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"At this time it is almost impossible to distinguish flu from covid"

2022-01-20T03:55:25.181Z


Samuel Ponce de León, UNAM expert in infection prevention and control, gives practical advice for the fourth wave of infections in Mexico: from tests to symptom treatment


Mexico has started the year in the midst of the fourth wave of covid. The omicron variant has triggered infections and tens of thousands of people make long lines every day to get a test that allows them to confirm whether they have the virus or not. In the midst of a winter complicated by the cold and the daily case records that have been broken in January, doubts have also multiplied. How long do you have to isolate yourself after getting sick with coronavirus? What medications should be taken? What works to protect yourself and what doesn't? The infectologist Samuel Ponce de León, who has collaborated with the World Health Organization in the fight against influenza and coordinates the UNAM Commission for Response to the covid-19 epidemic, answers the most common questions, from treatment to follow until sequelae and vaccination.This is an edited and condensed version of their answers.

Ask.

Many people have the same question: do I have the flu or covid?

What is the first thing to do if you have symptoms?

Answer.

It is really very difficult to make a differentiation based on clinical data, they are very similar.

In essence, right now it is almost impossible to distinguish a flu from covid.

What you have to do in these circumstances is think and assume that it is covid.

All the people who suspect they have a cold and don't think it's covid are wrong.

That is the first point and you have to act accordingly.

If it's not covid, it's influenza.

In either case, you have to confine yourself and isolate yourself immediately, thinking that you do not want to infect anyone else.

Second, from my point of view, testing is not necessary to treat an infection.

The test is not going to change your evolution, it is not going to improve you, it is not going to do anything more than confirm a diagnosis.

Q.

Why are there people who have all the symptoms and their tests come back negative?

R.

Because the tests are not perfect.

In the case of PCR, it is a sophisticated test and requires equipment and experience to perform.

It may be due to an error in the handling of the sample, a case of contamination or a false negative, for example.

Antigen tests, which are faster and cheaper, have the problem that if they come back positive, that is most likely the result. But if they come out negative, you have up to more than 30% chance that it is a false negative. Also, unlike PCR, which allows you to identify the virus 72 hours after infection and up to the seventh or eighth day, here your time window is much shorter: when you have the greatest amount of circulating antigens. If you take it 24 hours before or after, it can give you a negative result. And we return to this field where not all of them are well applied.

We also have the problem that the market is full of products of very diverse origin, including contraband or pirated.

It is advisable to take a test in a serious place such as government kiosks, health institutions or a prestigious private clinical laboratory.

The tests are basically used for two things and it is not in a bad sense of the term.

One, corroborate a clinical diagnosis.

However, I have told all my patients not to get tested, why?

It is better that they assume that it is covid instead of going out on the street for several hours.

The other point for which they are useful is to keep track of what is happening at the population level.

For example, if you have results that a high percentage of the tests in the capital have come out positive, you realize that the circulation of the virus is very intense and you take the temperature of how the infection is evolving.

From the beginning, this is my point of view, evidence has been overrated.

And in part, this stemmed from the mistake of the director of the World Health Organization (WHO), Tedros Adhanom, when he said: "Tests, tests, tests", when 90% of the countries affiliated with the WHO did not have tests and they were not going to have them in years.

The Mexican infectologist Samuel Ponce de León. Gisela Maya Tapia (CC)

Q.

Recent evidence has shown a huge difference between getting vaccinated and not getting vaccinated against omicron.

How is this reflected in the mortality and hospitalization data for Mexico?

R.

It is evident that the vaccination process in Mexico has had a profound impact on what is happening in the transmission of omicron. Although there is beginning to be an impact on the hospital system, the number of very seriously ill patients or deaths has not increased significantly. Surely, it will start to increase. Due to the time of evolution of the disease, we would expect that it will probably be this week or the next when there will be the greatest impact on hospital occupation and possibly we will have a better idea of ​​what is going to be happening with people who have a serious illness, which are initially a much smaller proportion than what we had experienced. This is a consequence of vaccination, which at least in Mexico City met almost 95% of its expectations.There are missing sectors that it will be convenient to vaccinate at some other time and advance in coverage, but of course there is a huge impact of vaccination.

Q.

In general, what treatment should a vaccinated person who has been infected with a mild or moderate illness follow?

R.

_

My general recommendations would be to monitor heart rate, oximetry, and temperature.

If you have discomfort such as a cold, sore throat and general malaise for a few hours or a couple of days, you take paracetamol and stay in isolation for five days and notify your work or your colleagues.

Most people will have an infection without symptoms, but if the symptoms are minor, drinking plenty of fluids and paracetamol once, twice or three times a day is more than enough.

Throat discomfort can be treated by also taking a simple remedy such as honey with lemon or eucalyptus lozenges and/or an anesthetic medication such as benzocaine in lozenges of different flavors.

If you have a fever, chills, severe headache, chest discomfort, very severe fatigue, check your oxygen saturation with an oximeter.

If it drops below 92 or you feel very bad, you should see a doctor and/or go to the hospital medical care services.

A doctor may tell you to get tested for covid or influenza or both and may prescribe medication.

All these recommendations must be supervised by a trusted doctor to check allergies to some medicines or conditions such as diabetes.

Q.

Many doctors now prescribe azithromycin.

