COVID-19, INFLUENZA AND RSV TRIDEMIC

BY FARZANEH AZIZI, Pharm.D., PGY1 resident, Meijer and JAMIE VROMAN, Pharm.D., regional clinical pharmacy specialist, Meijer

COVID-19, influenza and respiratory syncytial virus (RSV) infections are contagious respiratory illnesses that circulate year-long but usually peak in fall and winter. In late 2022, the co-circulation of seasonal influenza, COVID-19 and RSV was high across the United States. 1) This spike in viral infections led to a shortage of certain antivirals and over-the-counter (OTC) medications for symptom management.(2,3) COVID-19, influenza and RSV spread via respiratory droplets dispersed in the air when an infected person coughs, sneezes or talks, as well as on frequently-touched surfaces in communal areas, such as doorknobs and elevator buttons.(4,5,6)

Therefore, the Centers for Disease Control (CDC) and other healthcare organizations stress the importance of public practice of preventative measures. These include avoiding close contact with people who are ill; staying at home when sick; covering the nose and mouth when coughing or sneezing; wearing a face mask; and hand washing or sanitizing frequently. All are crucial steps in preventing the spread of viral infections.(4,5,6) difficult without laboratory testing.(4,5,6) These illnesses can present a combination of the following symptoms: fever, chills, pain, fatigue, cough and breathing difficulties.(4,5,6) Most mild to moderate infections are self limiting and resolve on their own, though symptomatic management can help the patient feel more comfortable.(1,4,5,6) However, there has been a shortage of certain OTC products such as acetaminophen and ibuprofen (especially children’s formulations) as well as prescription products such as oseltamivir due to the surge in the number of respiratory infections this season.

In addition, vaccination is the best tool to minimize disease spread and mitigate complications and disease severity.(1,4,5) In the absence of contraindications, the CDC recommends everyone six months and older receive the annual flu vaccine as well as the COVID-19 vaccine series and its appropriate booster.(7)

Signs and symptoms of COVID-19, RSV and influenza infections are similar, which makes the correct diagnosis

Acetaminophen (Tylenol®) and ibuprofen (Motrin® , Advil®) are medications for symptomatic pain management and fever.8 During such supply shortages, healthcare providers, including pharmacists, can recommend a switch to age-or-weight-appropriate doses of other available formulations of these medications. For instance, dose-appropriate chewable or tablet formulations of acetaminophen could be recommended for older children while reserving the liquid and suppository formulations for infants. Besides pharmacologic recommendations, pharmacists and other healthcare providers can emphasize the importance of non-pharmacological options when providing recommendations to patients or their caregivers, such as maintaining adequate fluid intake to prevent dehydration, wearing lightweight clothing and maintaining a comfortable room temperature.8

For patients infected with the influenza virus, antivirals such as oseltamivir or zanamivir can help decrease the symptom severity and duration of illness, especially when initiated within 48 hours of illness onset.(1,9) However, the CDC’s Health Alert Network Health Advisory has provided guidance on prioritizing oseltamivir to help guide healthcare providers’ decisions due to the recently reported shortages.9 In the outpatient setting, it is recommended to prioritize oseltamivir therapy for patients with a confirmed positive test for influenza.(9) This also includes patients who are at an increased risk of influenza complications due to multiple comorbid conditions, uncontrolled chronic conditions, or age (for example, less than two years old or more than 65 years old); patients with progressive or severe influenza who are eligible to receive outpatient care; pregnant patients, patients less than two weeks postpartum; patients with an immunocompromising condition; and/or children less than five years old.(9)

In conclusion, most mild to moderate viral respiratory infections are self-limiting and severe complications are best prevented through immunizations. When there are potential medication shortages, obtaining a laboratory-confirmed diagnosis can help prioritize treatment regimens for eligible patients according to practice guidelines.

References:

1. IDSA. COVID-19, Influenza & RSV. www.idsociety.org. Published 2022. Accessed February 5, 2023. https://www.idsociety.org/covid-19-real-time-learning-network/ disease-manifestations--complications/covid-19-influenza--rsv/

2. CDC. Weekly U.S. Influenza Surveillance Report. Centers for Disease Control and Prevention. Published October 18, 2019. https://www.cdc.gov/flu/weekly/index.htm

3. CDC. RSV National Trends - NREVSS | CDC. www.cdc.gov. Published 2023. https:// www.cdc.gov/surveillance/nrevss/rsv/natl-trend.html

4. CDC. Coronavirus disease 2019 (COVID-19). www.cdc.gov. Published August 26, 2020. https://www.cdc.gov/dotw/covid-19/index.html

5. CDC. Influenza (Flu). Centers for Disease Control and Prevention. Published February 1, 2019. https://www.cdc.gov/flu/

6. CDC. Respiratory Syncytial Virus Infection (RSV). Centers for Disease Control and Prevention. Published 2022. https://www.cdc.gov/rsv/clinical/index.html

7. CDC. Birth-18 years immunization schedule. Centers For Disease Control and Prevention. Published 2021. https://www.cdc.gov/vaccines/schedules/hcp/imz/childadolescent.html

8. Krinsky DL, Ferreri SP, Hemstreet B, Hume A, Rollins CJ, Tietze KJ. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. American Pharmacists Association; 2020.

9. CDC. Interim Guidance for Clinicians to Prioritize Antiviral Treatment of Influenza in the Setting of Reduced Availability of Oseltamivir. emergency.cdc.gov. Published December 14, 2022. https://emergency.cdc.gov/han/2022/han00482.asp