“As we get further away from the COVID-19 pandemic, we’ve seen an increase in vaccine hesitancy, and this flu season could be much worse if too few people get vaccinated,” said Michael Ben-Aderet, MD, medical director of Hospital Epidemiology at Huntington Health, a Cedars-Sinai affiliate, and associate director of Hospital Epidemiology at Cedars-Sinai Medical Center.

Starting today, Cedars-Sinai primary care physicians and pediatricians are offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 18 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Brentwood, Culver City, Marina del Rey, Playa Vista, Santa Monica and Tarzana.

Vaccination rates have fallen since the height of the pandemic. An estimated 52% of people in the U.S. received a flu shot in 2021, compared with less than 44% during the 2025-2026 flu season, according to the Centers for Disease Control and Prevention. Meanwhile, the flu continues to take a serious toll, killing about 45,000 people in the U.S. during the 2024-2025 flu season and sending 710,000 people to the hospital.

“The flu shot remains the most powerful tool available to help prevent serious illness caused by the influenza virus,” Ben-Aderet said. “I urge everyone eligible to receive the vaccine to get it.”

The Cedars-Sinai Newsroom spoke with Ben-Aderet about what to expect this flu season, when to get the flu shot, how to recognize flu symptoms, how to treat it, and what the newly approved mRNA flu vaccine means for the public.

When is the best time to get the flu shot?

September and October are a good time to get vaccinated, before flu activity typically picks up in November or December. It takes about two weeks for the body to develop an immune response to the vaccine.

The vaccine is recommended for eligible adults and children older than 6 months, according to physician organizations like the American Medical Association. When available, a high-dose flu vaccine is best for those 65 and older because immune response to vaccines can decline with age.

Will the new mRNA flu vaccine be available this year?

The U.S. Food and Drug Administration approved the first mRNA flu shot in early August. Vaccines made with this technology can be developed more quickly, which could allow for a better match to circulating strains of the virus if they change during a season. However, it is not yet clear when the vaccine will be available or which patients will be eligible. Regardless, it’s great to have another tool to fight the flu.

What are symptoms of the flu?

Flu symptoms can include nasal congestion, fever, body aches, cough, sore throat, fatigue, headaches. Vomiting and diarrhea tend to be more common in children. People with the flu can be contagious a day before symptoms start and as long as five to seven days after becoming ill. It’s best to stay home and avoid spreading the virus during that time, and until any fever has resolved.

What flu treatment options are available?

A mild illness can be treated at home with fluids, rest and Tylenol. Those who are very sick or at higher risk for a serious illness—including older adults, people with weakened immune systems and those with chronic health conditions—should speak with their physician at the first sign of illness to determine whether an antiviral medication like Tamiflu would be right for them. Antivirals should be started within two days after symptom onset to be most effective.

Children with mild illness also will improve at home with supportive care. Parents should watch for worsening symptoms and monitor children 2 and younger to make sure they eat and drink enough. Avoid aspirin when treating a viral illness like the flu in children. Aspirin has been linked to Reye’s syndrome, a rare but dangerous condition that causes brain swelling and liver damage and most often appears in children. As with adults, higher-risk children might need an antiviral treatment prescribed by a physician soon after symptoms develop.

When is it time to see a doctor in person or through a virtual appointment?

For those with a mild illness, a virtual visit through a mobile app like Cedars-Sinai Connect is a convenient way to get guidance on the treatment options. Cedars-Sinai Connect providers can order a flu test to rule out other illnesses, like COVID-19, or to prescribe Tamiflu. Over-the-counter flu tests also are available at most pharmacies.

People with more severe symptoms should see their physician in person or visit urgent care. Those symptoms include a very high fever, loss of appetite, trouble breathing or an inability to keep fluids down, as well as symptoms that are not improving. The same applies to people with underlying health conditions.

Read more from Cedars-Sinai Stories and Insights: When to Go to the ER for the Flu

“It seems to be a more aggressive strain, and it seems to be a tougher problem,” Sam Torbati, MD, co-chair and medical director of the Cedars-Sinai Emergency Department, said of this year’s flu. “Last year, I don't recall this many patients becoming this ill.”  

Torbati cautioned that it's still very early in Los Angeles’ 2026 flu season, particularly because in the U.S., the flu tends to start along the East Coast and spread westward.  

“It may get much worse,” he said.

The Cedars-Sinai Newsroom spoke with Torbati to learn why patients are getting so sick, how to treat the flu and how to avoid a serious illness.

Who needs emergency care for the flu?

We're seeing a lot of older patients who live by themselves, and if somebody is not keeping an eye on them and they become sick, then no one is taking care of them. They could be lying in bed for two days getting very dehydrated and getting into trouble.

There are also many patients with chronic diseases who develop the flu, and two or three days later they're wiped out. When they come to the hospital, sometimes they’re dehydrated, sometimes they have a bacterial infection and sometimes it's just the flu itself.

The flu, in and of itself, can cause significant problems for patients. It can make them very sick, can make them very much out of it to the point that they can't stand, become dehydrated, and hospitalization becomes necessary to get them back on their feet.

How bad is flu season so far this year?

Around the second week of December, we started seeing a lot of influenza patients coming to the Emergency Department. That spike in flu activity was similarly seen throughout the county. We're seeing patients—the very young, the very old—everybody that gets affected by flu.

We did anticipate, based on some of the predictions from the southern hemisphere, that we were going to see a moderately severe flu season.

What are the most common flu symptoms right now?

In the early phase, we typically see fever, body ache, bone pain, runny nose, cough. The fever usually lasts anywhere from two to five days. Fever tends to stop, and then we end up having a lot of the lingering symptoms. Some patients have coughs that linger for a while. Some can have congestion that can linger for a while. But the average is a good seven to 10 days. So people should expect if they get sick, that it may take that long until they're back to normal, to the point that they feel 100%.

What is the best way to treat the flu?

If you're healthy and younger and you have a viral infection with flu-like symptoms, you basically need to take care of yourself. If you're coughing a lot, take cough medication. If you have a fever, take Tylenol or Motrin. Rest, isolate, drink a lot of fluids so you don't get dehydrated.

For patients who have shortness of breath, asthma or respiratory issues—or for older patients who are developing more severe symptoms—a doctor's visit may become important primarily to make sure that there isn't any complication.

For patients who have underlying medical illnesses—heart failure, COPD (chronic obstructive pulmonary disease), severe asthma, and transplant patients—the sicker and more complicated their medical history is, and the sicker they feel, the more likely it is that a hospital would be helpful, and coming into the ER would be helpful. For some patients, we will prescribe an antiviral called Tamiflu to reduce the risk of a more serious illness if the medication can be started early enough.

What is the best way to avoid a serious flu illness?

It's still not too late to get a vaccine. And although the vaccines are not perfect—they don't completely prevent flu—there is ample evidence to show that they can reduce the severity of what flu does.

Cedars-Sinai Stories and Insights: When to Go to the ER for the Flu

Cedars-Sinai experts recommend getting the flu shot starting in September before flu season begins as early as November. They say vaccination is the most powerful tool to avoid influenza-related hospitalizations or worse. As many as 130,000 people in the U.S. died from the flu last year, according to estimates from the Centers for Disease Control and Prevention.

“By getting the flu shot, you’re not only protecting yourself, you’re protecting your family and vulnerable members of the community who would suffer a more serious illness,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and associate professor in the Department of Medicine.

Although vaccination is the best way to prevent the flu, Grein also recommends washing hands thoroughly and often, avoiding others who are sick, and wearing a mask when not feeling well to avoid spreading an illness to others.

The Cedars-Sinai Newsroom spoke with Grein and other Cedars-Sinai specialists about this year’s flu shot recommendations, how to manage flu symptoms and where to seek care during a flu illness.

Who Should Get the Flu Shot?

There are no significant changes to flu shot recommendations this year, Grein said. The vaccine is still advised for eligible adults, teens and children more than 6 months old, according to the Centers for Disease Control and Prevention. Those 65 and older are still encouraged to get a high-dose flu vaccine if available because it elicits a stronger immune response, and older adults’ immune systems weaken with age.

“If a high-dose flu shot is not available, older individuals should receive a standard dose, rather than skipping the shot,” Grein said. “It’s critical for older adults to protect themselves.”

Children 6 months to 8 years old who have never received a flu vaccine should receive two doses, spaced four weeks apart, said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s.

“Ideally, parents should vaccinate their children before the end of October to ensure protection before peak flu season,” Soni said.

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

How to Treat Flu Symptoms

Like other upper respiratory infections, flu symptoms include nasal congestion, fever, body aches, cough, sore throat and fatigue. Most people with mild symptoms will improve at home with fluids, a pain reliever such as Tylenol and rest, Grein said. Those at high risk of more serious infection—older adults, immune-compromised individuals and others with chronic health conditions—should speak with their physician soon after symptoms appear to find out whether an antiviral medication like Tamiflu would be right for them.

Those with more severe symptoms—a very high fever, loss of appetite or inability to keep fluids down—should see their physician or visit urgent care, said Jonathan Weiner, MD, chair of the Cedars-Sinai Medical Group’s Department of Primary Care and Acute Care Medicine.

Life-threatening symptoms like difficulty breathing should immediately be addressed in the nearest emergency department.

Flu Treatment for Children

Mild flu symptoms in children look similar to those of an adult and will likewise improve with fluids, rest, and Tylenol or ibuprofen, Soni said. She cautioned against giving children aspirin because of the risk of contracting Reye’s syndrome, a rare but serious illness linked to aspirin. Higher-risk children might need an antiviral treatment prescribed by a physician.

Soni explained that children 2 and younger run a high risk of dehydration, so their parents should make sure they drink and eat enough. She also advised parents to watch for signs that their child’s symptoms might be escalating.

“If a child is struggling to breathe, or showing signs of severe fatigue, vomiting or dehydration, they should be seen promptly by their physician or in the emergency department,” Soni said.

Where to Get Care for the Flu

For children and adults with milder symptoms, a virtual visit through a mobile app like Cedars-Sinai Connect is a great first step to get reassurance or guidance on the best treatment options, Weiner said.

“A physician or other provider can see you, assess how sick you appear and determine if you need to be seen in person or if you can manage your illness at home,” said Weiner, who treats patients in person and via Cedars-Sinai Connect. “If we determine that you need to see your Cedars-Sinai primary care physician or you need to go to urgent care for your symptoms, your provider will see the notes from your virtual visit in your chart because we all share the same Cedars-Sinai medical record.”

