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1. ## Do Not Compare COVID-19 (Coronavirus) To Seasonal Influenza

Covid-19 should not be compared to seasonal Influenza It’s normal to look at the CFR (case fatality rate) of seasonal influenza when considering Covid-19. After all, 20-45 million get “the flu” every year. The numbers vary depending on the year. The “low” was the 2011-2012 season with 9.3 million cases and 12,000 deaths and the high was the 2017-2018 season with 45 million cases and 61,000 deaths.1 Let us look at the worst of eight recent flu seasons. The CFR for that was 0.0014 meaning, 1.4 persons died per 1000 cases. Interestingly, if we look at the “best” of the past eight seasons (the “good” one) the CFR is 0.0013, almost the same number of deaths per thousand cases. So, hold on to this thought... Seasonal influenza’s average risk of dying is about one death per 750 cases. I see and hear CFR for the Covid-19 repeatedly being quoted at around 2-3%. CFR currently (as of 2/27 12:23AM EST) is 3.4%. That is 2,810 deaths divided by 82,550 cases. But to say that the CFR for Covid-19 is 3.4% is not wise. Why? Simply put, the CFR is not applicable are even a number that one can calculate since it's a "look-back" number. For data current as of 2/27, click here. CFR is a “look-back” rate It is very useful when we look back to an epidemic/pandemic that has ended. For instance, when comparing the “good” 2011-2012 flu season to this season’s numbers. CFR is death rate / # of confirmed cases. To divide the known number of cases today by the number of deaths, we get 3.4%. But this is not wise to use because it assumes that ALL of the remaining cases (total cases today of 82,550, minus cases where the person has recovered or died) will be cured. This is “magical thinking.” Many of those remaining 46,488 will recover, but some will die. In short, we won’t know the true CFR for another year or more. CFR is useless at this time, it will be helpful sometime next year. Known outcomes So, let us look at the cases with known outcomes, meaning the sum of the cases of those who have recovered plus those who have died. This population is composed of those 33,252 who have, to today, recovered plus the 2,810 who have died; thus, our population is 36,062. If we divide 2,810 (deaths) into our population of 33,252, we find an overall death rate of 8.45% or about 85 per one thousand cases with known outcome. Please let that sink in for a bit. Today, looking at Covid-19 cases with known outcomes, 85 out of 1000 cases have died. Should this hold, and it may, then 1 out of 12 cases will die. Compare this to seasonal influenza where 1 out of 750 cases will die. The death rate currently for Covid-19 is 62x the death rate of the average seasonal influenza. These two illnesses do not compare, although we’ll really not know for a year or so, at which time we can look back to see what the true CFR rate was. Let us look now at areas/countries to see the current death rate is, of those cases with known outcomes. I’ll call the current fatality rate of known outcome cases: CFR-KO. I shall call the population with known outcomes: PWKO Total deaths / PWKO = CFR-KO or current death rate. World: 2801 / 36,062 = 8.45% or ~85 deaths per 1000 cases. Hubei Province: 2641 / 26,024 = 10% or ~100 deaths per 1000 cases. South Korea: 13/35 = ~37.2% or 372 deaths per 1000 cases. Italy: 14/54 = ~26% or 260 deaths per 1000 cases. We see that regional epidemic outbreaks tend to drop in CFR-KO as time goes by. Whether the true “look-back” CFR will drop to 2 or 3% or some other number (lesser or higher) depends on many factors which are simply unknown. For instance, children appear to be much less at risk for Covid-19, and cases within Africa (other than the one in Egypt) seem oddly absent. Perhaps the virus does not do well in warmer climates. Perhaps the fatality rate will drop as we approach Summer in the Northern hemisphere—we do not know. Perhaps the tendency of the media to quote the 2-3% theoretical CFR comes from the fairly recent 2009 H1N1 flu pandemic. The 2009 “swine” flu was very feared. It infected 10-200 million world-wide with estimates of death ranging from 105,700 to 395,600 and a CFR of 0.03% or 3%. (30 per 1,000 cases). (Wikipedia). It was expected to return far, far worse numbers. The “swine” flu, which was the first pandemic of this century, turned out to be far less lethal than many expected. Triggle wrote in an article from December 10, 2009 titled, Swine flu less lethal than feared, "The swine flu pandemic is ‘considerably less lethal’ than feared, chief medical officer Sir Liam Donaldson says,” adding, “A study led by Sir Liam found a death rate of just 0.026% in those infected, the British Medical Journal reported.”2 Will we be lucky? Perhaps we’ll be lucky this time, too, although I suspect we won’t be as lucky as we were for the “swine flu.”

