Dr. Michaels

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Dr. Marian Michaels, Professor, Pediatric Infectious Diseases, UPMC Children’s Hospital discusses steps families should take to keep children safe from both flu and COVID-19, as well as the signs and symptoms of each virus.

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– This podcast is for informational and educational purposes only. It is not medical care or advice. Clinicians should rely on their own medical judgments when advising their patients. Patients in need of medical care should consult their personal care provider. Flu season is upon us, so what can you do to keep your children safe, especially as we are still dealing with COVID-19? Welcome to the UPMC HealthBeat Podcast. I’m Tonia Caruso, and joining us right now is Dr. Marian Michaels. She is a professor of Pediatric Infectious Diseases at UPMC Children’s Hospital. Doctor, thanks you so much for joining us.

– Thank you so much for having me.

– So, doctor, let’s begin with how parents can tell the difference between flu and COVID-19. What symptoms are similar? Are there any symptoms that set them apart?

– Well, that is a fabulous question. I wish there was a magic answer for that. Unfortunately, both COVID-19 and influenza have a lot of overlapping symptoms, so fever, headaches, myalgias, or achy body and joints. Those kinds of things can really be seen with both influenza and COVID-19. So sometimes it’s very difficult to tell without having an actual test. Now, there are couple of things that are a little bit different between one and the other, which is worth mentioning. Interestingly, with COVID-19, people have seen a new onset of just not being able to smell or taste, and that’s more common with COVID-19 than with influenza. And influenza in general comes on a little bit faster and a little bit harder, but to really be able to know, you would have to test to tell the difference.

– Is it possible to get flu and COVID at the same time?

– I wish I could say no, but unfortunately, it is possible to get two viruses, and these two viruses, at the same time if they’re co-circulating. You know, it was interesting because in China when it first started, it didn’t seem like there was a lot of overlap of two viruses. But a study that came out of Stanford last year found that one in five people who had COVID-19 also had another virus. It wasn’t always influenza, but it could be another one of the cold viruses that are circulating in the community.

– And what do we know in general about COVID-19 and flu and how they can affect children?

– Well, children, in general, have been getting mild disease with COVID-19. Now, having said that, I don’t think anyone should be cavalier and not care if their child gets infected with SARS-CoV-2, the virus that causes COVID-19. Because back in April, we started to see a couple cases in Asia originally and Europe of children getting very severe multi-system inflammation, so severe that it could actually cause very severe disease to the heart. So no one should be cavalier about this. With influenza, the children that are under age 5 tend to be at higher risk for getting complications. So, pneumonia, dehydration, ear infections, severe disease where they have to be hospitalized or have to be in the intensive care unit. So, we do take it very seriously, both of these viruses, regardless of age.

– So, then, is it safe to say that you believe both children and adults should get flu shots?

– Oh, my goodness, yes. Listen, it breaks my heart when I see a disease that I know we had something we could do to prevent it, and we have not done everything we could. There are so many things in life that we can’t prevent, but something like influenza where we have a vaccine that is good and safe and not to use it is a tragedy. In fact, it’s a travesty.

– So, at what age should children begin to get a flu vaccine?

– Great question. The vaccines are tested and efficacious. In other words, they work for children down to the age of six months and every age above that. In the old days, 10, 15 years ago, we only recommended the vaccine for the children under 5 and for senior citizens who were over 65 years of age. But interestingly, and some of you are old enough to remember, when the pandemic 2009-2010 happened, so a decade ago, where there was a new influenza type that came into the world, we saw all ages getting severely ill. Even here at Children’s Hospital, we had perfectly healthy 10-year-olds, 12-year-olds, teenagers, who were ending up in our intensive care unit. So because of that, people said, well, why aren’t we vaccinating everyone? And it was simply that we didn’t have enough vaccine. Well, we could do something about that. So the manufacturers really went to task and took this up and made more vaccines for us. So now the recommendation is everyone, six months of age and above, get a yearly flu vaccine.

– So your health care provider is probably the best place to start to get a flu vaccine, and they can let you know about other options as well. Does it always have to be a shot, or is a nasal spray acceptable?

– That’s a great question. There are a couple different kinds of shots that are available, and there’s also a vaccine that’s available for some people, previously healthy people 2 years of age to 49 years of age, that is from the nose. So an intra-nasal vaccine. But most of the vaccines that are available are the shot form.

– So along with prevention and getting the vaccine, should we be following the same guidelines that we’re following for COVID-19 in terms of trying to stop the spread?

– This may be the only good thing about COVID that I can think of, is people are so much more aware of how to protect ourselves from respiratory viruses than ever before. People know now about good handwashing for 20 seconds singing the “happy birthday” song. People know about masking, about avoiding crowds. So all of those things are really important for influenza prevention as well.

