Let’s Talk About the Flu
Kate Kolb: (00:00)
Thank you for joining us for our newest episode of Centra scripts. My name is Kate and I’m here with Dr. Jerry Price who is one of our fine physicians here with Centra. Thank you very much for being here today. It’s such a pleasure to meet you and be able to talk about this topic of flu today, but before we get started with that, I just want to kind of have you introduce yourself a little bit and give a little bit of your background for us.
Dr. Jerry Price: (00:24)
Sure. Kate, thanks for having me today. I came to Lynchburg, my wife and I did, in 1986 after graduating from East Carolina School of Medicine. We came here from 1986 through 1989 where I did my residency here at Virginia Baptist hospital. Started in 1989, I joined Lynchburg emergency physicians and had been practicing emergency medicine for 30 plus years and also currently I’m medical director of the Gretna emergent property, as well as medical director for health works occupational medicine center here in Lynchburg.
Kate Kolb: (01:09)
Very cool. So you were actually a part of Centra before Centra was Centra, as a hospital system so to speak, then? Right?
Dr. Jerry Price: (01:15)
Very much so. I’ve seen the hospitals merged back in, I think it was January of 1987 Centra Health was formed at that point in time and it’s been a part of the organization since then.
Kate Kolb: (01:29)
Oh, very cool. Well, we’re so excited that you’re here today to talk a little bit more about this topic of flu. This is such a hot topic this time of year and we’ve seen numbers already skyrocketing on the charts this year for, for different flu engagements and that sort of thing. So I want to dive right into this and talk a little bit about defining the flu. I think there’s a little bit of confusion sometimes about what flu is, what flu isn’t, what’s the difference between that and just a really bad cold? Talk a little bit about that for us.
Dr. Jerry Price: (01:59)
Very good question. So influenza or the flu is a respiratory illness caused by the implements of a virus and it causes symptoms of headache, sore throat, cough, aches, and fevers, and you compare that to your common cold, which is caused by different viruses in their adenoviruses and rhino viruses and different viruses that calls the common cold. But usually they don’t make you as sick as the influence of ours.
Kate Kolb: (02:31)
Now, there is a flu season that we talk about all the time, but I think it might be a little longer than people actually think it is. When, when this flu, when do we need to typically watch out for that?
Dr. Jerry Price: (02:41)
So flu is present in the population throughout the year. Okay. And we usually see peaks starting in around October, kind of mid fall, uh, and continues through March and April. The peak for the flu is actually February.
Kate Kolb: (03:01)
we haven’t even hit it yet.
Dr. Jerry Price: (03:02)
We have not hit it yet. Flu started a little earlier this year as far as seeing different cases of it than it did last year. So it’s, uh, it’s here, it’s, it’s time to, you know, get treated for it and watch out forward.
Kate Kolb: (03:16)
Yeah, for sure. Well, yeah, and actually that’s a good segue talking about symptoms. What are the symptoms that we should be looking out for when it comes to flu?
Dr. Jerry Price: (03:26)
So usually a flu is a fever. We just defined fever as temporary or greater than 100.4. So you’ll often get a call or you’ll call your provider and they say you’ve had fever and you might say I’ve had 98, but as medical professionals we define it as a 100.4. So it’s easy just to remember a hundred. If you have a fever over a hundred and you have respiratory symptoms, you have the sore throat getting headache, cough, aches and pains, myalgias (muscle aches) or just don’t feel good.
Kate Kolb: (03:59)
Okay. So some of those symptoms that I think people are sort of questioning anyway. Like is this a cold? Is this not a cold? But some of those can kind of run concurrently. So it’s important to kind of keep an eye on what your body is doing, right?