If a flu test is needed to rule out other illnesses or for a Tamiflu prescription, Cedars-Sinai Connect providers can order one through a streamlined visit at one of Cedars-Sinai’s urgent care locations. Patients also can get an over-the-counter test at their local pharmacy. Weiner said it’s good to know if you have the flu so you can avoid spreading the illness to others. People are contagious a day before symptoms start and up until their fever has resolved and symptoms are improving—as long as five to seven days after getting sick.

If symptoms do not improve, other causes of upper respiratory tract infections need to be ruled out, which could require in-person treatment, Weiner said. He emphasized that an in-person appointment also is recommended for patients with underlying conditions, high fever, trouble keeping food and liquids down, and for anyone who is having trouble breathing.

Read more on the Cedars-Sinai Blog: Flu and RSV: How to Protect Yourself Now

“Cancer patients are a vulnerable population,” said Jane Figueiredo, PhD, director of Community Health and Population Research at Cedars-Sinai and senior author of the study. “Their immune systems can be weakened by their disease and the treatments they receive, which is why major health organizations recommend that these patients be vaccinated against COVID-19. Our study supports these recommendations. We used real-world data across four major health systems in the U.S. to show that these booster vaccines reduce the risk of hospitalization and severe illness.”

Investigators analyzed data on more than 161,000 patients treated for cancer during 2022 and 2023 at Cedars-Sinai, Kaiser Permanente Northern California, Northwell Health, and the Veterans Health Administration.

The data showed COVID-19 boosters reduced cancer patients’ hospitalizations and ICU admissions by 29% and prevented one hospitalization or ICU admission for every 150-166 boosted patients.

“The reduction in hospitalizations was significant, and the number of patients we needed to treat to see a benefit to the boosters is quite low,” said Figueiredo, who is also program leader of Cancer Prevention and Control at Cedars-Sinai. “This shows a great benefit to our cancer patients and should encourage patients to discuss vaccination with their healthcare providers.”

Figueiredo noted that among their sample, the percentage of patients receiving boosters was quite low. By Jan. 1, 2022, 68% had received a booster. And after updated boosters targeting more than one COVID-19 strain had become available, only 38% of patients had received one.  

“Whether this is due to patient concerns about safety or provider uncertainty about whether to administer a vaccine during treatment is not clear,” Figueiredo said. “What is clear is that we need to advocate strongly for vulnerable groups, including cancer patients, to receive these vaccines.”

Figueiredo noted that the COVID-19 pandemic was the first opportunity for investigators to examine data on mRNA vaccines, and five years later there is still much to learn about the effectiveness of these vaccines in various populations.

“This is the largest study to date of COVID-19 booster effectiveness in cancer patients, a high-risk population of critical importance,” said Robert Figlin, MD, interim director of Cedars-Sinai Cancer. “It adds substantially to our understanding of the effectiveness of COVID-19 vaccines, and we will undertake additional studies as vaccine formulations change and new variants emerge so that we can make recommendations that best protect the health of our patients.”

Figueiredo’s team is preparing to publish vaccine effectiveness data on patients with autoimmune diseases and patients who have undergone solid organ transplants.

“There are several different groups whose immune systems have been affected in different ways, which gives us an opportunity to expand further our understanding of how these vaccines work,” Figueiredo said.

Additional Cedars-Sinai authors include Elham Kazemian, PhD; Karen L. Reckamp, MD; and Akil Merchant, MD.

Additional authors include Jacek Skarbinski, MD; Eric P. Elkin, MPH; Yonah C. Ziemba, MD; Brigid M. Wilson, PhD; Hinnah Siddiqui, MPH; Cheryl B. Schleicher, MS; Crystal A. Hsiao, MPH; Joshua R. Nugent, PhD; James M. Crawford, MD, PhD; David A. Zidar, MD, PhD; and Lawrence H. Kushi, ScD.

Funding: This work was supported by the National Cancer Institute Serological Sciences Network (SeroNet) [U01CA260584 to JS and LHK; U01CA260513 to DZ; 2UG1CA189850-09S1 to YCZ, CBS, JMC; 3U54CA260591-02S3 to JF], the Physician Researcher Program of The Permanente Medical Group Delivery Science and Applied Research Program (JS), and the United States Veteran Administration (COVID19-8900-05 to DZ).

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

highlight a potential link between pandemic-related stress on the gut-brain axis.

“Using data from a national online study, we found that rates of digestive issues such as irritable bowel syndrome and chronic idiopathic constipation rose significantly,” said Christopher V. Almario, MD, MSHPM, lead author and gastroenterologist at Cedars-Sinai. “These findings underscore the significant toll the pandemic has taken on digestive health.”

Also known as disorders of gut-brain interaction, conditions like irritable bowel syndrome and chronic idiopathic constipation are common gastrointestinal disorders driven by complex interactions between the gut and nervous system.

Nearly 40% of people in the U.S. are estimated to meet diagnostic criteria for at least one disorders of gut-brain interaction, making these conditions a major source of healthcare burden and reduced quality of life.

“These disorders involve chronic gastrointestinal symptoms that are often triggered or worsened by psychological stress,” said Almario.

To better understand how the viral infection might be linked with digestive health, researchers analyzed data from over 160,000 adults across the U.S. who participated in a national online survey conducted from May 2020 to May 2022.

Participants completed detailed questionnaires covering digestive symptoms, mental health and lifestyle changes. By tracking responses over time, the researchers observed a steady rise in gut-related health issues that began early in the pandemic and persisted throughout the survey period.

Key findings showed that:

• Rates of irritable bowel syndrome increased from around 6% among U.S. adults in May 2020 to about 11% in May 2022.
• Chronic idiopathic constipation rose slightly from 6.0% to 6.4%.
• Among adults who reported IBS, investigators noted that the prevalence of mixed IBS, a subtype of IBS where a person experiences both diarrhea and constipation, was most commonly reported. The investigators did not observe significant increases in other types of functional digestive disorders.

As doctors uncover the long-term health effects of COVID-19, study investigators hope this study may draw attention to how the virus’ impact on mental health may affect the gut—potentially triggering or worsening disorders like IBS and other gut-brain conditions.

“This research calls for a renewed focus on gastrointestinal health in the post-pandemic era,” said Brennan Spiegel, MD, MSHS, corresponding author of the study and director of Health Services Research for Cedars-Sinai.

Spiegel, director of the Cedars-Sinai Master's Degree Program in Health Delivery Science and the George and Dorothy Gourrich Chair in Digital Health Ethics, says even those who did not get COVID-19 but endured significant psychological distress also may have had alterations in their gut-brain axis.

“Healthcare providers must be vigilant in recognizing and addressing the long-term effects of the pandemic on digestive health,” said Spiegel.

Other Cedars-Sinai authors include So Yung Choi. Other authors include William D. Chey.

Funding: Support for this study was received from Ironwood Pharmaceuticals and Salix Pharmaceuticals in the form of institutional research grants to Cedars-Sinai. Brennan M.R. Spiegel, MD, MSHS is the guarantor of this article.

Cedars-Sinai Health Sciences University is advancing groundbreaking research and educating future leaders in medicine, biomedical sciences and allied health sciences. Learn more about the university.

What type of flu activity are we seeing in California this year and what are the symptoms?

As of early January, flu activity in California has been increasing and is comparable to levels observed at this time last year. Influenza (flu) typically presents with sudden onset of high-grade fever, accompanied by body aches, chills, headache, nasal congestion, runny nose and occasionally sore throat or fatigue.

When should you see a doctor?

The course of the flu can vary from person to person, but if you're experiencing prolonged fevers lasting three to five days, worsening cough or shortness of breath, signs of dehydration, or if you have exacerbation of underlying respiratory conditions such as asthma, it may be a good idea to check in with your primary care provider. Additionally, if you develop a new fever after initially recovering from the flu, be aware of the possibility of a secondary bacterial infection, such as a pneumonia, which would require medical attention.

Is it too late to get the flu vaccine?

While getting the flu shot earlier in the season is ideal, vaccination at any point during the flu season can still provide significant protection. The flu vaccine reduces the severity of illness and lowers the risk of complications, especially for high-risk individuals such as young children, pregnant women, the elderly and those with chronic medical conditions.

Each year, the flu vaccine is designed to target the most likely circulating strains. Although the vaccine may not be a perfect match for all strains, it provides partial immunity, which is highly beneficial in preventing severe illness.

What is norovirus and how is it affecting Californians?

Norovirus, often referred to as the “stomach flu,” is a highly contagious virus that causes gastroenteritis. We see symptoms including nausea, vomiting, diarrhea, abdominal cramping and occasionally low-grade fever. Norovirus is one of the leading causes of foodborne illness.

What can people do to stay healthy during virus season?

The advice is always the same. We need to be really mindful of our hand washing and being careful among high-risk individuals. Wearing a mask is of utmost importance because of the fires but also to prevent the spread of respiratory infections in this critical time period during the winter. Additionally, remember to listen to your body and stay home if you’re unwell.

Read more on the Cedars-Sinai Blog: Ask a Doc | What’s Walking Pneumonia?

Officials from the Los Angeles County Department of Public Health reported that several cats tested positive for the bird flu, also called H5N1, after drinking raw milk. Shortly after, the officials reported the first confirmed local case of the illness in a human.

But how much of a threat does the bird flu actually pose to humans?

“This is not yet a threat to everyday people who are not in close contact with affected animals, such as dairy cattle, poultry and wild birds, and we have not seen any human-to-human transmission of the virus,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and head of the medical center’s Special Pathogens Response Team, which can test for bird flu and treat the most severe cases.

Though most human cases of H5N1 in the U.S. have been mild since the virus first appeared in 1997, Grein cautioned that the bird flu can be severe and is still evolving.

“We’re concerned that this virus now spreads more readily across mammals—cattle in particular—and as this virus mutates and adapts, it has the potential to spread even more easily,” he said. “We must remain vigilant.”

The Cedars-Sinai Newsroom asked Grein what everyone should know about bird flu, including how to treat it and how to avoid getting sick.

How is bird flu different from seasonal flu?

They’re both from the same family of influenza viruses, but H5N1 binds to different cell receptors. They both cause similar symptoms—fever, sore throat, cough, muscle aches—but conjunctivitis appears to be more common with H5N1 patients who have had close contact with dairy cattle. Both viruses can cause mild illness or more severe forms like pneumonia, but these viruses behave differently. The flu generally follows more established seasonal patterns, whereas H5N1 is more unpredictable. We largely use the same antiviral—Tamiflu—to treat H5N1 as we do to treat seasonal influenza.

How can I know which type of flu I have?

There is no way to determine which virus you’ve contracted unless you get tested. As seasonal flu activity picks up, it will be really important to understand which virus you have. From a public health perspective, we need to understand what’s happening in the community. On a personal level, you’ll want to keep those around you safe, especially if you’ve contracted something beyond the typical seasonal flu.

