EDUCATION REGARDING PREVENTION, TESTING, AND TREATMENT
It is important that patients receive accurate education regarding prevention, testing, and treatment of both influenza and COVID-19. Sharing such knowledge is intended to help reduce the number of infections, increase testing, and implement treatment initiatives.
Influenza Education
There are steps that individuals can take to prevent contracting the flu. The most important step is to receive an annual flu vaccine (see also “2022–2023 Influenza Vaccine” later in this course). Children younger than 6 months are at risk but too young to be vaccinated. People who care for infants should be vaccinated instead.
Additional actions include:
- Avoid close contact with people who are sick.
- Stay at home when ill.
- Cover mouth and nose when sneezing or coughing.
- Avoid touching eyes, nose, or mouth.
- Perform frequent hand hygiene.
- Clean and disinfect surfaces and objects that may be contaminated.
- Stay at home for at least 24 hours after fever is gone except to obtain medical care or other necessities. (Fever should be gone without the need to use a fever-reducing medicine.)
- Take flu antiviral drugs if prescribed.
(CDC, 2021g)
The most common tests to detect influenza viruses are rapid influenza diagnostic tests (RIDTs), which detect the virus antigens that cause an immune response. Results are available within about 10–15 minutes. RIDTs are not considered as accurate as other flu tests. Rapid molecular assays are more accurate than RIDTs and provide results in 15–20 minutes. Other more accurate and sensitive tests must be performed in specialized laboratories. These tests require a nose or back-of-throat swab, and obtaining results takes several hours (CDC, 2021h).
In a patient infected with influenza, antiviral drugs may be a treatment option. Antiviral drugs can lessen symptoms and shorten the time of illness by one or two days. Such drugs can also prevent serious flu complications such as pneumonia. Antiviral drugs work best when taken within 48 hours of the onset of symptoms, but they may still have some benefit even if taken later. U.S. Food and Drug Administration (FDA)–approved antiviral drugs include:
- Tamiflu (oseltamivir phosphate)
- Relenza (zanamivir)
- Rapivab (peramivir)
- Xofluza (baloxavir marboxil)
Other treatment measures are largely supportive in nature. These include taking acetaminophen for fever, staying hydrated, and getting plenty of rest (CDC, 2021i; NIH, 2021).
COVID-19 Education
The CDC (2022o) offers the following recommendations on how individuals can protect themselves and others from becoming infected or sick with COVID-19:
- Get vaccinated and stay up to date on COVID-19 vaccines.
- For everyone ages 2 years and older, properly wear a well-fitting mask indoors and in public areas where the COVID-19 community level is high, regardless of vaccination status.
- For everyone ages 2 years and older (including passengers and workers), properly wear a well-fitting mask or respirator in indoor areas of public transportation (e.g., airplanes, trains, subways) and transportation hubs (e.g., airports, stations, seaports), especially in locations that are crowded or poorly ventilated, such as airport jetways.
- Inside the home, avoid close contact with sick people and, if possible, maintain six feet between the person who is sick and other members of the household. If taking care of someone who is sick, properly wear a well-fitting mask.
- Indoors in public, if not up to date on COVID-19 vaccines, stay at least six feet away from other people, especially if at higher risk of becoming very sick with COVID-19.
- Avoid poorly ventilated spaces and crowds.
- Test to prevent spread to others.
- Wash hands often with soap and water for at least 20 seconds (or use a hand sanitizer that contains at least 60% alcohol if soap and water are not available), especially:
- Before eating or preparing food
- Before touching one’s face
- After using the restroom
- After leaving a public place
- After blowing one’s nose, coughing, or sneezing
- After handling one’s mask
- After changing a diaper
- After caring for someone who is sick
- After touching animals or pets
- If not wearing a mask, cover coughs and sneezes with a tissue; throw used tissues in the trash. Immediately wash hands with soap and water for at least 20 seconds (or use a hand sanitizer that contains at least 60% alcohol if soap and water are not available).
- If wearing a mask, cough or sneeze into the mask. Put on a new, clean mask as soon as possible and wash hands.
- Clean and disinfect high-touch surfaces regularly or as needed after having visitors in one’s home (i.e., tables, doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets, and sinks).
- If someone is sick or has tested positive for COVID-19, disinfect frequently touched surfaces.