Do antibiotics work against covid?

A.

No way. In any of the cases that we have discussed, from what is covid to what looks like covid, there is no indication to receive antibiotics or antimicrobials. None.

It is very common to find prescriptions for azithromycin, ceftriaxone, levofloxacin and other antibiotics that have no reason to be prescribed.

Quite the contrary.

You lead the patient to be able to have a reaction to the drug and to spend significantly.

This increases the pressure on bacteria to generate bacterial resistance, which is going to be a very tough problem in the coming decades.

Unfortunately, nine out of ten patients you see will show you prescriptions with one or two antibiotics or antivirals that have no use or effect in these cases.

This does not serve what the population is experiencing in 99% of cases.

Q.

Other people take vitamins after getting infected.

Does this help fight the virus?

A.

There is

some

publications that suggest that vitamin D can help in the transit of the disease, but there is nothing very significant.

If you have a balanced diet, you shouldn't need to take additional vitamins.

Vitamins C and D are not contraindicated, they will surely not have any side effect, but they are not part of the main form against the disease either.

Q.

How many days do you recommend a person self-isolate after a positive diagnosis?

A.

The best-founded recommendation is that made by the US Centers for Disease Control and Prevention.

They reviewed roughly 100 studies and found that by day five, virtually no one was still infected.

The infection is much more intense in its multiplication and contagion during the first two days of illness.

Then it decreases drastically.

There are people who prefer to increase it to seven days to be safer.

Others go to 10 days.

This all stems from the first 14 days that were recommended two years ago, but we're past this.

It is also important to clarify that these recommendations are for vaccinated individuals.

For the unvaccinated, you may have to be more cautious.

Another recommendation that is fundamental is that after you get out of the contagion, you have to use the mask very strictly.

You can't go out without a mask.

Q.

There are some measures that we have adopted during the pandemic, but that are useless, such as the use of sanitizing mats.

What other actions do not work?

R.

There are a series of "magical things" that do not work.

Perhaps the most impressive thing is these "fumigations" that are put in some places, at the entrance of some buildings, like these tunnels that you enter and they splash you with a substance that is supposed to be a disinfectant, although we don't even know what it is.

They certainly have no effect.

Spraying people as if they were fumigated, as we saw a few weeks ago in the Basilica of Guadalupe, is of no use.

You have to use soap and water to wash a room in an office, in a school, in the house, you don't have to use a particular disinfectant.

The rugs are also good for nothing, maybe just tripping over and damaging people's shoes.

Taking temperatures in shops doesn't work either, despite the fact that they continue to be measured almost religiously.

Masks are only necessary for sample takers, doctors or chemists and other very specific cases, but outside of this there would be no need to wear masks.

Maybe if someone is on a plane and feels safer, it might not be unreasonable, but it's not necessary either.

Q.

If a person was recently infected, is it advisable to apply a booster dose?

A.

Yes. There is good clinical evidence.

Vaccinated people who had covid have to receive their booster.

Someone who has covid and is not vaccinated, of course they have to be vaccinated.

I would say that the sooner the vaccine can be given, the better.

If you can get the influenza and covid vaccine at the same time, without any problem.

If you can get the vaccine, take advantage and get it.

Q.

There is also a lot of concern about the combination of influenza and covid.

What is known about it?

R.

Indeed, there are people who can be infected simultaneously, but their evolution will depend on their vaccination status, their conditions, etc.

In general, there have not been particularly serious cases of this and it should not be a matter of concern for people.

Q.

Can the sequelae of covid be expected to be less with vaccination?

R.

It is something that is still being investigated.

What we know now about prolonged or long-term covid and medium- and long-term sequelae, we know in unvaccinated populations.

I believe that the impact is going to be much less in vaccinated people, but we still do not have certain data on this.

P.

At what point are we in this fourth wave and what should be on the radar in the coming weeks?

R.

We are about to reach the acmé [most intense phase of a disease] in our country.

In Mexico City, possibly we already are and in a couple of weeks it will start to decrease.

In other regions it will continue to increase until it reaches that acme.

Of course, we see that the engine of the epidemic in Mexico is in the capital, one in five cases occurs in the City and in the conurbation area with the State of Mexico.

As the pandemic subsides in Mexico City, it will be the best indicator of what happens in the rest of the country.

The cases of Baja California Sur and Quintana Roo are interesting and will depend on the flow of tourists.

In cities like Monterrey or Guadalajara, the acmé will arrive a little after Mexico City and the pandemic will begin to subside in two or three weeks.

Q.

Are there reasons to be optimistic?

R.

I am a chronic pessimist, but I think the worst is over in these previous 24 months.

We are living a moment that is not easy, but surely within four, eight, ten weeks we will have the data to say if we get rid of it or not.

What will happen next is much more difficult to anticipate.

Because dozens of variants are reported every day to the different authorities and one of these can hit us hard again.

They can be more complicated variants or ones that cause us less trouble.

One day less for this.

But governments have to think that 100 years do not necessarily have to pass for another pandemic of this size.

It could be earlier.

The population continues to grow, the agglomerations continue to grow, the areas of poverty continue to grow and all these circumstances can lead to another complicated situation, even more serious.

We have to identify it and react more quickly with more agile administrative systems.

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Source: elparis

All news articles on 2022-01-20

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