Dr. Jerry Price: (04:13)
Oh, absolutely. And it’s, you know, it’s where you need to contact your healthcare provider to source some of those issues and symptoms out. One of the things that we do see all different in children, pediatric population and adults, is the nausea vomiting that goes with it. So you hear people say they’ve got the stomach flu and so there’s really not a quote stomach flu, but you can have gastrointestinal symptoms. Children often will get nausea, vomiting. Usually adults don’t. So it’s one of the things is, so for parents, uh, their child has fever over a hundred and they’ve got nausea, they’ve got vomiting very well. Could be the Flint.
Kate Kolb: (04:54)
Right. Okay, good to know. I’m a parent of three and so that is good information to have for sure. So as you said, it peaks around February, flu season peaks around February. Typically we’re already well into January at this point. Is this I, there are people that are going to be asking, well, is this too late to get my flu shot? Do I still need a flu shot? What would your answer be to that? Oh,
Dr. Jerry Price: (05:16)
absolutely not. So this, this is the time. If you’ve not received your flu shot, this is time to get it. And there’s the influenza vaccines are available at multiple locations. I would contact your primary care provider. You can get the pharmacy, you can contact, uh, health departments, uh, urgent care centers and just see if the flu shots are available. It takes about two weeks for the flu shot to build up a resistance where you won’t get to flows. It’s not like you get the shot and I’m not gonna get it. So the sooner you can get the immunization now, the better off you are.
Kate Kolb: (05:53)
Okay. Well let’s talk a little bit about that then about this idea of prevention. I think for many of us, and I will say this from my own personal experience in my past, I was very adverse to getting the flu shot for years because the one time I had one, years and years and years ago, I got sick immediately after and I was like, well, the flu shot gave me the flu. Why do I want that flu shot? What would you say to people that that’s their argument for not getting one?
Dr. Jerry Price: (06:19)
So you were absolutely not get the flu from getting a flu shot. You might have some minor side effects. Just like you did you, you know, your arm might hurt, you know, just for a day or so, you might feel just kind of achy and you don’t feel as good as you’d normally do, but it is much better than not getting in, acquiring influence.
Kate Kolb: (06:38)
Right. So if you’re like me and you don’t want to get it because you’re afraid it might get you sick, it’s actually just better just to go ahead and go and go get it. Well, okay, so getting your shot is super, super important. We’ve talked a little bit about where to find those around in the area. I know this time of year it’s, it’s a little bit all over the place. So you’ve, you said you recommend making some phone calls and that kind of thing?
Dr. Jerry Price: (07:01)
Yes, I would. And it’s, you know, the issue with the flu shots and you might call and you just, where I usually get my medications, they’re out of it. And so the CDC has to decide about six months before the flu shots route. What is going to be in the flu shot for this year and say they did a great job of looking at prior strains of flu and what caused it and you know, you have to order the mail that you expect to use, you know, almost three, four, five months ahead of time. So that’s why all of a sudden you’ve got, you know, a big flu epidemic and people coming in and there might not be available, but don’t, don’t let that discourage you. Call somewhere else.
Kate Kolb: (07:42)
okay, good. Now are there other things that you can do in addition to getting your shot that can prevent the spread of flu?
Dr. Jerry Price: (07:49)
Yes, so the common things we always talk about as far as prevention, if you have any type of respiratory symptoms is you know, some common sense things when your coughing is to sneeze into your elbows,
Kate Kolb: (08:03)
Dr. Jerry Price: (08:04)
Use tissues. If you get sick, you know, get up, get a box of tissues, get a trashcan nearby, dispose of your tissues. If you have respiratory symptoms, whether it’s the flu or not, and you’ve got fever, you don’t need to be out in the general population. You need to stay home from work, stay home from school until you’ve been fever free for 24 hours without taking any medication.
Kate Kolb: (08:28)
Okay. And that’s key because I think a lot of people are like, well I haven’t had a fever for 24 hours, but you have to also not have been on medication for sure.
Dr. Jerry Price: (08:36)
No Tylenol or ibuprofen, whichever medicine you take, just, you know, you have to be off that for 24 hours.