Will my flu shot also protect me from H5N1?

The flu shot is our most powerful tool to protect yourself and those around you from seasonal influenza. But it likely does not confer protection against bird flu. Vaccines have been developed for H5N1, but they’re not widely available at this time, although some have been stored in a strategic national stockpile to be deployed in an emergency. Drugmakers are developing additional vaccines, and their development process would likely pick up if we began seeing H5N1 spread between humans.

How can I avoid bird flu?

Nearly all cases in humans have been in people who had close contact with dairy cattle, poultry or wild birds. Individuals who must be in contact with these animals should avoid cattle and birds if they appear sick. Also avoid drinking raw milk, which the virus can easily infect.

Read more from the Cedars-Sinai Blog: Flu and RSV—How to Protect Yourself Now

“It’s not just sniffles or cold-like symptoms. It can turn into pneumonia or an even more severe illness for older adults that can lead to hospitalization and, unfortunately, sometimes their demise,” said Leslie Ramirez, MD, a physician with Cedars-Sinai’s Senior Advantage program, which specializes in caring for medically complex Medicare Advantage patients 65 and older.

Because the body’s immune system weakens with age, Ramirez said, viruses like influenza can cause more serious illness in older adults. Once hospitalized, they’re at even higher risk for developing bedsores and skin infections from lack of movement. And unlike younger people whose condition rapidly improves once an illness passes, it can take weeks for older adults to regain their strength.

“If they’ve been in the hospital for a while, when they return home, they can struggle getting in and out of bed, getting to the bathroom or sitting down and standing up,” Ramirez said. “It complicates their care and increases the burden on the family members trying to help them.”

The Cedars-Sinai Newsroom talked with Ramirez about the most effective ways to help older adults avoid a hospital stay altogether.

What can cause an older adult with the flu to need hospital care?

The flu can trigger a huge inflammatory response in the lungs of older adults who may not be able to continue breathing on their own. They might need supplemental oxygen and fluids because we tend to eat and drink less when we’re ill. Dehydration can be very harmful in older patients, causing their blood pressure to drop, as well as respiratory distress.

Older adults also are more likely to have multiple chronic health issues—heart, lung and kidney conditions—and an influenza infection can make all of those worse.

If an older adult gets the flu, how can they avoid a severe illness?

They should contact their provider as soon as they experience flu-like symptoms—fever, chills, body aches, maybe a sore throat or diarrhea—or get tested for the flu at a nearby urgent care. With a confirmed diagnosis, patients might be eligible for Tamiflu, an antiviral treatment that can help shorten the length of illness and decrease severity. But the medication must be started within five days of symptom onset.

It's also important to rest and drink plenty of water. Chicken noodle soup or broth also can help with hydration. Acetaminophen can help reduce a fever, ibuprofen can ease body aches and over-the-counter cough suppressants can help ease a cough. But always check with a provider before taking a new drug to ensure it won’t interact with your current medications or chronic conditions.

Do you have any advice for caregivers or loved ones of older adults?

It’s important to identify flu symptoms early—a fever above 100.4 degrees, chills, fatigue, body aches, an itchy throat. If you notice that an older loved one with the flu is starting to become more lethargic, very weak or confused—they don’t know where they are or who they are, and they’re usually very aware of their surroundings—those are big flags that the severity of their illness is increasing. Take them to the emergency department or call their provider immediately.

If they start complaining that they haven’t gone to the restroom as much as they normally do, that could be a sign they’re not drinking enough, or their kidneys aren’t functioning well. If their cough worsens and they’re having difficulty breathing or they’re short of breath or they can’t walk to the bathroom—those are all red flags.

How can older adults avoid the flu?

Wash your hands, especially if you’re going to be eating or you’ve been in an environment that might not be clean. You might want to avoid crowded places like giant sporting events during flu season. I’m not advocating that people skip important life events like a wedding or gathering with family, but take precautions, such as masking or keeping your distance. Some people still choose not to shake hands.

And, of course, get the flu shot. The flu vaccine is available at local pharmacies and in our clinic at Cedars-Sinai. For those 65 and older, there is a high-dose flu shot because their immune system isn’t as reactive as it used to be, and they need a stronger dose to mount a successful immune response. Younger family members also should consider getting vaccinated to reduce their risk of contracting influenza and passing it on to their older relatives. But remember, it takes two weeks to become fully protected. Keep that in mind if you want to time your flu shot ahead of Thanksgiving, the holidays or major travel.

Read more on the Cedars-Sinai Blog: Care Coordination for the Sandwich Generation

Antibiotics are often prescribed for patients experiencing a respiratory illness. But when tests reveal that a virus—such as influenza—is causing the illness, antibiotics should be stopped, Cedars-Sinai investigators say. That’s because antibiotics are not meant to treat a viral illness; they are only effective against bacterial infections.

Some flu patients continue taking antibiotics out of concern that they will also develop a bacterial pneumonia—a common “secondary” infection often seen in vulnerable patients with influenza and a leading cause of death in flu patients.

A team of investigators led by Cedars-Sinai found that when influenza patients take antibiotics, the drugs disturb the gut’s fungal microbiome. This results in an increase in immune cells called eosinophils in the lungs that hinder the function of alveolar macrophages—important immune cells that clear out pathogens from the lungs.

This chain of events actually makes it more likely that a flu patient taking antibiotics will develop a bacterial pneumonia rather than avoid one. The investigators also showed that increased levels of eosinophils are associated with poor clinical outcomes and more systemic inflammation. The results of the experimental study were published in The Journal of Clinical Investigation. 

“We need to be aware that antibiotics are not innocuous and can have harmful side effects,” said the study’s corresponding author, Peter Chen, MD, the Medallion Chair in Molecular Medicine and the interim chair of the Department of Medicine at Cedars-Sinai. “To be clear: When a flu patient has a confirmed bacterial infection, you definitely need to prescribe antibiotics. But when there is no direct evidence of such an infection, antibiotics should not be prescribed because they will not help, and could, in fact, be harmful.”

To conduct the study, investigators examined laboratory mice that had been infected with influenza followed by a bacterial infection caused by MRSA (methicillin-resistant Staphylococcus aureus), one of the most common causes of a secondary bacterial pneumonia. One group of mice received antibiotics prior to the onset of a bacterial infection; the control group did not receive any medication.

Compared with the control group, those treated with antibiotics experienced greater weight loss and showed evidence of greater lung damage after MRSA infection. The mice that were given antibiotics also had higher levels of MRSA bacteria in their lungs and higher levels of immune cells (macrophages and eosinophils). In other words, this data suggests that antibiotic treatment during an influenza infection actually impaired the body’s efforts to clear the MRSA bacteria rather than helping the body heal.

The investigators also evaluated a cohort of influenza patients at Cedars-Sinai and critically ill patients at Northwestern University and the University of Pittsburgh. They found that eosinophils increase with antibiotic use and are associated with a higher length of stay and systemic inflammation.

“Altogether, this research demonstrates that prescribing antibiotics during influenza infections may do more harm than good. This research also sheds light on the role that eosinophils play in regulating lung immunity,” said co-author David Underhill, PhD, chair of the Department of Biomedical Sciences and the Janis and William Wetsman Family Chair in Inflammatory Bowel Disease. “These results also support clinical trials using eosinophil-depleting strategies as a therapy to improve outcomes in patients admitted with influenza and other viral illnesses.”

Additional authors include Marilia Sanches Santos Rizzo Zuttion, Tanyalak Parimon, Stephanie A. Bora, Changfu Yao, Katherine Lagree, Catherine A. Gao, Richard G. Wunderink, Georgios D. Kitsios, Alison Morris, Yingze Zhang, Bryan J. McVerry, Matthew E. Modes, Alberto M. Marchevsky, Barry R. Stripp, Christopher M. Soto, Ying Wang, Kimberly Merene, Silvia Cho, Blandine L. Victor, Ivan Vujkovic-Cvijin, Suman Gupta, Suzanne L. Cassel, Fayyaz S. Sutterwala and Suzanne Devkota.

This work was supported by grants from the NIH (TP: K08HL1411590; CAG: F32HL162377; RGW: U19AI135964, U01TR003528,P01HL154998, R01HL14988, and R01LM013337; GDK: R03HL162655; AM: R01HL163646, R01HL164177; BJM: P01HL114453; PC: R01HL159953, R01HL155759). This research was also supported by NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881.

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Vaccination clinics begin Sept. 9 and are scheduled through November across Los Angeles County.

“Cedars-Sinai is committed to keeping our community as healthy as possible during this upcoming flu season,” said Jonathan Vickburg, LMFT, associate director of Community Health Improvement at Cedars-Sinai. “Influenza is a serious disease, especially for young children and older adults. If you haven’t gotten your vaccination yet, please come see us at one of our clinics.”

Influenza can cause severe illness that can lead to hospitalization and even death. Symptoms include fever, chills, cough, sore throat, fatigue, nausea, diarrhea, runny nose and muscle aches. Flu activity often accelerates in October, making it critical to get vaccinated now. Infectious disease experts  from Cedars-Sinai strongly urge adults, children and infants to get the flu vaccine.

“You think it will never happen to your family, but every year, thousands of people in the U.S. die from flu complications,” said Jonathan Grein, MD, Cedars-Sinai’s director of Hospital Epidemiology and associate professor in the Department of Medicine. “It takes only a couple of seconds to get a shot and protect yourself and everyone in your family who is eligible for the shot, including babies 6 months and older and pregnant women.”

The flu vaccines formulated for the 2024-25 flu season protect against three different flu viruses that are circulating this year. Infectious disease experts recommend that everyone 6 months old and up get vaccinated. All ages are welcome at the community flu shot clinics, and children must be accompanied by a parent or guardian.

