Irum Noor, DO, on COVID-19 and Influenza Season 2020
In this podcast, Irum Noor, DO, talks about the challenges associated with influenza season 2020 and the COVID-19 pandemic, how her patients have responded to receiving the flu vaccine, and her best practices for treating patients with chronic conditions such as asthma who want to receive the flu vaccine.
- Q&A: influenza and COVID-19 - similarities and differences. World Health Organization. Published March 17, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/q-a-detail/q-a-similarities-and-differences-covid-19-and-influenza
- Olsen SJ, Azziz-Baumgartner E, Budd AP, et al. Decreased influenza activity during the COVID-19 pandemic — United States, Australia, Chile, and South Africa, 2020. MMWR Morb Mortal Wkly Rep.2020;69(37);1305-1309. https://doi.org/10.15585/mmwr.mm6937a6
- Maragakis LL. Coronavirus disease 2019 vs. the flu. Johns Hopkins Medicine. Updated October 20, 2020. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu
Irum Noor, DO, is an allergist-immunologist at ENT and Allergy Associates in Manhasset, New York. She is also affiliated with NYU Langone Hospital. For more, visit www.entandallergy.com.
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Amanda Balbi: Hello everyone, and welcome to another installment of Podcasts360—your go-to resource for medical news and clinical updates. I’m your moderator, Amanda Balbi with Consultant360 Specialty Network.
Influenza season is upon us, and with the COVID-19 pandemic still in full swing, this season comes with some unique challenges.
Here with us today to discuss COVID-19 and this year’s influenza season is Dr Irum Noor, who is an allergist-immunologist at ENT and Allergy Associates in Manhasset, New York. She is also affiliated with NYU Langone Hospital.
Thank you for joining me today, Dr Noor. To start, can you talk about how COVID-19 has influenced influenza season so far this year?
Irum Noor: Thank you. So COVID-19 has definitely been a big change for us this year with the flu season. Right off the bat I’d like to say the most important thing that we can do is to get the flu vaccine. The flu vaccine is recommended and approved for everyone 6 months and older.
And really, that is the best thing that we can do for ourselves and our community by getting vaccinated, given that we are unfortunately in the COVID-19 pandemic.
I think that, in general, not just this year with COVID-19, but in general, there is a lot of fear behind the flu vaccine. I think all of us as health care providers, it is important to make sure that we talk to our patients and try to dispel all the myths that are behind the flu vaccine.
Many things patients are not aware of, for example, “Does the flu vaccine give you the flu?” I think that's something that we should really address with our patients, discuss with them that is not the case.
We should talk about how there are different forms of the flu vaccine. There is an inactivated flu vaccine. There is also a weakened live vaccine that's given through the nose. It's important to note that we are never given the actual flu virus that causes the flu. If we give it in the weakened live form, we are giving the protein. If we are giving the inactivated form, we do not expect the patient to get the flu.
What we do expect in some cases is that patients may have mild symptoms that will last for a short period of time. This is not something that should deter anybody from getting the flu vaccine, because, as we know, getting the flu can lead to serious illness that can lead to many hospitalizations and, unfortunately, sometimes even death.
Every flu season is different. The influenza infection can affect people differently, depending on your age and your health status. We are lucky to have this flu vaccine. I think it’s important to encourage our patients, essentially that let's get the flu vaccine for something that we can prevent.
Amanda Balbi: What unique challenges might health care providers face this influenza season?
Irum Noor: I think as healthcare workers, we might find some challenges given COVID-19 and influenza season. I think some patients in general, we do see there might be less preventive care, because patients are more apprehensive about leaving their home with the shelter-in-place orders that we've had.
And so, I think it's important to make patients feel comfortable. If they have any questions or fears, we can talk about it through telehealth. We can make sure that we have safe practices in the office.
