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How will COVID-19 affect the coming flu season?

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With COVID-19’s presence, is the infamous flu season in dormancy?

The UAE National Center of Meteorology’s (NCM) recent announcement that tropical cyclone Shaheen is expected to hit the eastern coast of the UAE, has been a warning for residents to expect a change in weather. A shift in climate conditions can impact the resilience of the human body’s immunity, making it more susceptible to exposure to viruses.

Pre pandemic, a high temperature, cough, and sniffles were common indicators of the flu. However, in the present day, these symptoms may point towards a very different diagnosis. As the flu season approaches, questions of how cases will be differentiated from COVID-19, its acute counterpart, and will it peak again, is on many minds. In an interview with Omnia Health Insights, Dr. Fadi Hamwi Consultant Internal Medicine, and Dr. Palat K. Menon Specialist Microbiology, Molecular Biology and Head of Clinical Lab at Fakeeh University Hospital, provide answers to these pressing questions.

“The flu season marks its arrival in the region between summer and fall, peaking at the start of the school year. During December, January, and February, cases reach an all-time high. However, it is crucial to mention that influenza circulates throughout the year, rising in winter. One of the main causes of the increase in cases is notably weather change, and transmission due to crowding in schools,” comments Dr. Hamwi.

The climate’s influence on viruses can be significant as most diseases have a seasonal variation, with respiratory illnesses occurring typically during the winter months. “There are several contributing factors, with one of the most prominent being staying indoors and producing aerosols that are easily transmissible and have a greater incidence of cross-infection. In addition, an increased number of children returning to school immediately after holidays exchange their bacterial and viral genetic information,” adds Dr. Palat K. Menon.

However, with COVID-19 threatening patient's health globally, the dynamics of the disease have changed due to behavioural adaptation in humans. “COVID-19 had a large influence on the seasonal influenza pandemic, which is usually experienced yearly. Measures implemented to tackle the COVID-19 virus, including social distancing, mandatory masking, and hand hygiene, have simultaneously facilitated the prevention of the spread of the influenza virus. Last year, we saw that seasonal influenza infections were at a minimal rate,” explains Dr. Hamwi.

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“Masking lowers the ability of a human being to produce aerosols and prevents you from touching your nose. Most individuals touch their noses every few minutes, which is an ingrained behavioural trait. That infected hand goes through touching others, therefore, masking, practising hand hygiene, avoiding contact by not shaking hands, maintaining social distancing, are all factors which have helped in the reduction of influenza cases all over the world,” says Dr. Menon.

Similarities between COVID-19 and the flu

For specialists, during the pandemic, both influenza and COVID-19 are under the microscope. Dr. Menon explains: “The viruses are fairly similar in their mechanism of spread and only through testing can they be differentiated. Both Influenza and SARS- COV2 are RNA viruses, however, the membrane which covers the virus has differing protein structures. The ACE protein on the COVID 19 virus acts as a key opening the cellular doorway, by binding to the ACE2 receptor on the human cell. In contrast, influenza has two protein molecules known as Hemagglutinin (H) which is responsible for binding the virus to the cell being infected, and Neuraminidase (N) which cleaves the receptor to allow virus release. Scientists use these antigens to identify the influenza virus, hence the initial influenza viruses were called H1N1.

Current subtypes of influenza A viruses that routinely circulate in people include A(H1N1) and A(H3N2). (H2N2, H2N3), etc. When the antigens covering the virus suddenly change or when the immune system forgets or is unable to identify these new antigens, a pandemic starts. Therefore, when we look at COVID-19, various variants are rising due to the human body being unable to recognize the new strains. It is vital to monitor strains around the world and diagnose patients through both PCR and antigen testing to differentiate between the two viruses and to develop effective vaccine strategies.”

So, what does the future hold? According to Dr. Menon, the healthcare industry is amplifying its efforts in viral disease control through newer modalities of antiviral therapy. “Effective treatment options for influenza are accessible, however for COVID-19, we are still looking for effective antiviral agents. Vaccines play an important role in safeguarding individuals, for influenza we have a mixture of vaccines with combinations of antigens, and similarly, for COVID-19 many healthcare regulators are now considering mixed vaccines. It’s just a matter of time that we will develop these options further and add antiviral medication as an option to conquer COVID-19 effectively.”

“The best advice is to adhere to the proper precautions to prevent people from contracting COVID-19 and from contracting influenza. There are several types of seasonal cold and flu viruses and rhinoviruses that are similar to the symptoms of influenza. This can be extremely challenging for those who work in schools, offices, and for families. Therefore, it is vital to reduce the chances of being infected,” concludes Dr. Hamwi.

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