– Are there extra steps and protocols that families should be following now that some children are back in school?

– Well, I think it’s actually important to even teach the kids a couple more things or remind them about other ways to protect themselves when they’re in school. If the schools aren’t having masking, and I believe most of them are trying to have masking, but you want to remember to teach children about cough etiquette. So don’t cough into your hand, because then you’re going to touch the doorknob or touch something and spread your viruses onto that object. You want to cough into either a tissue or the crook of your arm; wash, wash, wash your hands like crazy, remember to use hand hygiene. So I think all of those things are really important. And then I think good communication with the school is important. If they’re having an outbreak, we want to know about it, so if we do have to go back to virtual teaching, that’s available.

– So what should parents do if their children start to develop symptoms of any kind, be it flu or COVID-19? What steps should they take?

– Many children will have mild symptoms: cough, mild fever, some sore throat, stuffy nose, runny nose. When anybody has any signs of illness, really, you want to keep them home, you want to make sure they’re having good hydration, keeping those fluids going, making sure that babies are peeing, that their diapers are wet, even using acetaminophen or ibuprofen for achiness or for the low-grade fevers, and then talk to your health care provider as well. If the symptoms are more severe, or if they come on fast, or if you’ve had an exposure or your child’s had an exposure to someone who has influenza, there actually are treatments for influenza if we start them early. So you want to talk to your health care provider about whether they should come in for a nose test to see about getting tested for COVID-19 or for influenza.

– Is there ever a time someone should go to the emergency room right away?

– Well, I’m so glad you asked that. So, yes, there are some signs and symptoms that parents should be aware of that would make you say, “My child needs to go to the emergency room.” If they’re having difficulty breathing — so breathing very rapidly, having trouble catching their breath, their lips or their face turning blue, if you see their ribs going in and out with every breath, those are the kinds of things that really are telling you that your child is in distress and should be seen in the emergency room. Seizures, which sometimes can happen when fevers go high, are also another sign or symptom, and very high fevers. Actually, any fever in a young infant under two months of age, you should be calling your doctor or going to the emergency room for them to be evaluated by a health care provider, but even older people with high fevers are one that you might want to have checked.

– And what do you want to say to someone who may be afraid to go to the doctor’s office or even afraid to get a flu shot for fear of COVID-19? What steps is UPMC taking to keep patients safe?

– The doctor’s offices, the hospitals, your health care providers, we’re all taking COVID-19 very seriously. Call if there’s any question, make sure that it’s the right time for you to be coming in. For some people that are going to labs for blood work, oftentimes they’re having them wait in their car until it is their turn to come in to get their blood work performed. But even at the hospital, if you need to come in, you shouldn’t be afraid to come in. We have greeters. When everyone comes in to ask questions about exposures and symptoms, we have everyone getting their temperature taken, and certainly remembering to wear a mask when you’re in public. I have my mask here, which I’ve only taken off for the camera’s sake, separated by at least 6 feet from everybody else. But when you wear it, you want it over your nose — not under your nose, because that doesn’t help. And you want it under your chin. So wearing the mask properly — teaching your child how to wear the mask is also really wonderful. Let them pick out the color. There are lots of masks that have cartoon characters or butterflies or flowers or things that your child might like. So make it fun and have the mask when they’re in public.

– Overall, what would your message be to someone who might be hesitant to get a flu shot this year?

– This is a question that I have dealt with for many, many years. And everybody’s concern for flu vaccine or for any vaccine is not the same as everyone else’s. So I think the most important thing that I have learned when a parent tells me they don’t believe in the flu vaccine is to find out why. What is it that they don’t believe in? We know flu exists, we know the vaccine exists, and we know that the vaccine works. So I try to find out what their concern is. If their concern is that their child’s had an egg allergy, you want to know a little bit more because mild egg allergies are not a contraindication to getting the flu vaccine. You want to know did they worry that the last time they had the vaccine, they got sick. You want to remind them that it doesn’t protect against anything but the vaccine. And you want to also remind people that when we do the research studies, in fact the symptoms of problems: the achiness, the redness, the soreness, is really only a couple days and is mild. Whereas influenza can kill. Each and every year, thousands of people will die from influenza, and when they haven’t had their vaccine and I could have prevented it, that breaks my heart.

– In closing, what’s your message to parents or really everybody out there?

– I think it is really important to be safe and do as much as we can to protect our children, ourselves, and our loved ones. Taking this seriously, getting our flu vaccines, as well as all the other immunizations that are available to protect our children from diseases that too often have killed people in the past, is really the most important thing we can do to help our families be safe.

– Dr. Marian Michaels, thanks so much for your time today. We appreciate it.

– Thank you so much. It has really been my pleasure.

– I’m Tonia Caruso. Thank you for joining us. This is UPMC HealthBeat.

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.