Scheduled Clinics:

Monday, Sept. 9
10 a.m.–1 p.m.
Roxbury Park 
471 S. Roxbury Dr. 
Beverly Hills, CA 90212

Sunday, Sept. 15
11 a.m.–2 p.m.
Saint Basil's Church
3611 Wilshire Blvd.
Los Angeles, CA 90005

Thursday, Sept.19
7:30–10 a.m.
Hope on Union – United University Church
2208 S. Union Ave. 
Los Angeles, CA 90007

Sunday, Sept. 29
8–11 a.m.
St. Kevin Catholic Church
4072 Beverly Blvd.
Los Angeles, CA 90004

Tuesday, Oct. 1
10 a.m.–1 p.m.
Plummer Park Community Center
7377 Santa Monica Blvd. 
West Hollywood, CA 90046

Friday, Oct. 4
9 a.m.–noon
Immanuel Presbyterian Church
3300 Wilshire Blvd.
Los Angeles, CA 90010

Sunday, Oct. 6
9 a.m.–noon
Cedars-Sinai Medical Center – Steven Spielberg Parking Lot
8723 Alden Dr.
Los Angeles, CA 90048

Saturday, Oct.19
7 a.m.–noon
Children's Institute Inc. – Otis Booth Campus
2121 W. Temple St.
Los Angeles, CA 90026

Wednesday, Oct. 23
10 a.m.–noon
Watts Labor Community Action Committee (WLCAC)
2528 West Blvd. 
Los Angeles, CA 90016

Saturday, Nov. 2
7 a.m.–noon
Michelle and Barack Obama Recreation Center
5001 Obama Blvd.
Los Angeles, CA 90016

Sunday, Nov. 10
9–11 a.m.
Young Israel of Century City
9317 W. Pico Blvd.
Los Angeles, CA 90035

Tuesday, Nov. 12
Noon–2 p.m.
Fairfax Senior Citizens Center 
7929 Melrose Ave.
Los Angeles, CA 90046

Read more on the Cedars-Sinai Blog: Flu and RSV: How to Protect Yourself Now

Flu shots are available now at Cedars-Sinai medical offices—even as much of the U.S. continues to cope with unusually high levels of COVID-19 infections from that virus’ summer surge.

Though COVID-19 tends to taper off in the autumn—when flu and RSV (respiratory syncytial virus) are beginning to set in—whether the U.S. will have a tough virus season is unpredictable at this point.

“Only one thing is certain,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and associate professor in the Department of Medicine. “We will definitely see influenza, COVID-19 and RSV circulating at the same time this winter.”

The most important advice Grein has for surviving this year’s respiratory virus season: Get vaccinated.

“The flu shot is still our most powerful tool to avoid influenza-related hospitalizations and deaths and keep our community safe,” Grein said. “The flu is linked to tens of thousands of deaths every year in the U.S. in addition to hospitalizations and clinic visits.”

The Cedars-Sinai Newsroom spoke with Grein for more information on vaccines, where to get medical care and other helpful advice for getting through flu season.

If someone gets sick, how can they tell which virus they have, and does it matter?

It can be tricky to tell these three illnesses apart because the flu, COVID-19 and RSV all can share similar symptoms—nasal congestion, headaches, fatigue, muscle aches, sore throat, cough and fever, and shortness of breath in more severe cases. Vomiting and diarrhea also can occur with COVID-19 or the flu. Only loss of taste and smell is more specific to COVID-19, though that occurs less often than it did early in the pandemic.

It’s important to get tested quickly to determine which illness—or illnesses—are causing your symptoms. Depending on which virus you have, you might need to start a particular treatment soon after symptoms appeared. If you’re considered high-risk—an older adult, someone who is immune-compromised or has a chronic health condition—your provider might recommend Paxlovid if you have COVID-19 or Tamiflu if you have the flu. To have the most benefit, Paxlovid should be taken within five days of symptom onset and Tamiflu within 48 hours, so it’s important to act quickly.

Who should get vaccinated against the flu, COVID-19 and RSV?

We strongly encourage adults and children older than 6 months to get the flu and COVID-19 vaccines. Ideally, you would get the flu shot in September or October and the updated COVID-19 vaccine when it becomes available shortly. Remember that it takes a couple of weeks for your immune response to develop after getting a shot.

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

To make an appointment for a COVID-19 vaccination, visit the My Turn website from the California Department of Public Health.

We also now have an RSV vaccine for older adults, a shot for pregnant people and an immunization for babies. If you or a loved one is in one of these groups, we recommend speaking with your physician to determine if the immunization or the vaccines are appropriate. 

When should someone seek treatment for flu-like symptoms?

Most mild symptoms can be managed at home with supportive care—fluids, Tylenol, rest. A humidifier can help with congestion and a saline nasal rinse can help clear mucus. Little kids might also benefit from a nasal suction device.

If you’re not sure if your symptoms are more serious, a virtual appointment is an easy way to get an expert opinion. Cedars-Sinai Connect offers quick access to Cedars-Sinai providers—available 24/7 for urgent issues—for those in California, including kids aged 3 and older, Spanish-speaking adults and patients new to Cedars-Sinai. Individuals with immediate concerns that are not life threatening—prolonged dizziness, not tolerating food or fluids—should visit urgent care. If symptoms truly are life threatening—difficulty breathing, pain or pressure in the chest or abdomen—go to the nearest emergency department. 

How long is someone contagious after getting sick with a virus?

Every virus is a little different, but in general people start becoming infectious with a respiratory virus shortly before their symptoms start, and then remain infectious for several days afterward when their symptoms are improving. With the flu, you’re infectious a day before symptoms start and until after a fever has resolved and symptoms are improving, as long as five to seven days after getting sick. It’s helpful to think of infectiousness as more of a gradient than an on or off switch. It’s also not unexpected for a cough to linger for many days or weeks after you’ve recovered, but it does not always imply you’re infectious for that period of time.

Is there anything unusual about this year’s flu season?

We should keep a close eye on what happens with the “bird flu,” the avian influenza A(H5N1) virus. Multiple outbreaks in cattle and poultry since the spring have been connected to more than a dozen infections in humans in the U.S. Even if you don’t work on a farm, it’s still relevant information. Families tend to visit farms in the autumn, and raw milk—which is sold in some health food stores—is another potential risk factor.

The good news is that we haven’t seen any human-to-human transmission of H5N1 with these recent cases in the U.S., but public health authorities are watching these outbreaks closely. If you’re someone who has been in close contact with cattle or poultry—even if it’s at a petting zoo or county fair—and you develop flu-like symptoms, alert your physician about your exposure to animals. I’d recommend washing your hands after being in contact with these animals and avoiding raw milk.

Read more on the Cedars-Sinai Blog: Tips to Survive Peak Flu Season from a Cedars-Sinai Expert

“We've seen a bit of a seasonal pattern emerge where we've had an uptick in COVID in the summer and then another one in the winter—usually the winter one being more severe,” said Michael Ben-Aderet, MD, associate medical director of Hospital Epidemiology at Cedars-Sinai.

The western U.S. is riding the biggest wave. Wastewater data for the region shows the virus that causes COVID-19 jumping from moderate to high levels in late June. The area had seen minimal levels circulating as recently as mid-May.

The uptick has largely been driven by the so-called FLiRT variants of COVID-19, such as KP.3 and KP.2, newer strains of the virus that began spreading in the spring. To stay on top of this latest wave, the Cedars-Sinai Newsroom sat down with Ben-Aderet to learn more about the FLiRT variants and why COVID-19 spikes over the summer.

Why are we seeing a COVID-19 spike this summer?

This has been the case for a couple of years. Why that is, I don't think anyone truly understands. A lot of viruses are seasonal in nature. Some viruses are seasonal in summer; some are in winter. COVID-19 seems to be in both. Some of that has to do with the virus itself—the virology, how it spreads. And another aspect of it is human behavior: School being out, people being on vacation, people traveling, people mixing and doing more activities does play a role in that summer surge.

What are the FLiRT variants?

The FLiRT variants is just a technical term for the continued mutation of the Omicron variants of COVID-19. And for the last year or so, pretty much all the variants of COVID-19 that we've seen circulate in the United States have been variants of Omicron.

How are the FLiRT variants different from previous versions of the virus?

So the symptoms that we're seeing in patients that are infected with one of the FLiRT variants are the same symptoms that we've been seeing with COVID-19 all along. There's no sense that there's any increased severity with the FLiRT variants. We're still seeing the relatively mild disease that we've been seeing with COVID-19 over the past year. It's primarily an upper respiratory illness. So think fever, chills, cough, runny nose, stuffiness— similar to a cold, essentially. And sometimes gastrointestinal symptoms.

Are existing COVID-19 tests and treatments still effective with the new variants?

All available testing, both commercial and home testing, will still test against the FLiRT variants. Paxlovid is still widely available and still works very well. So there hasn't been any reduction in activity of Paxlovid, and it’s still recommended for high-risk individuals with COVID-19.

How can we avoid getting COVID-19 at this point?

Masks still work. Make sure to wear a good, well-fitting mask. They’ve been proven to help prevent the spread of COVID-19. If you haven't been vaccinated, vaccines are still available, and it's really best to be up to date on your vaccinations. Avoid being around others who are sick. If you are exposed or if you're sick, stay home if you don’t need to go out.

Read more on the Cedars-Sinai Blog: Long COVID—What to Know

and led by a Cedars-Sinai investigator found that a medication used to treat COVID-19 also reduces a patient’s chances of developing delirium or coma, which is a form of delirium.

“This study continues our investigation of a protein called IL-6, which is produced by the body’s immune system in response to infection or injury,” said Shouri Lahiri, MD, director of the Neurosciences Critical Care Unit at Cedars-Sinai and senior author of the study. “We’ve previously shown that modulating IL-6 reduces delirium in a laboratory mouse model that we developed. This study shows that the effect also translates to human patients.”

Lahiri and co-investigators from Vanderbilt University Medical Center reviewed data on 253 patients hospitalized with COVID-19. Sixty-nine of those patients were treated with tocilizumab, a medication known to help with survival and recovery from COVID-19 but not previously studied in delirium.

“Across the world, millions of patients are suffering from delirium while critically ill, including especially high rates in diseases like COVID,” said study co-author Wes Ely, MD, MPH, co-director of the Center for Critical Illness, Brain Dysfunction, and Survivorship at Vanderbilt University Medical Center. “Delirium is depersonalizing in the moment and can lead to long-term dementia-like memory impairments that impair people’s recovery. We are working diligently to find solutions to improve quality of care and help people find healing in survivorship.”

Patients treated with tocilizumab experienced significantly more days without developing delirium or coma than patients who did not receive tocilizumab. And this was true regardless of whether tocilizumab improved patients’ other symptoms.

“This is very important and a much stronger effect than I expected,” Lahiri said. “It shows that the drug may have been a major factor in preventing delirium, and that patients weren’t just avoiding delirium because their COVID symptoms improved.”

Helping patients reduce the severity and duration of delirium, or avoid it altogether, could also help them avoid long-term cognitive effects, Lahiri said.

“We know that delirium, especially coma, is associated with significant long-term cognitive changes and is considered one of the few potentially modifiable risk factors for dementia,” Lahiri said. “Recent research concluded that delirium triples a patient’s risk for dementia and doubles the rate of decline in patients who develop Alzheimer’s disease.”

Lahiri has also studied delirium in patients with urinary tract infections, and found that estrogen treatment, like tocilizumab, was associated with lower levels of IL-6 and delirium. He said that many different conditions besides COVID-19 can cause IL-6 levels to go up and increase risk of delirium. In future studies, he would like to directly test tocilizumab in patients with acute respiratory distress syndrome.