- Monitor one’s health daily and be alert for symptoms such as fever, cough, and shortness of breath; take one’s temperature if symptoms develop.
- Avoid touching eyes, nose, and mouth with unwashed hands.
DIAGNOSTIC TESTING FOR COVID-19
There are several FDA-approved tests for diagnosing COVID. Viral testing can be done in a laboratory, at a testing site, or at home or anywhere else. Viral tests do not detect antibodies and do not measure immunity level. Specimens from the nose or mouth are analyzed (CDC, 2022p).
Testing Guidelines
The CDC offers the following guidelines for testing:
- If symptoms of COVID-19 are present, get tested immediately and follow current quarantine guidance while waiting for results. If no symptoms are present, go to Step 2.
- If exposed to someone with COVID-19, get tested at least five days after exposure. Follow quarantine guidance while waiting to test. If no such contact has occurred, go to Step 3.
- If testing is needed for travel, follow destination requirements.
(CDC, 2022p)
Types of Tests
The FDA has approved the following types of tests for diagnosing COVID-19:
- RT-PCR test: Also referred to as a molecular test, this test detects genetic material of the virus using a technique called reverse transcription polymerase chain reaction (RT-PCR). A nasopharyngeal swab is inserted into the nostril, and fluid is obtained from the back of the nose. Shorter swabs may also be used. Results may be available in minutes if analyzed onsite and within in 1–3 three days or longer if sent to an outside lab. RT-PCR tests are quite accurate when performed properly by a healthcare professional, but they can miss some cases of COVID-19 (i.e., false negative).
- Antigen test: This test detects particular proteins in the virus. A long nasal swab is used to obtain a fluid sample. Some antigen tests are able to produce results in minutes. A positive antigen test result is considered accurate when instructions are carefully followed. However, there is an increased chance of false-negative results. A RT-PCR test may be recommended to confirm a negative antigen test result.
Antibody tests (also known as serology tests) may be able to determine if someone has had a past infection with the COVID-19 virus, but antibody tests should not be used to diagnose a current infection. Their purpose is to detect past infections (CDC, 2022q).
A self-test for COVID-19 (also known as an at-home test, home test, or over-the-counter [OTC] test) gives rapid results and can be performed anywhere regardless of vaccination status or whether or not symptoms are present. Free COVID-19 at-home tests may be available at certain pharmacies or through local health departments (CDC, 2022r) (see “Resources” at the end of this course).
COMBINED COVID-19 AND FLU TEST
A PCR test called the Flu SC2 Multiplex Assay has been developed to detect any of the following three viruses at the same time: SARS-CoV-2, influenza A, and influenza B. However, a negative test does not rule out the possibility of any of these infections. Healthcare providers may take further steps such as additional testing and exposure information as part of the diagnostic process (Mayo Clinic, 2022e).
COVID-19 TREATMENT
Medications used in the treatment of COVID-19 are available by prescription only. These medications must be started within days of symptom development. Medications include antiviral treatments and monoclonal antibodies, which are described in the table below.
| Treatment | Who | When | How |
|---|---|---|---|
| (CDC, 2022s) | |||
| Nirmatrelvir with ritonavir (Paxlovid) (antiviral) | Adults; children ages 12 years and older | Start as soon as possible; must begin within 5 days of when symptoms start | Taken at home by mouth |
| Remdesivir (Veklury) (antiviral) | Adults and children | Start as soon as possible; must begin within 7 days of when symptoms start | Intravenous (IV) infusions at a healthcare facility for 3 consecutive days |
| Molnupiravir (Lagevrio) (antiviral) | Adults | Start as soon as possible; must begin within 5 days of when symptoms start | Taken at home by mouth |
In addition to medications, supportive measures include over-the-counter medications such as acetaminophen (Tylenol), rest, and adequate fluid intake.
PREVENTIVE MEDICATION
The FDA has issued an emergency use authorization (EUA) for tixagevimab plus cilgavimab (Evusheld) in adults and children ages 12 years and older as a preventive measure against COVID-19. Evusheld consists of two monoclonal antibodies provided together to help prevent infection with the SARS-CoV-2 virus. A healthcare provider administers Evusheld as two separate consecutive intramuscular (IM) injections at a doctor’s office or healthcare facility. If someone is moderately or severely immunocompromised or severely allergic to COVID-19 vaccines, that person may be eligible for Evusheld (CDC, 2022s).
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