Author: sekomar

One year after a winter that featured the worst peak of the COVID-19 pandemic, health officials are concerned rising cases and a worse influenza season could strain hospital resources.

U.S. flu season ocurrs in the fall and winter, peaking December-February, the same time period in which record-high cases of COVID-19 overwhelmed hospitals across Arkansas and the country last winter. 

At that same time, Arkansas experienced flu numbers far below previous years’. Throughout most of the 2020-21 flu season, the percentage of outpatient hospital visits in Arkansas for influenza-like illness (ILI) hovered around the off-season baseline, according to ADH data. Throughout the past five years, that rate has averaged a peak of more than 6% in mid-February, but in February 2021 it was at the off-season baseline level of less than 1%.

This was likely because fewer students were in school and more people were staying home and masking up in public, said Dr. Jennifer Dillaha, ADH chief medical officer and medical director for immunizations and outbreak response. Uncharacteristic flu spikes in spring and summer 2021, when mask requirements were lifting and more people returning to their normal lives, support this hypothesis, Dilaha said.

But this year, with mask mandates nearly nonexistent and thousands more children in school, hospital visits for ILI and school absentee rates are on the rise. Both measures, which can help indicate the extent of seasonal respiratory virus spread, are meeting or exceeding past years’ averages most weeks.

“(The) average, you know, that kind of varies from year to year,” Dillaha said. “But we’ll have a real flu season this year, as opposed to last year.”

With COVID-19 cases also on the rise — active cases in Arkansas have risen 51% since hitting a trough Nov. 9 — Dillaha worries that coronavirus, flu, and other seasonal viruses like respiratory syncytial virus (RSV), could put many Arkansans in the hospital once again, she said.

“It would definitely add to increased stress on our hospital systems,” Dillaha said. “And that is one of my concerns for this winter. A lower number of COVID cases, but influenza could potentially make up the difference in a high level of hospitalizations again. We know that the flu puts a lot of people in the hospital.”

Dillaha will be watching pediatric respiratory illness caseloads especially closely, she said. The delta variant of the coronavirus affects children more severely than any previous variant. Children are also the group most likely to get severely ill from RSV, and along with the elderly are the group most impacted by severe flu, Dillaha said.

“Flu and RSV and COVID in children, the main hospital that would be taking care of them is Arkansas Children’s,” DIllaha said. “And we have limited capacity for handling small pediatric cases, small children in Arkansas. Fortunately, the severe COVID cases are a little bit older. But even if the hospital is full of flu and RSV, then it does present a problem for small children who need the specialty care or being put on the ventilator.”

Dr. Jessica Snowden, division chief for pediatric infectious diseases at Arkansas Children’s Hospital, said the past year and ½ of the pandemic has shown the hospital’s doctors, nurses and staff they can adapt to anything, and they are prepared for surging hospitalizations they might face this winter. The team is staying vigilant and preparing contingency plans, expecting to see more flu admissions during the season’s peak. she said. Meanwhile, baseline COVID-19 admissions are still higher than they were before the delta surge. 

“So far, knock on wood, we aren’t seeing a ton of flu, but we are seeing a lot of other viral illnesses co-infected with COVID-19 that make kids much more sick than either one alone do. Like RSV  or like human metapneumovirus…which is an RSV-like virus. And so we’re seeing a lot of really significant respiratory ailments, because they’ve got both of them at the same time. And it speaks to the importance of making sure we’re protecting from everything that we can.”

Dr. Amanda Novack is the medical director of infection prevention at Baptist Health, the state’s largest healthcare system. Novack said Baptist’s locations had almost no flu admissions last winter, although COVID-19 hit the system hard. She and her team are anticipating more flu hospitalizations this year.

“This pandemic has taught a lot of humility, and nobody knows the future,” Novack said. “But I think we would be foolish to not be prepared for a possible surge. Even if COVID is under control, you know, without anyone being exposed to flu last year, that kind of background immunity that every flu season adds to the community, we didn’t have that.”

Like Snowden, Novack feels confident her home-base hospital in Little Rock, stocked with ample ventilators and with several difficult COVID surges under its belt, is prepared for the winter.

Still, an influx of severely ill patients would be hard on a staff already exhausted from the pandemic and stretched thin by a nursing shortage affecting the entire U.S., she said. Novack wishes more people would wear masks in public, get vaccinated against COVID-19 and influenza and stay home from school or work when sick with any virus, she said.

“We’ve known for decades that wearing masks helps prevent the spread of respiratory viruses. But I think that, take the politics and the controversy out of it — if an individual wants to protect themselves then a mask is a great way to do that. And vaccinations also have become controversial, even though from a medical, scientific standpoint, they are not controversial, it is a no brainer. If you have an injection that can prevent you from getting sick with a virus, then that’s clearly better than getting sick with the virus.”

Dillaha and Snowden agreed, saying that getting vaccinated, masking and avoiding others when ill are the best ways for adults and children to stay out of the hospital and live healthy, normal lives this season.