“These findings extend the previously reported benefits of tocilizumab to include the potential for significantly reduced delirium or coma episodes in patients with severe COVID-19,” said Nancy L. Sicotte, MD, chair of the Department of Neurology, the Women’s Guild Distinguished Chair in Neurology and professor of Neurology at Cedars-Sinai. “Confirmation of these findings in randomized prospective studies may lead to new pharmacological options for preventing or reducing risk of delirium and coma for patients experiencing critical illness.”

Funding: Dr. Ely has received a research grant from Dr. Franz Kohler Chemie GMBH and is supported by the NIH grants (R01 AG027472, R01 AG035117, R01 AG058639, I01RX002992). Dr. Lahiri is supported by a research grant from the F. Widjaja Foundation.

Additional authors include Tuqa Alkhateeb, PharmD; Joanna L. Stollings, PharmD; Ine Sohn, MS; Dandan Liu, PhD; and L. Montana Fleenor, PharmD.

Read More in Discoveries: A Double-Edged Sword: Inflammation and Your Health

The findings are published in The Journal of Infectious Diseases.

“Protection provided by infection wanes over time,” said Joseph Ebinger, MD, a clinical cardiologist, director of Clinical Analytics in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, and first author of the study. “These findings show that vaccination is still an important part of the arsenal for protecting people over the long term.”

Investigators tracked infections among 4,496 people who agreed to share serological samples as part of their participation in the study. From December 2021 to December 2022, when the Omicron variant was dominant, the investigators documented 2,053 new-onset infections in this group.

They examined incidence of new infections among people who were either infected less than 90 days prior or whose last known antigenic exposure was either recent (<90 days) or remote (≥90 days) infection or vaccination.

A key part of the study reviewed data from people whose most recent antigenic exposure was more than 90 days prior. For this group, people age 60 and older were significantly more protected by vaccination than prior infection.

“We know from previous studies by our group and others that the combination of prior infection and prior vaccination offers a hybrid immunity,” said Kimia Sobhani, PhD, associate professor of Pathology and Laboratory Medicine at Cedars-Sinai and senior author. “We wanted to understand whether if the last exposure was a long time ago, would it have been better if that last exposure was an infection or if it was a vaccination. Asking the question this way helps us understand if someone might benefit from another vaccination.”

The investigators are continuing to study the factors that can build and maintain immune memory against SARS-CoV-2 infection, even as the virus continues to mutate.

Other Cedars-Sinai investigators who worked on the study include Nancy Sun, MPS; Sandy Y. Joung, MHDS; John Michael S. Sanchez, MD, PhD; Minhao Wang, MPH; Yunxian Liu, PhD; Mallory Heath, MLS; Susan Cheng, MD, MPH; and Kimia Sobhani, PhD.

Funding: The study was funded by the Erika J. Glazer Family Foundation and Sapient Bioanalytics, LLC.

The findings, published in the peer-reviewed journal Nature Communications, suggest that more was in play than either factor alone.  

“Our results suggest that initially, differences in shared home environment influenced who was infected with COVID-19 more than genetic differences,” said Katie LaRow Brown, MA, first author of the study and a PhD candidate at Columbia University who collaborated with Cedars-Sinai on this study. “Over time, however, the importance of these differences in shared home environment decreased—and the importance of genetics increased—eventually eclipsing shared home environment.”

COVID-19 has infected more than 340 million people in the U.S., underscoring the urgency in conducting therapeutic research and uncovering potential treatments. However, until this study, little was known about how an individual’s environment and genetic background impacted their experience with the virus.

Using electronic health records from New York-Presbyterian/Columbia University Irving Medical Center, investigators identified 12,764 patients who received conclusive results—either positive or negative—from a PCR test for COVID-19. These patients belonged to 5,676 families with an average of 2.5 family members who had a bout of COVID-19. The time frame studied was Feb. 21, 2020, to Oct. 24, 2021.

The investigators’ analysis found that at the start of the pandemic, genetics accounted for 33% of variation in susceptibility. By the second half of the research study, however, genetics accounted for 70% of variation in susceptibility.

When measuring patients’ severity of COVID-19, investigators also found that a patient’s genetics were more of a factor than their home environment. Disease severity was defined by length of hospital stay. Genetics explained 41% of variation while shared environment explained 33%.  

“We were especially surprised by the percentages of susceptibility,” said Nicholas Tatonetti, PhD, senior and corresponding author of the study, vice chair of Operations in the Department of Computational Biomedicine and an associate director of Computational Oncology at Cedars-Sinai Cancer. “Since this is an infectious disease, we assumed that home environment differences would explain most variation for the entirety of the study.”

While Tatonetti says his team of investigators cannot know for certain, they suspect that over time, discrepancies between people’s home environments changed in important ways.

“This work also suggests that the specific genetic factors influencing susceptibility and severity have not been fully identified,” said Tatonetti. “This is very important in terms of directing resources and defining future research goals.”

Jason Moore, PhD, chair of the Department of Computational Biomedicine and a professor of Medicine, said the study provides critical information and insights for future pandemics.

“The age-old debate of what matters most—genetics or your environment—continues through the work of this important study,” said Moore. 

Funding: This study was supported by the National Institutes of Health National Institute of General Medical Sciences R35GM131905.

Other authors involved in the study include Vijendra Ramlall, Michael Zietz, and Undina Gisladottir.

Read more from the Cedars-Sinai Blog: COVID-19 and Flu Shots Provide a Double Dose of Protection

Women who received standard recommended immunizations during their pregnancy were more likely to accept the COVID-19 vaccine, according to new research from Cedars-Sinai. Investigators also identified disparities in vaccination linked to race and insurance status.

The findings on COVID-19 vaccine uptake during pregnancy are published in the Journal of Infection.

“We found that patients were more likely to accept COVID-19 vaccination if they were Asian, had private health insurance, and had received the recommended pregnancy vaccinations for Tdap (tetanus-diphtheria-acellular pertussis) and the flu,” said corresponding author Laura Ha, MD, a maternal-fetal medicine fellow in the Department of Obstetrics and Gynecology.

Maternal age and weight, in addition to race, also played a role in vaccine hesitancy.

“Pregnant women who were Black, under 35 years of age, not obese or had public insurance were less likely to accept COVID-19 vaccination,” Ha said.

In this retrospective cohort study, investigators examined the medical records of 7,857 patients who delivered at Cedars-Sinai in Los Angeles between December 2020 and March 2022. Immunizations received during pregnancy were among the health variables evaluated.

In May 2022, when the last of the cohort was included in the study, 78% of the U.S. adult population had received at least one dose of the COVID-19 vaccine, according to the Centers for Disease Control and Prevention. However, the rate among pregnant women was much lower; just 42% were vaccinated in spite of the recommendation of healthcare organizations, including the American College of Obstetricians and Gynecologists.

“COVID-19 infection is associated with an increased risk of severe illness and death in pregnant patients. The vaccine decreases the risk of hospitalization and death from the virus, which is why we recommend that pregnant patients get vaccinated,” said  Mariam Naqvi, MD, a maternal-fetal medicine specialist and co-author of the study.

The research also supports the growing body of evidence on the safety of the COVID-19 vaccine for mothers and their newborns.

Our findings were consistent with existing data showing that receiving the COVID-19 vaccine during pregnancy does not increase the risk of preterm birth, low birthweight, low Apgar scores, or admission to the neonatal intensive care unit,” Ha said. The Apgar score is a test given to newborns soon after birth. It assesses the baby's heart rate, muscle tone, and other signs to see if extra medical care or emergency care is needed.

Investigators urge continued research on COVID-19 vaccination in pregnant women to ensure equitable and widespread vaccine distribution and to provide safety data that could improve vaccine acceptance and perinatal outcomes.

Read more on the Cedars-Sinai Blog: COVID-19 Vaccine and Pregnancy

“We’ve had patients come into our clinics testing positive for both COVID and flu,” said Caroline Goldzweig, MD, chief medical officer of the Cedars-Sinai Medical Network. “Having one doesn’t protect you from the other.”

Goldzweig said Cedars-Sinai’s primary care and urgent care offices have seen a steady rise in respiratory viruses since November. Their percentage of positive COVID-19 tests has doubled since then, rising to 14% of tested patients by the end of December.

The percentage of positive influenza tests in Los Angeles County more than doubled to almost 23% by the end of December. RSV, which mostly affects younger and older patients, peaked late in November, but 10% of tests for the virus in Los Angeles County are still positive.

Cedars-Sinai Medical Center also has seen a steady rise of COVID-19 patients since Thanksgiving, although these patients still remain a fraction of those cared for in the hospital’s 915 beds. Flu has followed a similar pattern.

Priya Soni, MD, a pediatric infectious disease specialist with Cedars-Sinai Guerin Children’s, has treated many young children and infants who have not yet been vaccinated against COVID-19 and come to the hospital needing oxygen. She recommends that babies get the COVID-19 vaccine when they’re eligible, starting at 6 months of age.

RSV also is dangerous for young infants. Expectant mothers should consider getting not only the updated COVID-19 vaccine but the newly available RSV vaccine as well, Soni said, if they’re going to deliver during respiratory virus season “so that the antibodies can protect your infant during their youngest and most vulnerable few months of life.” This is especially important because a new RSV immunization for infants is in short supply.

Soni added that it’s not too late for people of all ages to get the updated COVID-19 vaccine, especially with the further increase in cases experts are predicting over the next couple of weeks. It’s also not too late to get the flu shot. This year’s formulation is very effective against circulating influenza strains. A new RSV vaccine is also available for adults over 60, with the greatest benefit for those who are at higher risk because of chronic medical conditions.

“Remember to mask,” Soni said. “It’s a really effective way to protect yourself in very crowded situations and when you have a vulnerable family member.”

But Wait, There’s More

If a tripledemic weren’t bad enough, a fourth illness—superimposed bacterial infection—has been exacerbating an already challenging virus season, landing vulnerable patients in the hospital, said Soniya Gandhi, MD, associate chief medical officer at Cedars-Sinai.

“When you have these viral infections, there is a risk of superimposed bacterial infection,” said Gandhi, an infectious disease specialist. “And we have seen a rise in pneumococcal pneumonia as a superimposed bacterial infection on top of the viral illness.” 

Still another culprit has been appearing in Cedars-Sinai’s outpatient clinics. Goldzweig said the staff members have seen many patients with viral gastroenteritis, a stomach bug causing nausea, vomiting and diarrhea. The virus spreads through contact, likely making the rounds at holiday meals. Avoid it by not sharing food and washing hands after eating or visiting the bathroom.

