An Ounce of Prevention: Managing Influenza and COVID-19 in Long-Term Care

Long-term Care Chronicles With Robbie Hilliard, MSN, RN, CIC

As influenza and COVID-19 overlap in long-term care facilities, testing, transmission-based precautions, and antiviral treatments are essential to manage and prevent further outbreaks.

Autumn is almost here, which means cooler temperatures, beautifully colored trees, crunchy leaves, and the onset of respiratory illnesses. The only thing more challenging than influenza season in a long-term care setting is cocirculating COVID-19 during influenza season. Elderly residents in long-term care facilities often fall ill during this time of year, but now there are several differential diagnoses to explore. When a resident presents with symptoms of acute respiratory illness in long-term care, what should be the next step?

Case Study: Mr. Smith is a 78-year-old male who has lived at a long-term care facility for 5 years. He has a history of chronic obstructive pulmonary disease and lives in a single room. One morning, he presented with a headache, fever, cough, shortness of breath, body aches, and fatigue. The facility has 1 known case of influenza and 1 known case of COVID-19.

Unfortunately, symptoms of COVID-19 and influenza are very similar, and symptoms alone will most likely not be enough to make a distinct diagnosis. Both are contagious respiratory illnesses caused by viruses, but the CDC suspects COVID-19 spreads more easily than influenza. COVID-19 can cause more severe illness and may be contagious longer than influenza.¹

What is the first thing to do when this happens?

When residents become symptomatic, the first step is to place them in transmission-based precautions using the personal protective equipment recommendations for SARS-CoV-2 infection. The resident should be in a single room or remain in their current room with the door closed if possible. Assuming it is COVID-19, this will slow the spread until a diagnosis can be confirmed.

Next, test for both viruses. Excluding one will not exclude the other, so for time’s sake, it is best to test for both to begin with. The most sensitive test for SARS-CoV-2 is by nucleic acid detection or by SARS-CoV-2 antigen detection assay.¹

If negative, consider testing for other respiratory pathogens, such as respiratory syncytial virus or bacterial testing for any pathogens circulating in the community. Keep the resident on transmission-based precautions until a diagnosis is confirmed.

Antiviral treatment should be prescribed for influenza-positive patients to shorten the duration of illness and prevent further complications. CDC advises:

The facility should promptly initiate antiviral chemoprophylaxis with oral oseltamivir to all exposed individuals (eg, roommates) of residents with confirmed influenza. When at least 2 residents are ill within 72 hours of each other with laboratory-confirmed influenza, the facility should expand antiviral chemoprophylaxis to non-ill residents living on the same unit as the residents with influenza (outbreak-affected units), regardless of influenza vaccination status.¹

For SARS-CoV-2 patients, follow the National Institutes of Health COVID-19 Treatment Guidelines Panel,² the most current guidelines for residents with mild-to-moderate COVID-19 who are at high risk for severe progression to severe COVID-19. Ensure that the latest recommendations on Therapeutic Management of Nonhospitalized Adults With COVID-19 are available for providers to review as recommendations change periodically.³

Repeating a standardized process each time a resident becomes symptomatic will decrease chaos and hasten the isolation from others to prevent the further spread of germs. Defining tangible criteria such as a positive COVID-19 test, symptoms of COVID-19, or exposure to COVID-19 are critical components of the prevention process. These components are also relevant to staff who work in these areas when conducting surveillance. Ensuring vaccinations are up to date for those who can receive them will aid in slowing the spread as well.

The great author F. Scott Fitzgerald wrote, “Life starts all over again when it gets crisp in the fall.” The cycle of COVID-19 versus influenza season was set in motion in 2020 and looks likely to continue in perpetuity. The best we can do is prepare, and this means disciplining ourselves to ensure that our areas at greatest risk are ready.

References

1. Similarities and Differences between Flu and COVID-19. CDC. Published July 10, 2020. September 10, 2024. https://www.cdc.gov/flu/symptoms/flul-vs-covid19.htm
2. National Institutes of Health (NIH). Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. Bethesda, MD: NIH; April 21, 2021 - February 29, 2024. Accessed September 10, 2024. https://www.ncbi.nlm.nih.gov/books/NBK570371/
3. National Institutes of Health (NIH). Nonhospitalized Adults: Therapeutic Management. COVID-19 Treatment Guidelines. Accessed September 10, 2024. https://www.covid19treatmentguidelines.nih.gov/management/clinical-management-of-adults/nonhospitalized-adutls--therapeutic-management/