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3. ## Influenza

Just curious how many are seeing Flu A or B? Seems we are getting hit with a lot of Flu A, especially in K.
4. ## It’s That Time of Year Again: Preparing for Influenza Season 2019-2020

Ah….fall! That time of year where we start to prepare for winter. Autumn brings leaves, pumpkins, and warm sweaters. Everyone heads outside for bonfires, football games, and trick-or-treating. Yet, lingering right around the corner is flu season. This isn’t a season that brings joy and happiness. The flu is a dangerous and even deadly virus that is preventable. Here are the essentials you need to know about the Influenza vaccination recommendations from the CDC for 2019-2020. What is the Flu? Influenza, commonly called the flu, is a respiratory infection. The flu can cause serious complications in those who are compromised for any reason, such as older adults, young children, or individuals living with conditions that decrease their ability to fight off infection. Vaccines are not 100% effective. However, they are the best way to prevent the flu and possible complications. How are flu vaccines created? Flu viruses are constantly changing. Each year, researchers across the country, study the current strains, and review the composition of vaccines. Updates to the vaccines are needed to match the viruses that are seen the most. There was a delay in selecting the viruses for the 2019-2020 season due to frequent changes in some of the common viruses. Flu shots protect individuals against three or four viruses that are expected to be most common during the season. Four vaccines will be available to the public this year. Medication Rights: Right Patient, Right Time Annual flu vaccination is recommended for everyone over the age of six months unless contraindications exist. Getting vaccinated is of utmost importance for a few specific populations, including women who are pregnant, young children, and older adults. Young children may need up to two doses of the vaccine to be fully protected. Other populations that are at high risk of complications from the flu include individuals living with obesity, liver or kidney disease, diabetes, HIV/AIDS, asthma, cancer, COPD, or cystic fibrosis. Will there be Enough Vaccine this Year? The amount of vaccine available each year depends on manufacturers. The projection for the 2019-2020 season is between 162 million and 169 million doses for the U.S. alone. These numbers may change depending on how the season progresses. Arguing for Mandatory Flu Shots If you work around people with the flu, your chances of contracting the virus are increased. Getting the vaccine not only protects you, but can also help to protect your family, friends, and patients. Individual’s with the flu are contagious one day before symptoms show up and up to seven days after becoming sick, which means that many people can pass the flu on to others without even knowing it. The CDC recommends that all U.S Healthcare workers get vaccinated against the viral infection. More than 78% of all healthcare workers received the vaccine during the 2017-2018 season. Doctors and pharmacists were the most vaccinated at 96.1% and 92.2% respectively. Nurses came in at 90.5% and nurse practitioners at 87.8%. Healthcare workers in long-term care settings were the least likely to get the vaccine, and those in hospitals were the highest. Some healthcare settings mandate flu vaccines for all clinical and non-clinical staff. These clinical setting had the highest rate of coverage at 94.8%. Arguing Against Mandatory Flu Shots While the CDC recommends getting vaccinated, not everyone wants to get a flu shot. Hospitals report that making flu vaccines mandatory is to protect patients. However, what about the rights of the healthcare worker? Researchers report that vaccinating healthcare providers will help with patient safety, increase the effectiveness of the vaccine, and protect those staff who are at an increased risk of complications from the virus. Those who oppose the vaccine report factors like side effects of the drug, setting a precedent to require healthcare professionals to comply with other medical treatments, or just feeling like a shot isn’t needed as their reasoning for opposing the requirement. Many nurses feel that following standard and transmission-based precautions such as hand washing, wearing masks, and even keeping people in isolation should be enough to minimize the spread of the infection. How Do You Feel? Vaccines can elicit much debate these days. And, requiring professionals to take a medication that they don’t want could cause some tempers to flare. So, where do you stand on the issue? Take our poll so that we get an idea of how many of you only take the vaccine because it’s required at work. And, comment below to let us know how you really feel about the topic.