Get Tested, Get Treatment

Flu, RSV and COVID-19 all share similar cold-like symptoms—nasal congestion, headaches, fatigue—plus muscle aches and fever. But it’s important to get tested to determine which virus, or viruses, might be causing symptoms.

“There's no way to tell specifically what you have without getting tested, so it's incredibly important to get tested early on during your illness because there may be specific treatment options depending on what you have, as well as specific recommendations regarding isolation and keeping you and your loved ones safe,” Gandhi said.

Gandhi said patients with COVID-19 may qualify for Paxlovid, which needs to be taken within five days of symptom onset or as soon as possible to be effective. Similarly, those with the flu might be prescribed Tamiflu, which must be taken within 72 hours of diagnosis to be effective.

For those who don’t know whether their sniffles or sore throat require a trip to the doctor, a virtual appointment can be a convenient first step. Adult patients in California can use Cedars-Sinai Connect, a new mobile app that provides quick access to Cedars-Sinai experts, who are available 24/7 for urgent issues. Same-day appointments also are available on the platform for primary care 

Mild symptoms can be managed virtually, Goldzweig said. Providers might recommend using a self-testing kit for COVID-19 or refer a patient for in-person testing or labs. Or they can follow up with a prescription if needed or advise on supportive care (fluids, Tylenol) to help patients manage symptoms at home. Goldzweig said patients with more serious symptoms—ongoing inability to tolerate food or fluids or prolonged dizziness—should visit urgent care.

For parents who want to prepare ahead of time for the possibility of a sick child, Soni recommends keeping a few things on hand: a humidifier to ease congestion and cold-like symptoms and a nasal suction device and saline solution to help clear mucus from a viral infection.

And all season long, she says, we should all “hydrate, hydrate, hydrate.”

Read more on the Cedars-Sinai Blog: COVID-19 and Flu Shots Provide a Double Dose of Protection

at Cedars-Sinai aimed to understand the possible connection between COVID-19 vaccination and a difficult-to-diagnose heart condition called postural orthostatic tachycardia syndrome, or POTS. The study validated that patients who were immunized with a COVID-19 mRNA vaccination and then went on to have new or exacerbated POTS all had preexisting conditions that can lead to a POTS diagnosis.

POTS is associated with nervous system dysfunction and causes an abnormal increase in heart rate after standing or sitting up. It used to affect primarily women of childbearing age. However, for POTS cases that developed during the COVID-19 pandemic, men were equally affected.

“We were surprised when all the patients in our small cohort already had conditions that could make them more likely to develop POTS even without vaccination, such as palpitations, fast heart rates, orthostatic intolerance, hypermobile joints, asthma, systemic lupus, fainting and chronic abdominal pain,” said Peng-Sheng Chen, MD, the corresponding author of the study and an international expert on the condition who leads one of only a few specialty clinics on the syndrome in the nation.

“These findings suggest it may be helpful to keep an eye on patients with underlying health issues after COVID-19 vaccination to monitor for post-vaccine POTS,” said Chen, who also holds the Burns and Allen Chair in Cardiology Research at Cedars-Sinai.

The observational study, recently published in the peer-reviewed journal Heart Rhythm and presented during the American Heart Association Scientific Sessions, analyzed data from 10 patients treated at the Cedars-Sinai multidisciplinary POTS clinic between July 2021 and June 2022. When provided guideline-directed care, all study participants reported an improvement in their POTS condition.

Although there is an association between POTS and COVID-19 vaccination, a previous study of patient data across the Cedars-Sinai Health System found that patients diagnosed with COVID-19 were five times more likely to develop the cardiac condition after infection than after vaccination.

“COVID-19 infection itself seems to be either causing or unmasking a startling amount of POTS or POTS-like conditions globally,” said Debbie L. Teodorescu, MD, a cardiology fellow at the Smidt Heart Institute and first author of the study. “In our cohort, most patients responded well to treatment, but a subsequent COVID-19 infection tended to bring significant setbacks in recovery. That is why we urge all patients to be meticulous about avoiding COVID-19.”

Read more from the Cedars-Sinai Blog: Long COVID: What to Know

found that a monoclonal antibody treatment reduced the risk of COVID-19 in a large group of solid organ transplant patients who were administered the drug as a preventive measure against the disease.

The study, recently published in the peer-reviewed journal Transplant Infectious Disease, analyzed data from 911 solid organ transplant patients, 381 of whom had received at least one dose of the monoclonal antibody treatment tixagevimab−cilgavimab. The U.S. Food and Drug Administration (FDA) provided emergency-use authorization for the monoclonal antibody treatment in the fight against COVID-19 in immuno-compromised patients from December 2021 through January 2023.

“In this group of transplant patients, we found that the antibody reduced infection risk even amidst emergent Omicron subvariants,” said Stanley Jordan, MD, medical director of the Comprehensive Transplant Center’s Human Leukocyte Antigen and Transplant Immunology Laboratory and study author.

“Additionally, we concluded that pre-exposure monoclonal antibody therapy likely represents a therapeutic strategy that will continue to offer clinical benefit for immuno-compromised persons who are known to derive limited protection from vaccinations,” noted Jordan.

Solid organ transplant patients often receive antibody treatments designed to deplete T-cells and B-cells before their transplant, and they remain on long-term immuno-suppression after their procedure, as well, to reduce the risk of the body rejecting the new organ.

Because of this, transplant patients do not have a strong antibody response to COVID-19 vaccinations, making them particularly susceptible to contracting the disease due to lack of immunity. If infected with SARS-CoV-2—the virus that causes COVID-19—this patient population is often at the highest risk for severe, life-threatening disease.

“Our message is that these transplant patients are still at risk for severe outcomes, even if vaccinated,” said study author Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science and director of the Institute for Research on Healthy Aging in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai. “We are hopeful that a replacement group of monoclonals will soon be approved by the FDA.”

To limit the risk of COVID-19 infection, study investigators recommend that solid organ transplant patients continue to wear masks in public places and avoid contact with individuals who are coughing or have had known contact with patients who have COVID-19.

Read more from the Cedars-Sinai Blog: COVID-19: What to Know About SARS-CoV-2 Reinfection

Shervin Rabizadeh, MD, chair of Pediatrics at Cedars-Sinai Guerin Children’s, says vaccinating your child helps protect the whole family, including elderly grandparents.

“Vaccines are critical in preventing transmission of the virus that causes COVID-19, especially during upcoming holiday gatherings,” Rabizadeh  said. “You want to prevent and stop passage of the virus between individuals, and kids are often the vectors. They are the petri dishes that pass things on, so this [vaccination] is a great means of prevention.”

At a recent Cedars-Sinai COVID Clinic, healthcare workers distributed free Pfizer 2023-2024 COVID-19 vaccines to children 6 months to 4 years old and Pfizer updated COVID-19 vaccines to children 5 to 11 years old.

Alison Chen’s two children were among the more than 120 who joined the pop-up clinic.

“We’re traveling to see family for Christmas, and airplanes are a bit nerve-wracking,” Chen said. “We also want to make sure we’re as safe as possible before seeing our grandparents.”

Priya Soni, MD, Cedars-Sinai pediatric infectious disease specialist, said there are many important reasons children should be vaccinated against COVID-19.  

“While many children have milder infections than adults, some children develop severe lung infections from COVID-19 that require hospitalization,” Soni said. “Children also can develop bacterial pneumonia after recovering from COVID-19. Another complication is multisystem inflammatory syndrome in children [MIS-C], which can require care in an intensive care unit [ICU].”

During the COVID Clinic, some young children cried as they received their vaccines, but the parents, including Arturo Garcia, were smiling. Garcia brought his 19-month-old daughter, Anna Sofia, to the clinic.  

“It’s important to keep our children safe and healthy,” Garcia said. “It’s the best gift we can give our children.” 

Read more on the Cedars-Sinai Blog: Here Are the Back-to-School Vaccinations Your Kids Need

The findings are published in the peer-reviewed journal Vaccines.

“The big message for primary care providers is that our words hold so much weight when it comes to helping patients make informed decisions,” said lead author Yelba Castellon-Lopez, MD, a primary care provider and a research scientist in the Department of Biomedical Sciences at Cedars-Sinai. “Taking a moment to ask ‘why’ can help you learn so much.”

In October 2021, the U.S. Food and Drug Administration authorized two COVID-19 vaccines for emergency use in children ages 5-11, but many eligible children remain unvaccinated.

In L.A. County, less than half of children ages 5-11 are vaccinated against COVID-19. These rates are even lower for Latin-American children in the area: Only 27.7% of these children had received at least one dose of a COVID-19 vaccine as of August 2023.

In March and April 2022, investigators conducted six virtual focus groups with 47 parents and caregivers of children ages 5-11. The parents and caregivers were recruited because of their participation in another study that assessed the effectiveness of MiVacunaLA, a mobile-phone text-based program meant to educate parents and caregivers and improve vaccination rates. Half of the parents and caregivers had been exposed to the intervention and half had not.

Answers from parents and caregivers fit into the following general themes:

• Needing to think about vaccinating their children more than about vaccinating themselves
• Needing trusted sources of vaccine information
• Being concerned about short- and long-term effects of the vaccine in children

Parents also said doctors and scientific studies are trusted sources of COVID-19 vaccine information and that they appreciate text messages containing information about COVID-19 vaccines. The investigators found that digital content, such as videos featuring doctors, can help parents in their decision-making.

The investigators are continuing to study how the MiVacunaLA program improves parents’ likelihood of vaccinating their children.

Funding: The study was funded by the VaxUp Innovation Challenge Grant sponsored by Children’s Hospital Los Angeles, the Los Angeles Department of Public Health and CEAL/STOP COVID-19 CA.

Read more on the Cedars-Sinai Blog: Tips to Navigate a COVID-19 Infection in Your Household

“We urge everyone in our community to get vaccinated because it’s so important for everyone’s health,” said Jonathan Vickburg, LMFT, associate director of Community Health Improvement at Cedars-Sinai. “Holding free flu vaccine clinics is the best way to demonstrate our commitment to our community’s health and wellbeing.”

The Oct. 8 clinics are part of a series of more than 40 free, Cedars-Sinai Health System flu vaccination clinics throughout the community. A list of upcoming clinics is below.

Influenza can cause severe illness that can lead to hospitalization and even death. During the 2022-2023 flu season in the U.S., the flu was linked with as many as 650,000 hospitalizations and as many as 58,000 deaths, according to the Centers for Disease Control and Prevention.

Flu activity often accelerates in October, making it critical to get vaccinated now if individuals haven’t already received their shots. Infectious disease experts from Cedars-Sinai and its affiliates strongly urge adults and children 6 months and older to get the flu vaccine.