Kate Kolb: (08:42)
Okay, good to know. I love the sneezing into the elbow thing. I did that with my kids when they were younger and they used to call it the Cape. They were pretending like they were putting a Cape around their face to do that. So if you’ve got little kids, you can make it fun even to try to prevent that.
Dr. Jerry Price: (08:55)
It should show and show them, teach them how to, how to do it. And you know, you oftentimes your people will get a little self conscious about they were out and they go to a doctor’s office and they’ve got respiratory symptoms and they’ll have them put on a mask. And the reason is because you don’t want the spread the flu out.
Kate Kolb: (09:11)
Absolutely. Just better safe than sorry and always to have that etiquette when you’re in, you’re in public, but even better to not go out in public if you don’t have to, if you’ve got those symptoms. Awesome. Okay. So we’ve talked a little bit about defining the flu, the symptoms, kind of early and ongoing symptoms and then a little bit about that prevention, um, with getting the shot and some additional things that you can do with that. Let’s talk a little bit about diagnosis. What happens when you are actually diagnosed with the flu? Because I think sometimes it can just feel like, you know, life is over for a little bit and you don’t really know what’s going on. So I know when you go into the doctor’s office you can, you can be swabbed for flu. What does that look like in terms of the testing phase for that?
Dr. Jerry Price: (09:52)
So the flu swab it takes when you go in, it takes 15 minutes, basically run that test and it’s a good test. If it turns out to be a negative, you go in and you haven’t, you know, a negative swab, you probably don’t have the flu. Got a positive swab, other things can cause it to be positive too so that the test is not an absolute and the test is actually not even recommended for everyone. If you go in and it’s flu season, which it currently is and right in the middle of it and you’ve got the symptoms of the flu, then most likely you will be prescribed antiviral medications. The question comes in is to when your symptoms started, cause that defines if you qualify for the antiviral medications. So you have to have, then your symptoms have started 48 hours or less. If you go in and you come to see me in the office and you’ve had symptoms for four days, the flu medicines, you probably would not be prescribed the flu unless you’ve got some really, you’re really sick with it. There’s some another things that are going on. But just for somebody to come in with the flu, you’ve not get it 48 hours or less. So it key when you start having symptoms and especially when you start having fever that you, you can get tested. And
Kate Kolb: (11:11)
Now we talked a little bit about this, you and I did when we were talking earlier, that just because it’s negative doesn’t mean that you don’t have the flu. Is that right? Correct.
Dr. Jerry Price: (11:20)
Yeah. So if it’s negative, there’s a small percentage that you still have the flu. But again, it’s, it’s based on a clinical diagnosis. Right? So there’s other things that can, cause you could, you could get a kid can have an ear infection. Your infection can be caused by the flu. So is it flu? Is it a bacterial infection that you need an antibiotics for? Is it, you know, this is a flu, flu swab comes back positive.
Kate Kolb: (11:46)
That’s why it’s so important to be able to go see a medical professional about it and not try to self-diagnosis when it comes to things like this.
Kate Kolb: (11:54)
All right. Let’s talk a little bit about strains because we hear in the news a lot from year to year. You talked a little bit about a few minutes ago when it talked about the development of the flu shot and how the CDC has to sort of develop that six months in advance and that sort of thing. But they do it based on what they think the strain is going to look like for the year. So tell us a little bit about what the differences between this strain A and strain B. I feel like those terms get thrown around and people don’t really know what that means.
Dr. Jerry Price: (12:22)
Yeah. So there’s for great information you can nurse, you can go to the cdc.gov and pull information and that website will give you where it flows active in your area. Okay. And the different types of flu change as this kind of season goes on into different seasons. So I recommend again the cdc.gov but for this year through last week we were seeing primarily type B. 60% or so of the cases are type B, about 40% are type A, but it varies with the different populations. So it’s kind of interesting that the pediatric population up to young adults through age 24 have been predominantly type B, from 25 to 65 had been sort of a mix, both A and B, and the over 65 population has been primarily A.