6. ## Five Ways to Convince Patients they Need Flu Shots

Patients, especially chronically ill patients, need flu shots, but many in the general public have an open distrust for this vital vaccine. In fact, some people reject all vaccines, and that's a different issue entirely. Flu shots are still important, and some members of the public take a little convincing to get them to accept the shot. There are a great deal of myths and misconceptions about this shot, and some patients believe the hype. As nurses, we have to try to do what's best for the patient, and sometimes that means educating about those myths. Of course, we could never force someone to take a shot that they are dead set against, but the persuasion of education may be enough to allow them to see that the need for the shot. If you come up against a patient who is chronically ill that refuses a shot, here are a few strategies to combat the myths they may believe. Explain How Flu Shots are Created Some patients do not understand exactly what the flu shot is, and this can lead to distrust and refusal. It helps to explain to them that it is an amalgamation of the various flu strains thought to be active for the coming season. You can also use this information to help explain why the shot needs to be performed every year. The flu strains change, and the new vaccine differs every year. It helps to explain the flu and get patients to understand that it can knock them out for weeks. Emphasizing that the people in charge of creating the vaccine make it as safe as possible, but it isn't a guarantee against getting the flu. Some strains pop up every year that can infect even patients who have gotten the shot. Once this is explained, some patients are more open to the idea of getting a flu shot. Emphasize Safety of Flu Shots Flu shots are generally considered safe. You can use this information to educate the patient that they are better off with it than without it. Of course, there is often local irritation where the shot is administered, but most people don't tend to have reactions to the shot itself. The vaccine is rigorously tested for safety, and the possibility of a reaction is minimal. You may also find patients who are afraid of getting a shot. It helps to explain that the shot only hurts for a minute, though they may have soreness later. The shot goes into the deltoid, an IM shot, and these are usually more painful than others. Explain that they will feel some discomfort at first, but it quickly goes away. Usually, the benefits of the flu shot are far more important than the momentary pain that some patients experience. Assure Them They Won't Get the Flu from the Shot One of the most prevalent myths about the flu shot is that it gives you the flu. This keeps more patients away from the shot than any other excuse. It is your job to explain to them that the preparation is a dead one. This means that the virus isn't active and helps the immune system recognize and destroy the virus when it comes around to infect. Some patients do get the flu after a flu shot, but this is usually because they were already infected when they got the shot. In this case, it is difficult to convince the patient that the shot didn't lead to their symptoms. If you were the patient, you would have a hard time believing it, too. Tell the patient that getting the shot as early in the season as possible will prevent this phenomenon, but it is still possible. Educate about Symptoms of Flu Those who refuse the flu shot should be told the symptoms for several reasons. First, it is more likely that they can get the flu without the shot, and they should know what to look for in case they do become infected. Second, they may decide to have the shot once they realize how miserable it is to actually have the flu. The public is not usually educated about the signs and symptoms of the flu, and they may change their mind once they know. You should tell them to watch for high fever, over 101 degrees F. The symptoms of the flu often are confused with that of the common cold. Stuffy head, congested chest, and muscle aches are all common symptoms. The difference is that the flu is generally more severe and lasts for a longer time. While the cold can last for a few days, the flu can linger for weeks, and this can cause inconvenience and health problems for the patient. Explain the Complications of Flu Healthy people do not usually suffer complications of the flu. Yes, they are miserable, can't go to work, and generally inconvenienced, but it doesn't descend into a medical crisis. This isn't true for those who are very young, very old or have a chronic disease. The immune system in these patients is not generally as robust, and this means that the flu can take hold and lead to further problems. The most common problem that arises from the flu is the manifestation of pneumonia. In those with a compromised respiratory system, pneumonia can lead to a stay in the hospital and possibly a trip to the ICU. Even those with diabetes are at risk for the condition developing into pneumonia because of the general decrease in immune function due to high blood sugars. For the very young and the very old, pneumonia can be devastating and particularly hard to treat. Explaining these complications can help to convince even the most recalcitrant patient to accept the vaccination.
7. ## The flu, how it could be worse...