“The flu shot is the best tool we have to protect ourselves from the flu,” said Kimberly Shriner, MD, medical director of Infection Prevention and Control at Huntington Health. “Make sure everyone in your home is vaccinated against the flu and also up to date on COVID-19 vaccinations as we approach the holiday season when people will be gathering.”

People especially vulnerable to the flu include adults 65 and older, patients with certain chronic medical conditions (asthma, diabetes, heart disease), those who are pregnant and children younger than 5.

“We hope that the public will take advantage of these free flu clinics to protect themselves and others in their community who are vulnerable to the flu,” said Torrance Memorial infectious disease specialist David D. Rand, MD.

The complete list of flu vaccination clinics includes:

• Cedars-Sinai Medical Center–Spielberg Building
  Oct. 8, 9 a.m.–12 p.m.
  8723 Alden Drive, Los Angeles 90048
   
• Huntington Health–Light of Love Mission Church
  Oct. 8, 9:30–11:30 a.m.
  2801 E. Colorado Boulevard, Pasadena 91107
   
• Torrance Memorial–Richard B. Hoffman Health Conference Center
  Oct. 8, 9:30–11:30 a.m.
  3315 Medical Center Drive, Torrance 90505
   
• Huntington Health–Friends In Deed
  Oct. 10, 9–11 a.m.
  444 E. Washington Boulevard, Pasadena 91104
   
• Huntington Health–Jefferson Public Library
  Oct. 10, 10 a.m.–12 p.m.
  1500 E. Villa Street, Pasadena 91106
   
• Huntington Hospital–Cafeteria
  Oct. 11, 11 a.m.–1 p.m.
  100 W. California Boulevard, Pasadena 91105
   
• Huntington Health–South Pasadena Farmer’s Market
  Oct. 12, 4–6 p.m.
  905 Meridian Avenue, South Pasadena 91030
   
• Huntington Health–Living Rock Church
  Oct. 14, 9–11 a.m.
  2181 E. Washington Boulevard, Pasadena 91104
   
• Cedars-Sinai–St. Kevin Catholic Church
  Oct. 15, 8–11 a.m.
  4072 Beverly Boulevard, Los Angeles 90004
   
• Huntington Health–St. Elizabeth Parish School
  Oct. 15, 9–11 a.m.
  1840 N. Lake Avenue, Altadena 91001
   
• Huntington Health–St. Joseph Center (Holy Family Giving Bank)
  Oct. 16, 8–10 a.m.
  1524 Fremont Avenue, Pasadena 91030
   
• Huntington Health–Villa Parke Farmer’s Market
  Oct. 17, 9–11 a.m.
  363 E. Villa Street, Pasadena 91101
   
• Cedars-Sinai–Plummer Park
  Oct. 17, 10 a.m.–1 p.m.
  7377 Santa Monica Boulevard, West Hollywood 90046
   
• Huntington Health–Hastings Branch Public Library
  Oct. 18, 10 a.m.–12 p.m.
  3325 E. Orange Grove Boulevard, Pasadena 91107
   
• Cedars-Sinai–Taste of Soul Event
  Oct. 21, 10 a.m.–7 p.m.
  Crenshaw Boulevard (between Stocker and Obama)
   
• Huntington Health–Community Church (Dream Church)
  Oct. 22, 9–11 a.m.
  1305 E. Colorado Boulevard, Pasadena 91106
   
• Huntington Hospital–Emergency Department
  Oct. 24, 4–6 p.m.
  100 W. California Boulevard, Pasadena 91105 (Fairmount Courtyard Entrance)
   
• Huntington Health–Sacred Heart Church
  Oct. 29, 10 a.m.–12 p.m.
  2835 N. Lincoln Avenue, Altadena 91001
   
• Cedars-Sinai–Young Israel of Century City
  Nov. 5, 9 a.m.–12 p.m.
  9317 W. Pico Boulevard, Los Angeles 90035

Visit Cedars-Sinai’s events page and Huntington Health’s flu page to find a nearby location.

Read more on the Cedars-Sinai Blog: Cold vs. Flu Symptoms

Flu season started early in the Southern Hemisphere, which typically gives experts some clues as to what we’ll experience here in the U.S. To avoid getting caught off guard, it’s important to get the flu shot in September or October, said infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai.

“Even a typical flu season can be deadly and can cause significant hospitalization,” Gandhi said, pointing to 58,000 deaths in the U.S. and more than half a million hospitalizations—all caused by last year’s flu. “We should do what we can to protect ourselves—and others—with the best tool we have: the flu vaccine.”

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during regularly scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment online through My CS-Link at clinics in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

In addition to the flu, COVID-19 and the respiratory syncytial virus (RSV) could again spike at the same time, triggering a “tripledemic,” Gandhi said. Last year, that same triple punch filled emergency departments across the country and strained children’s hospitals with young patients, who are vulnerable to RSV—a virus that can be serious, if not deadly, for infants and older adults.

But there’s a silver lining this year. In addition to the flu vaccine, new RSV shots are available for babies and adults over 60, and a new COVID-19 booster is coming this fall.

“These new shots and vaccines could really help protect us and our community during the upcoming season,” Gandhi said. “We need to preserve capacity in hospitals for those patients who really need that care.”

Help for Youngest and Oldest

RSV causes mild cold-like symptoms in most people, but it’s the leading cause for hospitalization among infants in the U.S. In babies, the virus can cause mild illness or it can cause dangerous inflammation in a child’s tiny airways.

“There's really no way to predict how your child would do even if they're completely healthy,” said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s. “If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures.”

Most children in the U.S. will be infected with RSV within the first year of their life, and almost all infants will have been exposed to the virus by the time they're 2 years old.

But parents of infants have a new way to protect their children. The U.S. Food and Drug Administration (FDA) recently approved an immunization—a monoclonal antibody treatment called nirsevimab-alip (Beyfortus)—that can be given as a single-dose shot to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season also can get the shot.

Soni said she “100%” recommends the immunization because of strong clinical trials that yielded positive results.

The FDA also recently approved a Pfizer RSV vaccine for women who are 32-36 weeks pregnant to protect their infants at birth. The same vaccine also was approved for adults 60 and older, as was another vaccine from pharmaceutical company GSK.

For older adults, the Centers for Disease Control and Prevention (CDC) recommended these new vaccines only for those who are at highest risk of severe RSV, such as patients with asthma, diabetes or heart failure. Although both vaccines are considered safe, a very small number of cases of Guillain-Barre syndrome—a condition in which a person’s immune system attacks their peripheral nerves—were reported after vaccination.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC. But the significant risk RSV poses to some older adults could outweigh the very low risk of developing potential side effects.

Sonja Rosen, MD, section chief of Geriatric Medicine at Cedars-Sinai, said that for now,  she recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness. “Patients should speak with their physician and make an informed decision about whether this shot is right for them,” Rosen said.

New Twist on the COVID-19 Booster

The new COVID-19 booster has been updated to include a sub-variant of Omicron called XBB, which was the predominant strain at the time the shot was approved by the FDA this summer.  The vaccine should provide protection from all the strains circulating in the U.S. right now, Gandhi said.

Thanks to the new booster, antiviral medications like Paxlovid and at-home tests, Gandhi is grateful that “we're in a very different position in 2023.” She encouraged the public to take advantage of the booster when it becomes available this fall, to keep themselves and their loved ones safe, especially when gathering throughout the fall and winter holidays.

“We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time,” Gandhi said. “I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion.”

She said it’s safe to get the COVID-19 and flu vaccines together. For older adults who determine with their physician that the RSV shot is right for them, they should get that immunization alone and two weeks apart from the other vaccines, if possible, Gandhi said. 

Read more on the Cedars-Sinai Blog: Flu—When to Go to the ER

The Newsroom caught up with a few of them to find out how they’re doing now that the pandemic is waning, and what they’re finding most rewarding as they continue their work on the front line.

Maureen Chin, RN, associate director, Department of Pediatrics, Guerin Children’s

Chin spent much of the pandemic planning for the opening of the Guerin Children's in the summer of 2022. The new facility offers highly specialized care for children of all ages and spans neonatology, gastroenterology, cardiac services, orthopaedics, neurology and beyond.

Chin has spent her career at Cedars-Sinai Medical Center and is accustomed to a bustling atmosphere. But she was surprised at how quickly patient volume increased at Guerin Children’s. 

“The number of patients doubled within weeks,” she said. “Then respiratory season came, and again, we had record-breaking admissions. We were also getting calls every day from all over the region about having patients transferred here. I was proud of our team for keeping the patient care flow moving.”

A year after opening its doors, Guerin Children’s has newly expanded services, including halo-gravity traction, which gently stretches and straightens the spine, as well as increased epilepsy monitoring.

“Our nurses are masters in varied types of specialized care, from oncology conditions to seizure disorders to trauma,” Chin said. “Then there are the outpatient clinics that are a part of the Guerin Children’s family. It’s quite expansive.”

When Chin has a rare free moment, she heads to the Healing Garden at Guerin Children’s. It was created to bring tranquility to patients, their families and staff members. Chin calls it an “instant mood-lifter.”

Another boost to the spirits comes when Chin brings a friendly volunteer to work with her: Rhone, her 2-year-old certified therapy dog. “Rhone brings a smile to everyone’s face—kids, parents and staff.”

The most fulfilling event for Chin, though, is when a young patient leaves the hospital.

“Kids are so resilient—often, they go home better than I could’ve ever imagined. And that’s the best feeling.”

Paulina Andujo, RN, clinical joint surgery manager in the Joint Replacement Program

Andujo turned to music to get through the pandemic and even learned a new skill to help her co-workers escape the intensity: DJing.

Throughout the pandemic, Andujo occasionally hosted virtual dance parties for her fellow caregivers. Now, she’s looking forward to an in-person party in the coming weeks. During National Hispanic Heritage Month, Andujo will DJ at a Cedars-Sinai celebration for nurses while they dance to the beat of “DJ Pau Pau.”

Now that the pandemic has eased, Andujo also is getting back to another passion—traveling on global volunteer missions with Operation Walk to provide joint replacement surgeries. Andujo recently returned from her seventh volunteer mission—this time, to Arusha, Tanzania, where 54 volunteer healthcare pros replaced 49 joints for 43 patients over three-and-half 13-hour days. They also collaborated with local hospital staff, helping patients in need as well as training the staff on surgical care techniques.

One patient was a 30-year-old man whose hip issues prevented him from working the hours he needed to support his family. He also couldn’t get down on the floor to play with his 4-month-old child. Hip replacement surgery changed everything.

