Masks work, COVID Thanksgiving tips and more advice from infectious disease experts

Two infectious disease specialists offered some advice, during a Facebook live interview, on how to protect yourself through flu season under COVID-19, why the flu shot is very important this year, how to protect yourself from misinformation around COVID and more.

Dr. Wong and Dr. Chagla strongly encourage people to get a flu shot this season

Two infectious disease specialists offered some advice, during a Facebook live interview, on how to protect yourself through flu season under COVID-19, why the flu shot is very important this year, how to protect yourself from misinformation around COVID and more.

Read an edited and abridged transcript below or hit play above and watch the entire interview with Dr. Jacqueline Wong, a pediatric infectious disease specialist at McMaster Children's Hospital and Dr. Zain Chagla, infectious diseases physician and medical director of infection control at St. Joseph's Healthcare Hamilton. They spoke with the CBC's Conrad Collaco on Thursday and took questions from members of the public.

Dr. Jacqueline Wong and Dr. Zain Chagla 

How can we tell the difference between the flu and COVID-19?

Dr. Wong: So. there's definitely a lot of overlap with the symptoms and we see this every fall season — September, when the seasons change — on the pediatric side. Trying to tell the difference between a cold, the flu and now COVID-19 is difficult. Even the most astute clinician may not be able to tell the difference when you see the patient in front of you. And so with the assessment centers that are out there, with the changes in how patient flow is happening in doctors' offices, the most important thing, if you want a definitive answer, is to get assessed and tested.

Right now, if you have symptoms it's important to protect the community around you and to stay home. Obviously, if you have an emergency, call 911 but stay home and get in touch with your primary care provider so that you can talk through the symptoms that you have and then they can help you decide what the next step is in terms of trying to get to the bottom of what symptoms you might be feeling, be it a cold, be it influenza or be it COVID-19. 

Dr. Chagla: I don't think any physician at the bedside is going to be able to put their nose on one or the other. There are a couple of little differences. But again, it's not going to be every patient that has those differences. And so realistically, we're left with testing to deal with which one or the other.

What more should people be doing to avoid COVID and the flu?

Dr. Chagla: When we look at what happened in March and April is everyone was in lockdown indoors, distance, wearing masks and really monitoring their symptoms, we saw one of the best influenza years on historical record in Ontario and in Canada. And that really is a testament to those controls. Now, it's very different this year, obviously, in the sense that we need kids to be at school. We have workplaces that are opened up again. And so that complexity of having no one enter society is really not possible. This is something we hold off on to the last possible moment. 

But we do know those controls are important, that we wear a mask while indoors and you don't go out while sick, even experiencing minor symptoms and going to get tested in that context. We're washing our hands regularly. We're distancing from others. We're recognizing high risk settings like break rooms or those types of settings where we can transmit back and forth and not share drinks or any other shared items.

The only difference between the two is the one tool we have for influenza we don't have for COVID-19 is a usable vaccine. So, that is going to be the other tool in the chest for people to reduce their rates significantly. In good years, we get 60 percent prevention with influenza vaccine. And so to drop that rate in the community by 60 percent is incredible. 

The flu shot

How important is the flu shot this year compared to previous years? 

Dr. Wong: It's so important to get the flu shot this year and to get it as soon as you can access it. Pharmacies are rolling it out this week to try to make it available for people in the community. And as Dr. Chagla mentioned, this is the one tool that we have for reliably preventing influenza. But also looking at it from a societal perspective, probably it's talked about a lot in the news about surge capacity and our ability as a health care system to support people who are unwell right now, be it outpatient or in the inpatient setting or ICU setting. If we can decrease the number of people who become ill and need to come into hospital, that would be really important for having the capacity to look after patients who are very sick with COVID or, as Dr. Chagla mentioned, with other noninfectious things for people who need their surgeries done that had them put off from the spring. At so many different levels, getting the influenza vaccine this year is really important. 

At what age is it safe for someone to get a flu shot?

Dr. Wong: Public health societies recommend offering the flu shot to children as young as six months. We do know that children under the age of six are at higher risk of complications from influenza be it more severe illness, be it admission to hospital. And so that's why we really strongly encourage the vaccination in this younger age group to protect them from getting the illness, becoming unwell, or if they do get sick, like Dr. Chagla said, the symptoms will hopefully be milder. 

If we're washing our hands, socially distancing and wearing masks to avoid COVID will this help us avoid the flu?

