeypox was first discovered in 1958 when two outbreaks of a pox-like disease occurred in colonies of monkeys kept for research, thereby giving the disease the name “monkeypox.” Its typical animal hosts, however, are rodents and other small mammals.

The first human case of monkeypox was recorded in 1970 in the Democratic Republic of Congo during a period of intensified effort to eliminate smallpox. Since then, monkeypox has been reported in humans in other central and western African countries.

Although relatively new to the U.S., a large monkeypox outbreak occurred here in 2003 as a result of imported rodents.

Transmission is different

Next, the ways the two viruses are transmitted are completely different.

Unlike the largely airborne transmission of SARS-CoV-2 through aerosols that linger in the air, the monkeypox virus can only be spread through close contact with an infected person or animal, or materials such as bedding or towels that are contaminated with the virus.

In addition, monkeypox appears to be far less transmissible than COVID-19. One study found that just three percent of those in close contact with an infected person would develop monkeypox.

It appears at this time to be spreading primarily among gay and bisexual men following sexual encounters, but anyone who comes into close and prolonged, direct contact with the pox sores can become infected.

Even women, and at least two children, have been reported to have contracted monkeypox, as a result of being in close proximity to men who have sex with other men.

The symptoms are different

Unlike the stealth infections of the coronavirus, it’s very apparent when a person is infected with monkeypox. As with COVID-19 and other viruses, they develop fever, headache or body aches, chills, muscle aches, and exhaustion.

These symptoms are also similar to those of smallpox, a cousin of monkeypox, with one difference:

“A feature that distinguishes infection with monkeypox from that of smallpox is the development of swollen lymph nodes,” the CDC says.

Otherwise, however, both smallpox and monkeypox exhibit the same signature fluid-filled lesions (the so-called “pox”), which the coronavirus doesn’t produce. Some individuals have these sores all over the body, while others may have only a single lesion. This rash can be extremely painful.

The vaccines are different

When COVID-19 first appeared two-and-a-half years ago, it was a brand new virus (i.e., “novel” coronavirus).

We knew nothing about it, and at the time had no way to combat it in the form of either effective treatments or vaccines.

Because of our long history with monkeypox, however, we do have vaccines and antiviral treatments. Monkeypox and smallpox come from the same family of viruses (although monkeypox is not as severe as smallpox). That has allowed us to utilize the stockpile of smallpox vaccines and antivirals to fight monkeypox.

And, unlike the coronavirus vaccines, the vaccines for monkeypox are effective even after infection, if given within four days of exposure. Even if the vaccine is given as late as two weeks after exposure, it can still lessen the likelihood of severe illness.

Not to worry?

Does all this mean we don’t have to panic about monkeypox? Panic is never a good idea because it prevents thoughtful responses in a crisis. But at this time the monkeypox outbreak still appears to be confined largely to men who have sex with men and those who are closest to them and who may come in contact with the open sore or infected linens.

If you fall into one of those categories, it’s important to take precautions until the supply of vaccines and antivirals becomes sufficient to cover everyone at high risk of exposure, because cases are spreading rapidly in the U.S. At the end of July, the Centers for Disease Control and Prevention (CDC) reported more than 3,500 confirmed cases but noted that is probably a significant undercount.

Experts advise that, if you’re at risk, you temporarily reduce your number of sexual partners, reconsider sex with new partners, and exchange contact details with any new partners to enable follow-up, if necessary.

Infected people are encouraged to self-isolate from other humans as well as pets, and to wear a mask and long clothing over any sores.

Although there is currently a limited supply of vaccines in the U.S., the government has purchased 2.5 million doses, which should be available in the coming weeks. This means it isn’t yet enough available to offer shots to all high-risk individuals.

So until there is, take precautions, and let us know if you think your symptoms might be those of monkeypox. It’s a painful, debilitating, and sometimes deadly disease, but we can treat it if it’s caught in time.

flurona

What is the Double-Trouble ‘Flurona’

Just when we were beginning to think we could see the light at the end of the tunnel on COVID-19, it turns out that the light might be a train coming the other way. Or maybe not. But all signs are pointing to the possibility of a “twindemic” of the flu and the coronavirus hitting at the same time this winter.