“We’ve gotten pictures and videos from this patient since surgery,” Andujo said. “He has a light about him that wasn’t there before. As with many patients we meet on missions, being unable to work was detrimental to his livelihood and his relationships. We provide many patients their only opportunity to get surgery that can change their lives.”

Andujo is grateful to Cedars-Sinai for supporting her mission work.

“When I come back to work, everyone is eager to hear what I learned. It’s interesting to see what nursing looks like in other parts of the world. I can tell you that nursing care is nursing care, no matter what country.”

Kayla McBride, RN, digital care service nurse, Cedars-Sinai Virtual Second Opinion 

McBride said the pandemic is partially responsible for the unique job she stepped into a year ago.

With the popularity of telehealth and virtual meetings increasing dramatically during the COVID-19 pandemic, McBride’s job is helping more patients than ever connect with Cedars-Sinai experts to get second opinions on the diagnoses or treatment recommendations they receive from their local physicians.

Cedars-Sinai’s Virtual Second Opinion is available to people in 20 states (more states continue to be added) who need complex cardiac, spine or gynecologic care. McBride is the first person with whom second opinion seekers connect when they enroll in the program. McBride's assessment to learn more about why a patient is seeking a second opinion is an in-depth conversation that can take more than an hour. 

McBride partners with the patient to collect and organize their medical records and imaging, which are provided to a physician with specialized expertise. Within one to three weeks (depending on how long it takes to receive medical records), the patient gets a customized report with the physician’s feedback. Patients can review the report prior to their telehealth physician visit, and there are multiple opportunities to get questions answered.

McBride said that patients seek a second opinion from Cedars-Sinai for different reasons. Some patients simply want validation that what their first doctor recommended is a good treatment plan. Others want to know if there are breakthrough treatments on the horizon.

“We’re giving them access to one of the best opinions they can get,” she said. “Sometimes our opinion is that the patient doesn’t need the risky surgery, or that we can offer them a procedure that their local hospital wasn’t able to provide.”

Patients often tell McBride that they are comforted knowing that their voice is being heard.

“When patients say that we were great listeners and answered all their questions, that’s the extra cherry on top,” McBride said.

Read more from the Cedars-Sinai Blog: Transition Program Gives Promising Nurses Extra Support

Only this time, there’s good news: The number of infections hasn’t increased as much as in past summers. Plus, most people with COVID-19 are reporting mild symptoms, and hospitalizations in the U.S. are significantly lower than they were last year at this time.

At the end of July 2022, some 38,000 people nationwide were hospitalized with COVID-19. Late July 2023 saw 7,000 patients hospitalized—just 18% of July 2022 hospitalizations. Although it’s the highest number of COVID-19 hospitalizations since June, it’s also a lower number than any point in previous years during the pandemic.

Infectious disease specialist Jonathan D. Grein, MD, director of Hospital Epidemiology at Cedars-Sinai, said that experts aren’t sure why COVID-19 surges in the summer months, though there are many theories.

“We expect surges in the winter—that’s when we typically see a lot of respiratory viruses circulate,” Grein said. “But we also see respiratory infections in the summer, and COVID-19 is no exception. One reason for this summer’s uptick in cases could be that people’s immunity has waned over the course of the year, but really, it’s just speculation.

“The bottom line is that we should all be mindful that we’re seeing more COVID in our community right now, and we shouldn’t let down our guard.”

Still, today’s COVID-19 reality is much different from the early days of the pandemic, when COVID-19 was the third-leading cause of death in the U.S. between March 2020 and October 2021, according to the National Institutes of Health. Today, most patients with COVID-19 who are hospitalized at Cedars-Sinai Medical Center are hospitalized for unrelated reasons, Grein said, and were incidentally found to have the virus.

“It’s important to keep in mind when looking at hospitalization data that it doesn’t always necessarily reflect severity of illness,” he said. “We have seen some sicker patients requiring higher levels of care—especially among those who were already at risk for severe illness—but the good news is that it’s been relatively infrequent, particularly compared to other surges.”

People who are at high risk of developing serious complications from COVID-19, such as organ transplant and cancer patients, are especially encouraged to take more precautions during the summer surge and avoid situations where they could be exposed to the virus, Grein said.

Those precautions include wearing a well-fitted mask indoors and in crowded areas, washing hands often and thoroughly, avoiding people who are sick, eating outdoors when possible, socializing in well-ventilated indoor areas, and for everyone—high risk or not—staying up to date on COVID-19 vaccinations.

The Centers for Disease Control and Prevention (CDC) reports that only 17% of the U.S. population has received the most recent bivalent vaccine, which was introduced in September 2022. An updated booster targeting the newer strain, Omicron subvariant XBB.1.5, is expected by fall 2023. The CDC has not yet recommended who should receive the newest booster.

“The vaccine may not prevent everyone from getting COVID-19, but it will certainly reduce your risk of becoming very ill,” Grein said.

If you do get sick, he added, test for COVID-19, stay home and rest. Also, he advised knowing in advance what treatment options are available if you test positive—especially if you’re at higher risk for severe illness.

“Let’s not forget the lessons we learned during the last few years of the pandemic about ways to stay safe,” he said. “We should continue to use the tools in our pandemic toolbox as this virus continues to wax and wane.”

Read more on the Cedars-Sinai Blog: Facts About Rebound COVID-19

While lower-income communities had lower vaccination rates than higher-income communities, the impact of vaccination on disease incidence was larger in lower-income communities. As a result, investigators say, vaccination led to reduced income-related disparities in COVID-19 incidence. 

The findings were published today in the Morbidity and Mortality Weekly Report, a publication of the Centers for Disease Control and Prevention (CDC).

“This study is a unique demonstration of how vaccination promotes health equity,” said Timothy Daskivich, MD, assistant professor of Surgery at Cedars-Sinai and senior author of the study. “Through this investigation, we also found that disparities in COVID-19 incidence between low- and high-income communities in the first two surges in Los Angeles were not observed in the first surge that occurred after vaccines were widely distributed.” 

The findings also serve as a model for future pandemics and mass vaccination needs across the country, said Daskivich.

“This study shows the benefit of prioritizing vaccine efforts in underserved communities to reduce disparities and improve overall population health,” Daskivich said.

The analysis included vaccination and reported COVID-19 illness data from 81 Los Angeles communities, representing more than 5 million people.

Community-level COVID-19 vaccination coverage and incidence data from April 2020 through September 2021 was obtained from the Los Angeles Times COVID-19 data repository, which is populated with California Department of Public Health data.

Key findings from the Cedars-Sinai analysis include:

• In 81 assessed Los Angeles communities, COVID-19 incidence during two surges before the availability of vaccines—July 2020 and January 2021—was higher in lower-income communities relative to higher-income communities.
• During the first surge after vaccines became available—September 2021—the disparity in COVID-19 incidence between the highest- and lowest-income communities disappeared.
• The impact of vaccination on COVID-19 incidence was highest in the lowest-income communities despite lower vaccination coverage.

Study authors point to public health programs that helped reduce disease incidence disparities. For instance, efforts in California included allocating 40% of vaccination appointments to communities in the lowest quartile of the California Healthy Places Index early in the vaccine rollout.

“Our study, alongside California's initiative to target vaccine rollouts, highlight the importance of improving vaccination access and reducing vaccine hesitancy in underserved communities to reduce disparities in COVID-19 incidence,” said Brennan Spiegel, MD, MSHS, director of Health Services Research at Cedars-Sinai and an author of the study. “Reducing barriers to vaccination in lower-income communities, including providing updated COVID-19 vaccine boosters, is critical to reducing disparities in disease burden and decreasing COVID-19–related illness in the United States.”

Other Cedars-Sinai authors involved in the study include John Masterson, MD, and Michael Luu, MPH.

Follow Cedars-Sinai Academic Medicine on Twitter for more on the latest basic science and clinical research from Cedars-Sinai.

The study—published in the peer-reviewed journal Current Problems in Cardiology—also found that the Black, Hispanic, Asian and Pacific Islander patients who had both COVID-19 and an acute myocardial infarction (AMI)—the medical term for a heart attack—fared worse than their white counterparts.

“The COVID-19 pandemic had a significant impact on heart attack patients and disrupted optimal care that led to delays and changes in traditional, often lifesaving treatment approaches,” said Martha Gulati, MD, director of Preventive Cardiology in the Smidt Heart Institute and the study’s senior author. “Most importantly, we found significant racial disparities in the management of AMI in patients with concurrent COVID-19, with Black, Hispanic, Asian, and Pacific Islander patients receiving lower rates of treatment when compared to white patients.”

Gulati, the Anita Dann Friedman Endowed Chair in Women’s Cardiovascular Medicine and Research and the associate director of the Barbra Streisand Women’s Heart Center, said these findings point to the urgent need to address disparities and enhance access to care.

As investigators explain, the COVID-19 pandemic put a spotlight on gaps in cardiovascular care that already existed based on race and ethnicity. Addressing these disparities in healthcare urgently requires a multifaceted approach.

“While this study provides valuable insight, it is one piece of the puzzle,” said Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute. “Addressing healthcare disparities, particularly during a global pandemic, requires a concerted effort from all stakeholders, including policymakers, healthcare providers, and the community at large.”

The Cedars-Sinai Newsroom sat down with Gulati to learn how the findings of this research study prompted ideas on addressing healthcare disparities and enhancing access to care:

Newsroom: Please share your recommendations on how best to address healthcare disparities and enhance access to care.

Gulati: There are four main ways to address these disparities, which include improving access; providing culturally sensitive care; addressing social determinants of health; and policy changes.

Newsroom: How might the medical field improve access?

Gulati: We must increase access to high-quality healthcare in and for underserved communities. This could include establishing more medical offices in these areas, improving transportation to healthcare facilities, and enhancing telehealth capabilities.

Newsroom: How can providers better provide culturally sensitive care?

Gulati: We must first ensure that healthcare providers are trained to provide culturally sensitive care. This includes understanding and respecting cultural differences, addressing language barriers and actively combating biases and stereotypes.

Newsroom: What are some of the ways the broader medical community can address social determinants of health?

Gulati: We must address the social determinants of health that contribute to these disparities. This includes efforts to reduce poverty, improve education, and provide safe and secure housing.

Newsroom: How can policy changes make an impact?

Gulati: Implementing policy changes to reduce systemic bias and racism in the healthcare system could involve changes to how care is funded. This might include assessing measures of quality, rewarding quality care and better identifying how resources are allocated.

DOI: https://doi.org/10.1016/j.cpcardiol.2023.101798

Additional Cedars-Sinai investigators include Amer Muhyieddeen, MD, and Susan Cheng, MD, MPH.

Read more on the Cedars-Sinai Blog: Preventing Heart Disease in Women