Kate Kolb: (13:18):
Now in layman’s terms, how would you define the difference between what is A and what is B? What does that mean?
Dr. Jerry Price: (13:24)
So there’s subtypes of A, and this goes back to, I can give you a little bit about the history. Most people that listen to the podcasts, they’re probably not born in 1918 but there’s where the first pandemic of the flu was, you know, during the time of world war one. And there were, you know, millions of death from, from the flu at that point in time. And then we had another pandemic. These are all type A flus and type A flu have caused pandemics all over the world. Type B lives have not overseeing this year’s type B, which is, which is bad, but that is the, the viruses is not as aggressive as the Taipei. But we had another pandemic, you know, 50 years later in the mid fifties one that most people remember. It’s about 10 years ago in 2001 and that was a talk day and it was time. Does the H one N one you’ll see that on the news, a very aggressive, uh, virus. And what happens with the flu virus is that it changes. It’s probably smart virus that we are. So if you, you know, we, we say, Hey, we’ve got prevention against this strain. And then the virus changes a little bit, mutates to it, to a different antigen and causes different problems.
Kate Kolb: (14:45)
Okay. So when it comes to getting your flu shot, then they are trying to type it for what they think will be the strain that will be most popular that year. Is that how that works?
Dr. Jerry Price: (14:56)
And they’ve been the influence of vaccination this year has lined up with the type of fluid if the CDCC.
Kate Kolb: (15:04)
Okay. And this year it’s primarily B.
Dr. Jerry Price: (15:08)
yeah. At this point in time you might see, we might see it switch over to a [inaudible].
Kate Kolb: (15:11)
Sure. Let’s hope not. Let’s hope it just stays with B. So if you end up contracting the flu and you get diagnosed with that and you’re starting to get treatment for that, is it an automatic blanketed yes. That everyone in your family needs to also receive treatment or how does that work when you live in a household of people?
Dr. Jerry Price: (15:30)
Yes, that’s a great question. So the recommendations from the CDC is your household context do not get treated in last. Dave cannot diseases of your kidney problems. They’ve got a lot of code, morbid issues, kidney problems, you know, severe diabetes and then they will put them on prophylactic treatment.
Kate Kolb: (15:52)
Okay. So kind of, it would just depend on what you mean.
Dr. Jerry Price: (15:55)
Depends on the family member. But if you’ve got a healthy family members, usually we do not do prophylactically treat those other families.
Kate Kolb: (16:03)
Okay. And then of course if symptoms start to pop up with anybody then you would need. Right. Okay. So we talked a little bit about your blue report the other day too. The emergency medicine reports kind of on a national level. How does Virginia match up with what we’re seeing nationally for, for the flu in terms of treatment and how things are being diagnosed. I know a few years ago Virginia was one of the hot button States for the flu and it was like red on the map of the heat map.
Dr. Jerry Price: (16:33)
It’s still the whole East coast is if there’s not any part of the East coast, I don’t think you’ve probably seen, it just flows. Not very active. And you know, it’s a major cause of respiratory illnesses.
Kate Kolb: (16:45)
Yeah. So it’s just that time of the year and okay, this is a question that we receive often and it’s sort of the, the scare tactic that sometimes people hear, you know, well what if I don’t get my flu shot or what if I can’t access one? I’ve heard that there’s been deaths on the news and that sort of thing. What do you say to people that, that are just sort of afraid of the flu and what that looks like?
Dr. Jerry Price: (17:06)
So the, the question is, like we talked about earlier as you get your flu shot and I get the flu and that’s not the case. You don’t get the flu from, he might feel bad. So the, there’s been reported as pediatric deaths so so far in 2019 or 2020 from flu. So the chances of getting sick and having critical illnesses and being hospitalized or greater from acquiring a flu thing, DeMay side effect of it.
