COVID-19 or Influenza, or Both? A Comparison and Algorithmic Approach to Management

Context: First cases of Coronavirus disease 2019 (COVID-19) were reported in December 2019. With more than 100 million confirmed cases 14 months later, the disease has become the worst public-health dilemma of the century. The rapid global spread of COVID-19 has resulted in an international health emergency, threatening to overwhelm health care systems in many parts of the world, especially poor resource countries. Evidence Acquisition: Influenza and COVID-19 have similar clinical symptoms, and both cause a respiratory illness that may vary from mild to severe. Both diseases have the same mode of transmission and require similar public health guidelines to prevent their spread, but their treatment strategies are different. In this study, an algorithmic method is proposed for managing patients according to their symptoms for each of these infections. Results: In fall and winter, infections with seasonal influenza and other respiratory viruses become common. As influenza also causes significant morbidity and mortality, especially at the two extremes of age and in those with compromised immunity, it is of major importance to know the similarities and dissimilarities between COVID-19 and seasonal influenza and plan appropriate public health measures to deal with each of these illnesses. Conclusions: Will there be a devastating combined epidemic of COVID-19 and influenza (COV-Flu) during the 2020 - 2021 season? Does co-infection increase the risk of severe illness or amplify virus shedding? Actually, we do not yet know the answers to these questions; so, in this article, first, we attempt to define the similarities and differences between COV-Flu. Then, we will have a brief discussion on how to manage patients presenting with symptoms suggestive of both diseases. However, as COVID-19 has been recognized as a pandemic since December 2019, the management of this emerging disease is rapidly evolving as new information is collected from different parts of the world.

Severe acute respiratory syndrome coronavirus-2: implications for blood safety and sufficiency

Background and Objective

Severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) is a novel coronavirus, first identified in China at the end of 2019 and has now caused a worldwide pandemic. In this review, we provide an overview of the implications of SARS‐CoV‐2 for blood safety and sufficiency.

Material and Method

We searched the PubMed database, the preprint sites bioRxiv and medRxiv, the websites of the World Health Organization, European Centre for Disease Prevention and Control, the US Communicable Diseases Center and monitored ProMed updates.

Results

An estimated 15%–46% of SARS‐CoV‐2 infections are asymptomatic. The reported mean incubation period is 3 to 7 days with a range of 1–14 days. The blood phase of SARS‐CoV‐2 appears to be brief and low level, with RNAaemia detectable in only a small proportion of patients, typically associated with more severe disease and not demonstrated to be infectious virus. An asymptomatic blood phase has not been demonstrated. Given these characteristics of SARS‐CoV‐2 infection and the absence of reported transfusion transmission (TT), the TT risk is currently theoretical. To mitigate any potential TT risk, but more importantly to prevent respiratory transmission in donor centres, blood centres can implement donor deferral policies based on travel, disease status or potential risk of exposure.

Conclusion

The TT risk of SARS‐CoV‐2 appears to be low. The biggest risk to blood services in the current COVID‐19 pandemic is to maintain the sufficiency of the blood supply while minimizing respiratory transmission of SARS‐CoV‐19 to donors and staff while donating blood.