Read more
kids and COVID-19

Kids and COVID-19: Latest Updates

With all the millions of words that have been written about the novel coronavirus over the past year, relatively few have covered the topic of COVID-19 and kids. That’s because, once it was discovered that most of the serious illnesses and deaths were concentrated in those who are older, kids seemed to have been forgotten, except for the impact on their schooling.

But our concierge doctors in Jupiter, Florida, have been seeing more studies and reports that have begun to focus on children. We want to pass along the newest information in this area.

Read more
coronavirus symptoms

One More Reason to Avoid COVID-19 Infection

“I feel like an old person; I’m only 46,” a bank examiner from Brooklyn, told the New York Post recently. “I don’t wish this on my worst enemy.” She contracted the virus March 23, and still experiences body aches, hot flashes, arthritis and her hair has been falling out in clumps.

As some people toss around phrases like “herd immunity” (the notion that the virus should spread through the population to eventually produce a general immunity) and blithely attend “covid parties” hoping to achieve the same effect, our concierge doctors thought we’d explore one of the lesser-known risks involved in that type of thinking.

Read more
Important Message

A Covid-19 Update from Dr. Poncy & Dr. Lubarsky

So much has happened in the last few weeks. Finally, though, it seems as though we can see a faint light at the end of the tunnel. There is so much conflicting data on how to move forward that we thought we would try to help you parse through it.

As I’m sure you have noticed, there has been noticeably less talk about hydroxychloroquine. Unfortunately, some recent studies have shown no positive effect with its use, and possibly increased risk. It’s too early to say since there are larger ongoing studies, but for now hydroxychloroquine doesn’t seem to be recommended for treatment of Covid.

There has been exciting news from Gilead in regards to their drug Remdesivir. Their most recent studies showed significant improvement in a vast majority of critically ill patients. That’s one to definitely keep an eye on and may be one to help us come out of this crisis.

There are recommendations that have not changed, and, frankly, ones that should continue indefinitely. Those include staying active, exercising, eating well, sleeping well and avoiding excessive alcohol use. Although we would discourage outdoor activities at peak sun exposure (10-2), we would strongly encourage you to go outside for walks, bike rides, etc. This helps build Vit D levels which are helpful for your immunity, improves physical fitness which has shown to correlate with improved Covid survival, and can have a significant positive impact on your mental health.

There is a lot of confusion about testing and test results. And, to be honest, the picture is not clear. Rapid Immunoglobulin testing has gained significant traction. Several of you have already had the test. While the accuracy of the testing nationwide is under investigation, we still have to make certain assumptions based on the information we have. If you have a positive IgM it suggests that you have had a recent exposure to Covid. IgG antibodies develop later following infection, and generally do not begin to appear until 7 – 10 days after infection. When IgG antibodies are present it often indicates a past infection but does not exclude recently infected patients who are still contagious, especially if detected with IgM antibodies. It is unknown how long IgM or IgG antibodies to SARS-CoV-2 will remain present in the body after infection and if they confer long term immunity. Therefore, we suggest, if you are positive for IgM (with or without IgG) that you follow strict isolation guidelines for 2 weeks assuming you can be contagious. If you are positive for IgG only, then hopefully congratulations is in order. We do not suggest letting your guard down and encourage you to follow statewide mandates. However, there is a good chance you have some degree of immunity which could have implications going forward. There are several options for testing for active Covid infections. If you have symptoms that are concerning please call (561) 642-1000 to schedule a test at FITTEAM ballpark of the palm beaches. Another option, while a little pricey, is a home test provided by Access labs in Jupiter. If interested please go to https://accessmedlab.com/covid19.

Some of you who have tested positive have generously volunteered to donate plasma. While the protocol is not exactly clear, we have been made aware that Oneblood is taking plasma donations at their center in Pompano. If interested, please check their web site at Oneblood.org.

We are very thankful to you, our wonderful patients, for your patience and understanding during these difficult times. Although we are encouraging you to stay away from the office to avoid unnecessary exposure, we are still available and ready to take care of any issues, Covid related or not. We look forward to seeing you face to face in the near future when things settle down.

 

Sincerely,

Morgan and Amir

1 2 3