Have I got the flu or Covid-19? Could I have both?

The best card in the prevention pack for the winter is to get the flu vaccine

‘I truly believe a flu jab and a renewed zeal for hand washing and social distancing will make the winter ahead a bearable one.’ Photograph: iStock

‘I truly believe a flu jab and a renewed zeal for hand washing and social distancing will make the winter ahead a bearable one.’ Photograph: iStock

 

As the evenings begin to close in and a distinctly autumnal air prevails, the sense of a challenging winter ahead is difficult to ignore. For many patients, an ever-growing concern is being vocalised in conversations with their doctors: how will we know if our annual flu-like illness is influenza or Covid-19?

Get swabbed and have the PCR Covid test is the obvious answer. But the turnaround time on these tests is likely to lengthen as demand rises. And with false positive and false negative test results a fact of life, clinical judgement will be central to addressing the concerns of anxious patients and their relatives.

Listening, and listening even more, will be key. Speaking to Medscape, an online magazine for doctors, Dr Lewis Jay Kaplan, a critical care surgeon at the University of Pennsylvania, says every patient has a story, “and it’s up to you to figure out which chapter you’re in and how far along you happen to be”.

Each patient’s story can point to the correct clinical approach. We know that, traditionally, some 80 per cent of diagnoses are made by attentively listening to the patient, without any hands-on clinical examination. Following up with a series of questions about how the illness has impacted them, how their symptoms differ from the usual, and how they responded to treatment, will further refine the doctor’s assessment. A narrative based medicine approach such as this is especially useful as the majority of primary care consultations will be carried out via telemedicine.

Overlap

The biggest challenge in the months ahead is the degree to which signs and symptoms between Covid-19 and the flu overlap. A fever, headache, muscle pain, cough, and fatigue are common to both.

A badly blocked and congested nose and sore throat are characteristic of the flu; shortness of breath and losing your sense of smell and/or taste point firmly towards Covid -19. Gastrointestinal symptoms such as diarrhoea occur in up to 40 per cent of novel coronavirus infection cases.

Chart comparing coronavirus, flu and and cold. Source: 2.hse.ie/conditions
Chart comparing coronavirus, flu and and cold. Source: 2.hse.ie/conditions

But some people infected with Covid-19 have no symptoms, while others have mild symptoms. And the common cold - caused by a myriad of viruses including other strains of coronavirus - remains the most likely diagnosis if someone has a runny nose, a sore throat and a normal temperature. However, a major red flag and something not to be ignored, is the onset of breathlessness or difficulty breathing. Should this happen, seek urgent medical attention.

What about those unfortunate enough to be hit with the double whammy of overlapping influenza and Covid -19 infection? Early studies suggest about one in four Covid-19 patients have been diagnosed with an additional respiratory infection, including influenza. But researchers in Hong Kong and Japan have reported a reduction in influenza cases during Covid-19 outbreaks. Preventing flu might make the Covid pandemic more manageable, and preventing coronavirus transmission might reduce the occurrence of flu as well, as witnessed in South Africa and Australia during the Southern Hemisphere’s just-completed winter period. And while it is possible the novel coronavirus is mutating into a less virulent strain, the evidence is anecdotal at best.

Interestingly, scientists who have tracked historical epidemics have found that outbreaks of respiratory viruses usually do not reach their peaks during the same time period. Though no-one knows exactly why this is, one study has postulated that temporary bursts of immunity to different viruses at a cellular level could be at play.

The best card in the prevention pack for the winter is to get the flu vaccine. This will help you escape flu or at least minimise it’s effects. It will also reduce the chances of contracting flu and Covid-19 simultaneously.

I truly believe a flu jab and a renewed zeal for hand washing and social distancing will make the winter ahead a bearable one.

mhouston@irishtimes.com

The Irish Times Logo
Commenting on The Irish Times has changed. To comment you must now be an Irish Times subscriber.
SUBSCRIBE
GO BACK
Error Image
The account details entered are not currently associated with an Irish Times subscription. Please subscribe to sign in to comment.
Comment Sign In

Forgot password?
The Irish Times Logo
Thank you
You should receive instructions for resetting your password. When you have reset your password, you can Sign In.
The Irish Times Logo
Please choose a screen name. This name will appear beside any comments you post. Your screen name should follow the standards set out in our community standards.
Screen Name Selection

Hello

Please choose a screen name. This name will appear beside any comments you post. Your screen name should follow the standards set out in our community standards.

The Irish Times Logo
Commenting on The Irish Times has changed. To comment you must now be an Irish Times subscriber.
SUBSCRIBE
Forgot Password
Please enter your email address so we can send you a link to reset your password.

Sign In

Your Comments
We reserve the right to remove any content at any time from this Community, including without limitation if it violates the Community Standards. We ask that you report content that you in good faith believe violates the above rules by clicking the Flag link next to the offending comment or by filling out this form. New comments are only accepted for 3 days from the date of publication.