“I’m hearing from organizations that are requiring vaccines that they are getting pushback from their employees about the flu vaccine,” Dillaha said. “So I think some of (the COVID-19 vaccine hesitancy) has carried over, and I hope that people will use this as an opportunity to learn more about the safety and effectiveness of vaccines so that they can make well-informed decisions.”

Sarah Komar, Arkansascovid.com

Skye Harris, a healthy, happy 18-year-old Rogers native, was enjoying a vacation in June when her head began hurting and she started feeling like she had a cold. On her way to the drug store, she collapsed, seized and lost her ability to speak and walk. In that moment, her life changed completely.

After returning home from the trip, Harris visited emergency rooms six or seven times, eventually testing positive for COVID-19 and being diagnosed with functional neurological disorder.

“Basically, whenever I get overstimulated or excited my body takes it out physically,” Harris said. “And that can look like I pass out, lose my ability to speak, have —they’re not seizures, but it looks like a seizure, it’s like a convulsion. Oh, I also lose my vision sometimes, and I have a lot of weakness on the right side of my body. So I walk with a cane a lot. And they think it’s because of COVID, because they used to only see five or six cases of this in teenage girls a year. Now, each hospital is seeing five or six cases a week.”

For many who live through COVID-19, the story doesn’t end when they leave the hospital or their at-home quarantine ends. The pandemic has led to a second health crisis of so-called “long COVID,” although recent discoveries might provide some hope to long-haulers.

Long-term COVID, also known as post-acute sequelae SARS-CoV-2 infection or PASC, can cause COVID-19 survivors to experience lingering or new symptoms that negatively impact their lives for weeks or months after infection. These can include symptoms similar to active infection or additional ailments like neurologic, lung and heart disorders. Preliminary evidence suggests that those with PASC, also known as long-haulers, might be more likely to develop autoimmune diseases and postural orthostatic tachycardia syndrome (POTS), a condition that affects blood circulation and heart rate.

Researchers led by Destin Groff, Ashley Sun and Dr. Anna Ssentongo found the median (IQR) rate of those experiencing symptoms six months after infection was 54% when they performed a literature review of 57 studies comprising more than 250,000 COVID-19 survivors. The review was published Oct. in JAMA Open, the American Medical Association’s open access medical journal.

The most common symptoms identified were neurological disorders including difficulty concentrating and memory problems, lung function issues and abnormalities on lung scans, fatigue and muscle weakness and mental health disorders like anxiety and depression.

After her diagnosis, Harris lost the ability to drive and had to close down the food truck she operated in Northwest Arkansas because of her illness. She has made countless visits to specialists and participates in physical therapy and cognitive behavioral therapy twice a week.

Researchers at the University of Arkansas for Medical Sciences, led by Dr. John Arthur, recently made progress toward understanding what causes PASC. They think some survivor’s bodies overproduce an antibody that attacks ACE 2, a protein on the surface of many cells, and leads to the buildup of a hormone that causes the immune system to attack the body. No other known virus triggers this antibody, Arthur said. 

Aurthur has been moved by the stories of COVID long-haulers whose lives have been devastated by the illness, and it has spurred his passion for the research, he said. Although the best way to avoid getting PASC is to protect oneself from getting COVID through vaccination and masking, there is hope for those currently suffering, Arthur said. The team hopes to begin treatment trials soon that could help reduce levels of the harmful antibody in patients. Long-haulers interested in participating can register at arresearch.org.

“One of the main messages I’m trying to get out is that things are going to get better for people. I know that a lot of people are really impacted by this, and some of them are feeling sort of desperate, but things are going to get better.”

Donn Seidholz, a retired private airline executive from Omaha, Nebraska, is living proof that things can improve. After contracting COVID-19 in summer 2020, Seidholz struggled with debilitating fatigue that would come on suddenly, brain fog that made it impossible to complete simple tasks, and a lingering loss of taste and smell, he said.

The illness was devastating for the former professional baseball player who was used to working out five days a week and was passionate about eating and cooking. After about a year of visiting many doctors who had few answers, and focusing on living a healthy lifestyle, Seidholz said his symptoms cleared up on their own.

“It just takes time and it feels like it’s never going away when you’re going through it,” Seidholz said. “But it does gradually get better. I mean, I just last night made chicken piccata, and actually, it tasted very good. And I could tell what I was eating and you know, six months ago, there’s no freakin way I could have done that.”

With no known cure for functional neurological disorder, Harris knows her disability will likely last years or a lifetime, she said. But Harris is staying positive and focusing on the good her illness has brought into her life, including the kindness of strangers, a new understanding of accessibility issues and an increased appreciation for what she has.

“It’s honestly made me a lot stronger person, so I’m not I’m not too mad about it,” Harris said. “You know, there are things that hold me back. But there’s also things that push me forward. So I’m not going to stop my life for something that can also push me forward.”

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