Flu season 2023: Brace for a rough winter

IF YOU have not already done so, get your flu vaccine.

That’s the advice from medical experts as winter 2023 is expected to be harsh.

The prediction is based on trends in the northern hemisphere, which was hit by concurrent waves of Covid-19, influenza and respiratory syncytial virus (RSV) throughout their winter this year; typically from December to late February.

According to a recent report in The Washington Post, for many parents with young children, winter was a slog through a ‘tripledemic’ of the three, and other resurgent infections.

The report said children under one made up almost a quarter of emergency department visitors for respiratory diseases in early December. According to the United State’s Centers for Disease Control and Prevention, this was closely followed by children below the age of 11.

Meanwhile, a report by Xinhua News Agency in March said Australians were warned to brace for a virus "triple threat" during their winter; typically from June to August, much like South Africa. The warning came on the back of the northern hemisphere experience.

POST asked local experts for their opinion. Should South Africa also brace for such a challenging winter?

Professor Veronica Ueckermann, the head of infectious diseases at the Department of Internal Medicine at the University of Pretoria and Steve Biko Academic Hospital, said we are already seeing all three viruses in South Africa.

“Influenza has always plagued our winters, and here I have to add that we remember it is vaccine preventable. RSV used to be considered a disease of those under 2 years of age, but we have seen trends of increasing cases in adults too. So in short, we are already seeing all three viruses in our current season.”

Ueckermann said South Africa had admissions due to influenza each year.

“In fact influenza still causes death every year. It's just not as well-published or extreme as Covid was. The number of hospitalisations we see depends very much on the uptake of the currently available flu vaccine.

“We are seeing vaccine hesitancy leading to outbreaks of measles and diptheria, so I am concerned that we will see high numbers of cases and potentially hospitalisations. The flu vaccine is currently still available. Generally uptake increases when people see others getting ill, so it is best to get the shot early on.

“Remember penicillin is an antibiotic and we do not treat flu with antibiotic. This is critically important for people to understand, because misuse of antibiotics is creating a major health challenge in terms of antimicrobial resistance,” said Ueckermann.

“The best way to protect yourself against both Covid and flu is to get vaccinated. Influenza can cause severe disease. We should also protect those around us by avoiding public places when ill and taking time to rest at home and recover.”

Why outbreaks now?

Dr Mohammed Kathrada is based in the Bluff, serving the area and communities of Wentworth, Merebank and the greater Durban South region.

He said at the time that the Covid-19 pandemic hit the world, total shutdowns/lockdowns meant that children were at home. This meant they had less exposure to viruses.

“We must remember that it is normal for children to get sick with colds and flu, up to at least seven or eight times a year. It's these types of mild infections that they contract which helps them keep on building antibodies to these type of viruses, so that when they get in contact with a virus, they already have some sort of protection.

“But during the Covid period they were not getting sick. They were mainly isolated at home. This has now resulted in extra strain on them because now, when they come into contact with the same type of viruses which previously they would have been able to easily fight off, they don't have these antibodies anymore. That is why they get quite ill. Unfortunately, this is the reality of living in a post Covid-19 world,” said Kathrada.

He said his surgery had been busy in recent weeks, particularly heading into Autumn and the change of season. But Kathrada said it was important to know the difference between the various symptoms.

Know your symptoms

“Allergies must not be mistaken with flu symptoms. Allergy is related to a changing climate, increased pollen, etc. It presents with hayfever-like symptoms - you have a runny nose, a tickle in the throat and a bit of a cough.

“Then you might have a cold which can also have similar types of symptoms: a sore throat, blocked nose, a bit of body ache and that's about it. These kind of symptoms are normally quite harmless,” said Kathrada.

“Then you get your worse one which is the flu/influenza. Now although we use them interchangeably, a cold and the flu are not the same thing. Influenza can range between Influenza A, which also includes Swine Flu, and Influenza B.

“Now with Covid-19 still around, it falls within the influenza type of category of diagnosis, although it's not influenza it is Coronavirus. But it is also a severe flu illness as such. However, the Covid-19 we see today is not the same that we saw two years ago when it first broke out. We can't compare Covid-19 now and let's say the strains of 2020 or early 2021. It's now more like an influenza that type of virus,” he said.

When to see a doctor

Assessing the difference between allergies, cold, flu and Covid-19 can be confusing. So what’s the best way to tell when you need to see a doctor?

Kathrada said a lot of people used systemic symptoms as a good marker.

“If you are getting fever, chills, a temperature that is very high, of over 40; that is something you would want to go see a doctor for.

“You want to see a doctor if you are getting chest symptoms because that is below the neck. Anything below the neck might be something that would require a doctor's examination.

“Then something that is persistent. So, if a fever, for example, is going on for more than two days, you've got to wait at least two days. See if your symptoms are improving and then take it from there.

“At the start of any cold or flu, if there's a temperature, the temperature will usually be high at the beginning and then it should start improving. You may end up with a cough at the end of it, but once your body pain and fever has subsided, it will just be snotty and chesty. And that might persist for a week but it does not mean you need to see your doctor

“We have also had a tummy bug that was going around. Again, these kind of things are generally viral as well. Similarly if it's a day or two and you are not dehydrated and you are able to tolerate some liquid, then there is no need to rush to see a doctor,” Kathrada advised.

He agreed, that based on what happened in the northern hemisphere, South Africa could face a triple threat.

“It is definitely possible. We have already had one RSV outbreak. It did settle quite quickly and I think that is because it came around at the time of the Easter school holidays here. Children were not at school, so the spread was less and that makes a big difference.

“Fortunately, our school winter holidays are just around the corner. It is actually coming at the right time, to try and stop the spread of these kind of infections and viruses, because the kids are often the ones who are the main transmitters of these outbreaks.

“Assuming that our kids in South Africa have not had already had these kind of viruses for a while, due to the pandemic shutdowns, then we would assume that their antibodies towards these viruses are are quite low. So when they get these viruses they will get it quite severely. It will take some time to get better,” he said.

Kathrada said in the case of RSV, it was a viral infection that does not respond to antibiotics.

“It also gets better with the time, but then again, monitor for symptoms like, for example, if the children get short of breath.

“I like to abide by the rule that if it's anything below the neck, always have it checked out by a doctor. If someone is having trouble breathing, or having chest pain while breathing, or chest pain while coughing, or if someone is coughing green mucus. These are among the worst type of symptoms that should always ring the alarm bells that the patient needs to go in to see a doctor,” he said.

Vaccines

In recent months the National Institute for Communicable Disease reported outbreaks of measles, RSV, diphtheria and mumps. Headed into flu season, Kathrada advised that all vaccines are up to date.

“Definitely mumps, measles and Rubella vaccines have to be up to date. If you can give a booster, do so. These are a must. Your influenza vaccine is an absolute must. My son has had influenza A and influenza B within the same year and it it was horrific. I would argue that patients presenting with influenza A are worse off than patients who have the Omicron variant of Covid-19. Don't underestimate how severe influenza A and influenza B can be.

“Covid-19 does not harm younger people as badly as influenza A and influenza B does. With the current strain of Omicron, the mortality rate is so minimal, that we cannot be giving the same advice that we were giving two years ago. Now there is no justification for the Covid vaccine, the flu vaccine is more important,” he said.

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