Also, it's important to know that the flu vaccine is not just available at the primary care physician or a specialist office. It's available at urgent care centers. It's available at your local pharmacies. And so, there isn't necessarily always going to be a crowd of people waiting to get the flu vaccine. It's very important to make sure we have appropriate PPE on before we are administering the flu vaccine, as well as when we are receiving the flu vaccine.
There are various populations where we have to have special considerations. There are flu vaccines that are meant for patients that are older than 65. They are receiving a more-potent, higher dose. Those patients who may be worried because they have egg allergy—it's very important to let those patients know that even if you have egg allergy, it is important to go to your allergist to receive the flu shot there under supervision.
I have had patients come to season, who have never gotten the flu shot before, and now because of COVID-19, they realized they should get the flu shot. They want to have less to worry about. They don't want to have to have, unfortunately, 2 serious illnesses.
So, I will skin test them. I will give them a Graded challenge with the dose, and these patients tolerate the vaccine well. I think that's something that we should make everyone well aware of.
Amanda Balbi: You’ve talked about the flu vaccine generally. But can you talk about this year’s flu vaccine? And how have your patients have responded to the vaccine this year?
Irum Noor: Usually the flu season starts in October and essentially goes until May. The peak months that we see are between December and February. Every year, usually the flu vaccine covers 4 different viruses. We have influenza A, broken up into different viruses, as well as influenza B.
This year we've started to look at the trends—essentially what percentage of patients who are testing positive for flu, who are patients tolerating the flu vaccine.
So far in my practice, I've seen no patients have any adverse reactions to the flu shot. And in general, we are at the very, very beginning of the flu season. And so just as reference, up until October 3, the rate of positive test was about 0.21%. This is something that we have to also remember that it's the beginning of the season. Before we get into the depth of the season, I do tell all my patients that it does take about 2 weeks for your immune system to make the antibodies to be able to fight against the influenza virus. We should try to stay ahead of it.
In terms of this year's flu vaccine and how effective it is, we will see that as we get deeper into the flu season, how well the vaccine matches with the strains that are out in the community. Every year, that is different, but we have to remember that the flu shot is including different strains. If you think about it, there might be various strains in the community. You might be protected against one, maybe not against another. But we say that any protection is really better than no protection.
Amanda Balbi: What are some of your best practices for providing care to patients?
Irum Noor: Anybody who, especially this year, has walked into the office, I always ask, “Have you gotten your flu shot this year?”
As an allergist, we do see a lot of patients with asthma, and that is a very special population who is at higher risk. If they do get influenza, unfortunately, they can have more serious illness. They can have more hospitalizations, and unfortunately, there's always the end result of death, which we definitely want to prevent.
So, I always like to tell my patients, especially if you have any chronic illness—diabetes, asthma—you want to get the flu shot.
If you do get the flu, unfortunately, the vaccine does protect us against certain strains, but sometimes we have to think about the timing of receiving the flu shot, the age, and the health risk factors of the patient receiving this flu shot. And again, which strains are covered.
If you are infected with influenza, there are antiviral therapies that are very effective. We recommend, especially for children, within 72 hours of being symptomatic that we try the antivirals. It's something that has proven to be very effective. And I definitely recommend it for all of my patients.
Amanda Balbi: And what is the overall key take-home message regarding COVID-19 and this year’s influenza season?
Irum Noor: I would like to emphasize that receiving the flu shot, especially given the environment that we're in this year with the presence of COVID-19 and the upcoming flu season, I think that right now we are just about to go into the peak of flu season from December to February.
I think that we can really get ahead and have our patients be safe, get the flu vaccine, prevent hospitalizations, prevent spread. Unfortunately, because we have the fear and the presence of COVID-19 as well, we don't want to also confuse our patients when they get the flu. “Do I have COVID-19? Do I have flu?”
There's a lot of anxiety. There's a lot of fear. Unfortunately, these are both serious illnesses, and at least right now for one of them we have something that will help prevent, hopefully. So my take-home message is everyone please get the flu vaccine.
Amanda Balbi: Thank you again for speaking with me today and answering all my questions!