Kate Kolb: (17:35)
It’s been a flu vaccine. Yeah. And obviously prevention is, is huge and is key and we want to make sure that we get that, that messaging out to people just to try to keep that under control. But we also don’t want people to be afraid that there’s pandemic waiting to happen at any moment either. Because what we’re hoping is that through education and wellness prevention, people are starting to sort of get on board with that and um, that education is going to hopefully keep those numbers down going forward. So that’ll be good, I think, hopefully. All right. So we, we talked a little bit about the diagnosis then. What does treatment for flu actually look like? I think that there’s a little bit of a discrepancy maybe in what people think that they should be doing when they are treated for the flu and, and kind of what does that look like?
Dr. Jerry Price: (18:21)
Yeah, so the, the flu is a clinical diagnosis. The laboratory tests certainly can supplement that and confirm it. If you’re having symptoms and you go there, the treatment options or give you anti prowl medications, if you present less than 48 hours after your symptoms. And there’s basically four medications that have been currently recommended for flu treatment. And the most common is Tamiflu, which has been around since 1999 hard to believe it’s 20 years.
Kate Kolb: (18:50)
Wow, that’s crazy.
Dr. Jerry Price: (18:52)
Versus a so Lusa, which was approved by the FDA in October of 2018 it’s been on the market. So both of these or a male, since you take by mouth, the difference in the Tamiflu is you end up having to take it for, usually it’s a five day course versus the newer medication that was approved last year. The [inaudible] is a single take one. So that’s the difference. Cost is a factor, so you need to discuss that with providers and that sort of thing. Those are all cultural, always the concern. And then there’s a intra-nasal that we also use into there. If you get sick enough where you’re in the hospital and you can’t take anything by mouth, you’re snobby. So there’s, we’ve got it covered.
Kate Kolb: (19:40)
So it’s sort of a gradient of treatment options. Okay.
Dr. Jerry Price: (19:45)
Denton, the Denton fear, the float. People say, okay, you know, go and I’m getting my medication. And after you’re not cure for the flu, it just decreases your symptoms pop out a day, your side. So you’re usually, when you get sick from the flu or you’re exposed to it, let’s say I’ve got a cold now and I’m exposed to you as we’re doing this podcast, is that it takes one to kind of four days for you to start. You need to incubate and you will start having symptoms, but you’re actually contagious about usually 24 to 48 hours before you start having symptoms. So sometimes you can change it. You don’t
Kate Kolb: (20:24)
Dr. Jerry Price: (20:26)
you know, if you’re feeling bad, you know, you really think about, you know, sugar,
Kate Kolb: (20:30)
right? Right. We should all just live in a bubble for three months during the winter. Is that what it is?
Dr. Jerry Price: (20:36)
You get your fever, that’s when you’re really shedding the virus tremendously. And that’s when you’re really contagious to other people and the things we talked about earlier, staying out of the public eye. Sure.
Kate Kolb: (20:45)
Well, if I suspect them that I have the flu and I need to go be diagnosed, what is my best course of action? Where do I go first?
Dr. Jerry Price: (20:54)
Yeah, so I think in there, there are a lot of options there. In the area. There’s different urgent cares. You certainly can go to that. Your wait times are not very long. Everybody’s busy this time a year. You can certainly call your primary care office health departments here locally, there’s Johnson health center, so there’s a lot of resources. People, citizens, you know, I can’t get an appointment, but you know, there’s resources available in a white towns. Probably the urgent cares are certainly list in your own emergency. Raymond, if you go to the, uh, emergency department, there’s a lot of really sick people there. If you’re in a waiting room, you’ve got, you know, a lot of folks that are exposed, you’re exposed to different things. So I would say the urgent care would probably be [inaudible].
Kate Kolb: (21:35)
So ideally we want to say don’t immediately go to the emergency room if you’re, if you’re sick like that, you want to kind of go through these other areas first,
Dr. Jerry Price: (21:43)
exposed to as many sick people initially.
Kate Kolb: (21:47)
Good to know. I want to talk a little bit more about the medicine that we just talked about a few minutes ago on the treatment. Are there different ages that certain medicines are better for? Is there something that you need to be mindful of if it’s a pediatric case versus an elderly case or someone in the middle? And what does that look like in terms of treatments for those?