Dr. Chagla: Yeah, absolutely. I think we saw this again in March and April as people were less communicative and less in each other's environments. We saw that in Australia this year as their season went through, although they had some advantages in that they have nice outdoor environments where people can congregate. But we did see other respiratory viruses go down significantly as part of this. So, those benefits that you have for handwashing,  for sanitisation, for masking, for physical distance, they aren't COVID specific. They're going to help with reduction in some of the viruses during the season for sure.

The misinformation is 'challenging' 
Live at noon on Thursday Dr. Zain Chagla (left), infectious diseases physician and medical director of infection control at St. Joseph's Healthcare Hamilton and Dr. Jacqueline Wong, a pediatric infectious disease specialist at McMaster Children's Hospital spoke about what to expect as flu season and COVID-19 converge. (St. Joseph's Hamilton and McMaster Children's Hospital)

Most people seem to believe it's a good idea to wash your hands. Not everybody believes it's a good idea to wear your mask. What do you say to people who don't believe what the majority of doctors are saying to them about the virus and how to keep people safe?

Dr. Wong: This is definitely a challenging time for a lot of us right now in health care, outside of health care, in our personal circles as well. There's a lot of different information that is being made available to people and that really sets this pandemic apart from pandemics prior or other epidemics prior to the involvement of social media as well as the easy access to information. It is important to help people or redirect people to reliable sources of information such as websites that are offered by public health. For us, the Canadian Pediatric Society and other advocacy groups for the well-being of children and other Canadian citizens as well, (we want people) to make sure that they're tapping into the most accurate and up to date information. And certainly venues like this offered by CBC as well as other news broadcasting systems are trying to really help play that societal role in easy access to health care providers who are working in the field and also working hard to stay up to date on this information. I think at the end of the day, it's a conversation. It's a conversation that we always want to have civilly and respectfully... And if we remind people that there are vulnerable members of our families and communities out there, that sometimes can also help with the conversation. 

Do masks work? The story of Great Clips salon in Springfield, Missouri

Dr. Chagla: We learned very well that although most people still develop symptoms, the time they're infectious starts usually 48 hours before their symptoms start. And it's hard for me, you or anyone else to know what their 48 hours before symptoms start are because they feel fine. But that's the time where this disease spreads... Maybe you're symptomatic. Realistically, we have to treat each of all of us as infected, to enter society knowing that we could be infectious to others. And that mask is the last barrier of protection to help. The physical distancing, appropriate ventilation, not going out while sick — those are going to be huge controls to prevent major transmission events. But for us to be able to re-engage in society, the masks are our biggest tool.

I'll give you one really good example. So there was a salon in the United States where two hairdressers worked, Both had COVID. Both were sick and symptomatic for about eight days. Every single one of their customers wore a mask and they wore a mask with it. And you can imagine a hair salon — two people really close contact. It's hard to really distance in that context. Zero people were infected with COVID. Over a hundred cases traced. Zero were infected with COVID. And so it's just a proof of principle to this concept where masks are powerful intervention for those things that we can't control. Their use in society really does have benefits for us to really engage with society again. 

Thanksgiving outdoors?

What advice do you have for people who want to know if they should get together for Thanksgiving with friends or extended family?

Dr. Wong: There are ways where friends and family can still give thanks, come together and enjoy this fall time tradition. There are different ways to go about it safely. We've definitely heard of different families and friends opting for an outdoor lunch Thanksgiving dinner so that you can be in an environment where it's easy to physically distance, where ventilation is a non-issue. I think be very honest and open with your, even your immediate family, if you're choosing to consider having a meal together in an enclosed space such as indoors. It's important to talk about the risk, to talk about how people have been feeling, to talk about how we can keep ourselves at a safe distance from each other rather than sitting all cramped together at the same table. Can we leave the windows open? There are many different tools that people can use... We're talking about smaller numbers of people than we're probably used to gathering and changing the environment in different ways so that we can maintain distance, so that we can improve ventilation and so that we can be safe with each other as possible. 

Dr. Chagla: It's not going to be the perfect Thanksgiving. I think we're going to not have the large meal with everyone that we want knowing that indoor, poorly ventilated, crowded settings is where this virus transmits. When you eat a meal it's very hard to have a mask on, too. So, you know, there are some you know, some concessions we have to make... And if you want to take an extra layer of precaution, maybe it's not a meal this year. Maybe it is a day outdoors in the park with someone that's the way we actually do things and socialize. We are used to Thanksgiving being a meal, but there's ways to do it safely that we get together and interact with each other and still have that bonding connection that we're so desperately seeking, but not necessarily introducing the risk with it. 


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