According to the CDC, the influenza activity continues to increase from week to week this 2017-2018 season. The number of influenza cases is extremely widespread and seen across all the states in America. As a matter of fact, the number of states experiencing widespread influenza activity increased this past week to 47 states. Each year there are different strains of influenza dispersing in the population. The current strains this season include H3N2, H1N1 and B viruses. It has been noted that H3N2 is the most prevailing strain and is linked to more hospitalizations according to the CDC. Due to the high involvement of H3N2 in this year's flu season, health officials are seeing more health complications and higher flu-related deaths. The H3N2 is noted to hit people harder than other strains of the flu. The flu vaccine is modified or revised every year in hopes of targeting the most common strain. However, this is not a guarantee and the CDC estimates that this year the vaccine is approximately 30 percent effective against the H3 strains. Research shows that the current H3N2 component of the vaccine is a poor match for the circulating strain and has a low effectiveness rate. This week it was noted that the hospitalization rate for influenza is higher than the previous years. Recent data collected by the CDC shows that the flu-related hospitalizations increased to about 60 people out of every 100,000. It was also noted that people seeking medical attention for influenza-like symptoms is 7.7 percent. This is the highest reported percentage since the flu pandemic in 2009. However, there is something even more dangerous to our health than influenza and that is pneumonia. Pneumonia is a serious infection of the lungs that leads to inflammation. Pneumonia can be caused by bacteria, a virus or even a fungus. Influenza can absolutely turn into pneumonia without people even realizing it. In the United States, approximately one-third of all pneumonia cases were caused by respiratory viruses, and the most common contributor was influenza. The flu and pneumonia were actually the eighth leading cause of death in 2014 in the United States. The percentage of deaths contributed to influenza and pneumonia has drastically increased this season to 9.7 percent. Everyone is at risk for getting pneumonia since it is airborne and highly contagious. However certain populations are more at risk including the elderly (especially with multiple comorbidities), pediatrics, people who are immunocompromised, people in intensive care units, people who recently had a cold, people with respiratory illnesses such COPD, smokers, and people who recently had surgery. What's important to remember is if you have influenza and begin developing new symptoms such as a new fever, shortness of breath, tightness in the chest, congestion leading to chest pain, rapid heart rate, coughing up green/yellow or bloody mucus and rapid breathing, seek medical attention. Do not wait! The flu creates the perfect breeding ground for pneumonia. As soon as the pneumonia-causing organism enters the lung tissues, the air sacs known as alveoli, fill up with fluid and mucus. The organism then causes the lungs to swell blocking the flow of oxygen. This combination is what makes it difficult to breathe. The fluid and mucus buildup in the lungs along with the sedentary recovery period associated with being sick allows for the growth of the organism. The key is not to stay at home with the development of these symptoms. Untreated pneumonia can develop into sepsis. Sepsis is a serious complication of an infection caused by the body's reaction to that infection. It can be life-threatening. Sepsis is when the body's defense mechanisms work overtime to fight an infection. When sepsis occurs the body releases a large number of chemicals in the bloodstream to the fight the infection resulting in an inflammatory response. The inflammation can then lead to a cascade of changes causing damage to organ systems and clotting disorders, ultimately resulting in organ failure. Severe sepsis restricts the blood flow to vital organs such as the brain, heart, and kidneys. Sepsis is treatable but early detection and aggressive treatment are vital. Antibiotics and fluids play a huge role in treating sepsis depending on the infectious organism. If the organism is bacterial then antibiotics are required. If the organism is fungal then antifungal medications are used. If the organism is viral then rest and fluids are required. It's important to stop the infection to keep the vital organs functioning. Fluids and vasopressors are often used to help improve low blood pressures associated with sepsis. There is a vaccine available to help prevent pneumonia and hand washing is also important to help reduce the occurrence of pneumonia. Covering your mouth when you cough or sneeze can go a long way in decreasing the exposure of gems. It's important to wipe down surfaces that come in contact with infectious organisms because the flu contagion can live up to 24 hours on them. Prevention is key but if you or someone you know starts to develop symptoms of pneumonia seek medical attention. Are you guys seeing any complications from influenza in your work setting? If so, what are they and how have they affected the overall health of your patients? Also, are you finding that many of your staff members are contracting the flu?

