When influenza meets pandemic: How to keep long-term residents safe and healthy as flu season approaches 

Date: October 25, 2020 | By: Dr. Chris Morgan, MD, Chief Medical Officer, AMS Infection Prevention Partners

We’re weeks away from embarking upon an unprecedented time in healthcare and science and we haven’t even made it through the current scenario in which we’re all living amid the COVID-19 pandemic. As cases of COVID-19 in the U.S. continue to climb - 6 million+ and counting - we’re getting ready to be faced with yet another formidable opponent in infectious disease - influenza.

 

While the number of cases and the severity of those cases vary greatly, the Centers for Disease Control and Prevention (CDC) estimate that influenza has caused between 9 million and 45 million illnesses a year in the past decade. The 2018-2019 flu season is estimated to have caused 35 million illnesses, 490,000+ of which required hospitalizations and 34,157 resulted in death. And we know long-term care residents can suffer disproportionately higher influenza burdens than the general public due to both compromised immune systems and living in close proximity to others.

 

This upcoming flu season could further the burden on long-term care residents if precautions aren’t taken now to protect them.

 

There’s still so much we have yet to learn about COVID-19. Initially, we thought it was primarily an infection that affected the lungs. Now we know that it is a systemic infection, yet we still have no treatment options from the standpoint of outpatient therapies. Like other systemic infections, however, it makes patients more vulnerable to co-infections or super-infections. And this is particularly true for long-term care residents.

 

If a patient were to acquire both influenza and COVID-19 as co-infections, it would be a double-whammy on the lungs. It’s certainly a risk for the general public, but the two together could significantly increase the morbidity and mortality of residents in long-term care.

 

Fortunately, there are steps to take to reduce the likelihood of bringing COVID-19 and influenza into your facility and the first step is not to let up with routine screenings of anyone and everyone who enters your facility. Unlike COVID-19, in which many infected people are presenting without any symptoms, very few people with influenza are asymptomatic. Again, the symptoms may be mild, but there should be some respiratory symptoms, so they are extremely unlikely to be silent spreaders like there are with COVID-19.

 

Following are steps to take to protect long-term care and skilled nursing residents this flu season and year-round:

 

  • Wear a mask. If there’s any silver lining from the pandemic it’s that we’re all now used to wearing masks and this will serve us well during flu season.

  • Ensure residents’ influenza and pneumonia vaccinations are current. There is some very early data being discussed that suggests that other vaccinations might help against COVID. But regardless of the evidence, everyone needs their flu shot.

  • Monitor resident EHR data closely for subtle change in condition; data analytics delivered in real-time can help identify the early warning signs of flu and COVID-19.

  • Test (staff and residents) frequently. For influenza, we have proven therapies, but you have to test early and frequently.

  • Isolate to prevent outbreaks. Isolating residents and putting everyone on a Tamiflu regiment in a safe and precautionary manner have been very successful in preventing wide-spread outbreaks in facilities.

 

In addition to the above recommendations, it’s critical to conduct comprehensive testing for all respiratory ailments; not just COVID-19. The CDC updated its guidance in July recommending nursing homes test for influenza and other respiratory pathogens as included in full respiratory panels in addition to testing for COVID-19. With broad-panel testing, many symptomatic residents with respiratory infections will be found to have viral infections. Accurate and confirmed diagnosis will result in fewer prescriptions of unnecessary antibiotics, greater compliance with CMS’ Antimicrobial Stewardship Mandate regarding antibiotic reduction and, over time, will decrease the prevalence of multi-drug resistant organisms.

 

Broad-panel, multi-pathogen testing is going to be extremely important this time of year. If you’re unsure where to begin, we can help. Drop us a line or click here to learn more about our full-panel respiratory testing for long-term care facilities.