Dr. Jerry Price: (22:07)
So back up a little bit. Cause I think the thing, this is an important friction as far as preventing the floaters in pregnancy. So you started out with with that. So the flu shot is approved in pregnant women. Okay. And one of the nice things about that is you can’t get your flu shot. It’s not approved for children that are six months or less. So you know, when you have a baby now all of a sudden we’ve got an infant that they are very susceptible to respiratory illnesses this time of year or has the flu, whatever. So if the mom gets the flu shot when she’s pregnant, then it will protect that baby until she uh, she or he can get her flu shot at age six months. As soon as you can, you can first get it, no contraindication during your pregnancy. If for some reason your infant acquires the treatments available down to one month of medications had been proved down to four weeks.
Kate Kolb: (23:02)
That’s really good cause I think a lot of parents assume that you can’t treat infants when they get very, very sick like that. So all the way down to one month,
Dr. Jerry Price: (23:09)
it’s an essence approved in this time of year infants we end up seeing a lot of respiratory syncytial virus or ice V is common. So it’s just a flus and RSV and as she knows or is it routine ear infection that got fever?
Kate Kolb: (23:23)
Yeah. Kids, they catch everything, all those germs. But yeah. But we would definitely encourage them if you do have a child that is symptomatic of any of those things to get that checked out as soon as possible cause you don’t want those symptoms to go super long without being diagnosed. And treated with that. All right. The other question that’s sort of a one off that we get often around here is what happens if I’m allergic to eggs? Can I still get the flu shot? Because you’ll see that come up sometimes in those pre shot questionnaires and what does that mean?
Dr. Jerry Price: (23:56)
Yeah, so eggs is not a country in the case. Sugary egg allergy is not a country indication to getting to flu. If you’ve had severe reactions from an egg allergy, recommend that you see your allergist do a little test and see if you can take it. Most people can, but just if, if you don’t have it, if you’ve not had a severe reaction to eggs, you can, you can get a flu shot.
Kate Kolb: (24:21)
Good to know. Well that’s good because I think sometimes that pops up in that questionnaire and people are like, well, I don’t know what to do with that information, so that’s good. All right, well this is awesome. We’ve, you know, again, we’ve talked about defining the flu. We’ve talked about some symptoms and prevention and then what that looks like for diagnosis and treatment. Is there anything else that we’ve missed that you just feel like the public needs to have this information?
Dr. Jerry Price: (24:44)
I would just say I wish I could show him my graph now. Cause skin it were, you know, peak season flu season is probably not here. I can’t encourage you enough to, if you’ve not had your flu shot to make that happen. The side effects are minimal. If benefits are a lot greater. If you acquire a respiratory illness, you know as we talked about the prophylactic things are you covering your mouth using the tissues, keep yourself hygiene, plenty, plenty of RAs, plenty of sleep and stay home until you don’t have a fever without any medications for 24 hours.
Kate Kolb: (25:20)
Yeah, I think that’s key, especially in all of this is the preventive. The prevention side of things is absolutely key and making sure that’s good. But if you’ve been sick, don’t come back to work. Don’t be the hero with right now is not the time to be the hero. So if you’ve,
Dr. Jerry Price: (25:33)
isn’t it, what happens if you get your office workers or your school friends and you know, your basketball team, whoever, all of it now everybody stick with it,
Kate Kolb: (25:41)
right? Which is great. And while we all want to be the person that shares lovely things with people, we don’t want to be the person that starts a flu pandemic. Nobody wants to be patient zero. Well, Dr. Price, thank you again very much for being here with us today and talking a little bit more about flu and all of these important features of, of things that we need to learn about it and to operate with. And uh, once again, thank you guys for listening. This is always such a privilege to be able to talk with you, our community, and our patients. And we hope you stay tuned for our next episode coming soon.