12. ## Caregivers Taking Care Of Ourselves

Let's get it together folks. As health care professionals, we sound like the silly group of birds on the ice age. Remember the ones that are going "prepare for the ice age" and trying in vain to hide the last melon? How are we going to help our patients over their fears and answer their questions if we are panicking? Let us start by realizing that the vast majority of us will only suffer from the flu and that is only if we are the unlucky ones to get sick. The people most affected will be those who don't have access to health care, and those that are healthy. That's right, it's hitting the 20 something's to the 40 something's the hardest. Yeah, it sucks, we will deal with it, ladies and gentlemen. What is one way to deal with a tough situation at work...come on you remember...it was in nursing school...a thorough self-examination of the way you feel about something. Talk to your peers, talk to your family, really examine how you feel. Don't just go through scenarios in your mind, actually talk it over with other staff members. What are your facilities policies regarding a flu pandemic? Is there one in place? Could you be instrumental in helping put policies in place that help in patient flow and reducing infection rates? Actually doing something about the problem can help in reducing your fears. That way you know what is coming down the line should there be a problem, and not only for pandemic flu but also for internal/external disaster scenarios at your facility. Are you prepared at home for an emergency in the community if you had to leave in a hurry? Despite what I said above it does help to ease your mind if things are taken care of at home. There should be water stored, canned and dried foods available, important papers in a fireproof container, and emergency routes made out from homework and schools along with an emergency contact number that everyone knows by heart. Now, are you all like me, go to work...go home...sleep...go to work...go home...kiss the kids...go to bed...you all know what its like. We all need to start taking better care of ourselves. We have all heard it before but now we really need to take inventory of our stress level and reduce it, because it's going to be the main thing that gets us sick (besides the nasty little old man in room 512 that just harked up a lung on your scrubs). Get some exercise, play with your children/grandkids, garden, run, read something besides a drug guide, make passionate love (what a great stress reducer eh?). Do something not nursing related. In the end, please take care of yourselves guys so we can take care of those frightened patients out there. You are important and we need you!!!
13. ## "I'm sick and I'm off" - "me too!" Flu!!!

Every year, cold and flu outbreaks result in hundreds of missed office days for workers especially health care workers in the hospital. The problem often stems from - when a worker comes to the workplace sick and spread germs via touch points. Influenza is a serious disease that can lead to hospitalization and sometimes even death. Every flu season is different, and influenza infection can affect people differently, but millions of people get the flu every year, hundreds of thousands of people are hospitalized and thousands or tens of thousands of people die from flu-related causes every year. Even healthy people can get very sick from the flu and spread it to others. Often times germs, bacteria, and viruses are found on doorknobs, keyboards, desks, and railings. The threat of infections lurks on every surface workers touch, and on every door handle they open. That is why it is important to know how to prevent their spread. It means knowing what tools - soap or sanitizer - to offer and where. Hand sanitizers are best at killing microorganisms where hand washing helps to take out the microorganisms from our hand. Even though among these two, hand sanitizers are best in case of easy accessibility. But you can kill them, but science shows that those germs can repopulate pretty quickly. You never kill 100 percent of the germs when you're using hand sanitizer. So repeated hand hygiene is needed whenever possible. "Hand sanitizers are never a suitable replacement for washing your hands if your hand is visibly soiled. Along with, early recognition of your sickness and early medical advice always helps you and your workplace to prevent further spread. If you recognized that you are sick - be away from others - seek medical advice. Say no for shake hands - even your friend can offer you FLU. Cleaner hands reduce the risk of cross-contamination and goes a long way in creating healthier facilities. In fact, a strong hand hygiene program can reduce absenteeism by a fairly significant number. The best way is always following WHO's 5 moments of hand hygiene. i.e, Before contact with the patient Before an aseptic/clean procedure After contact with the patient After exposure to patient body fluids After contact with patients surroundings and 6 steps of hand hygiene... Palm to palm (5 times) Left palm over right dorsum (5 times) Right palm over left dorsum (5 times) Palm to palm with fingers interlaced (5 times) The back of fingers to opposite palm - fingers interlocked (both hand) Rotational rubbing of right thumb by the left palms (5 times) Rotational rubbing of left thumb by the right palm (5 times) Rotational rubbing of the tips of right fingers by the left palm (5 times) Rotational rubbing of the left fingers by the right palm (5 times) Most importantly take your flu shot before you get sick with flu.... Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Traditional flu vaccines (called "trivalent" vaccines) are made to protect against three flu viruses; an influenza A (H1N1) virus, an influenza A (H3N2) virus, and an influenza B virus. There are also flu vaccines made to protect against four flu viruses (called "quadrivalent" vaccines). These vaccines protect against the same viruses as the trivalent vaccine and an additional B virus. Remember - the vaccine should be new and if it's not - you may not be covered. Seek medical advice for the prophylaxis if it is necessary..