“Early on, I worked with a lot of patients with underlying illnesses such as asthma and chronic obstructive pulmonary disease [COPD] who experienced significant worsening of their symptoms due to wildfire smoke,” said pulmonologist Samuel Cohen, MD.

“Thankfully, most of those patients have improved now that the major trigger has subsided, and they’re back to a more baseline maintenance.”

Stephanie Koven, MD, a Cedars-Sinai primary care physician in Santa Monica, also treated many patients affected by the Palisades fire.

“Not only were we seeing flare-ups of asthma and emphysema for those in affected areas, but a significant increase in anxiety and depression,” Koven said. “I had patients in their 70s and 80s who were retired, and the home they were planning to live in for the rest of their lives was just gone.”

In addition to those retirees, Koven has cared for several members of the L.A. Fire Department who were on the front lines battling the blazes across Southern California.

“With firefighters, we’re most concerned about ongoing exposures over years,” Koven said. “Because of this, we’re more proactive with testing for things like heavy metals and PFAs, often called ‘forever chemicals.’ Firefighters also typically will receive earlier cancer screenings.”

While the general air quality has improved, Cohen said it’s possible that construction in the affected areas could rustle up particulate matter that may have previously settled in the soil.

“It’s especially important for workers in these areas to be sure they have appropriate respirators for protection,” Cohen said.

Koven agreed, adding that while residents who have moved back amid these construction zones may not need to wear masks in their own homes, they can still take other precautions.

“Using a HEPA filter in the home to help pull particulate matter from the air can be helpful,” Koven said. “If you’ve been to a burn site and are returning home, a general recommendation is to take off your shoes so you’re not tracking anything inside. You also could consider changing your outer layer of clothes when entering your home.”

Cohen also noted that some new smart thermostats can track air quality inside your home and will even set reminders for when to change your filters.

And if patients want to increase their overall respiratory health to combat any potential negative impact of returning to an affected area, Cohen says frequent cardiovascular exercise is key.

Both experts say it’s difficult to know yet what, if any, lingering health issues the public may experience because of the initial wildfire smoke exposure or rebuilding in and returning to burn areas.

“If you’re someone who will be moving back to these areas, it’s just important to make sure you’re in tune with how you’re feeling,” Cohen said. “If you begin to experience new-onset symptoms such as shortness of breath or a lingering cough, it’s time to speak to a medical professional.”

Read more on the Cedars-Sinai Blog: How Does Wildfire Smoke Affect Your Health?

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

The late-breaking study presented at the American College of Physicians Internal Medicine Meeting and published simultaneously in the Annals of Internal Medicine compared initial AI treatment recommendations to final recommendations of physicians who had access to the AI recommendations but may or may not have reviewed them.

“We found that initial AI recommendations for common complaints in an urgent care setting were rated higher than final physician recommendations,” said Joshua Pevnick, MD, MSHS, co-director of the Cedars-Sinai Division of Informatics, associate professor of Medicine and co-senior author of the study. “Artificial intelligence, as an example, was especially successful in flagging urinary tract infections potentially caused by antibiotic-resistant bacteria and suggesting a culture be ordered before prescribing medications.”

However, Pevnick said that while AI was shown to be better at identifying critical red flags, “physicians were better at eliciting a more complete history from patients and adapting their recommendations accordingly.”

The retrospective study was conducted using data from Cedars-Sinai Connect, a virtual primary and urgent care program that began in 2023. An extension of Cedars-Sinai’s in-person care, Cedars-Sinai Connect aims to expand virtual healthcare for patients in California through a mobile app that allows individuals to quickly and easily access Cedars-Sinai experts for acute, chronic and preventive care.

The study reviewed 461 physician-managed visits with AI recommendations from June 12 through July 14, 2024. Key medical issues addressed during these virtual urgent care visits involved adults with respiratory, urinary, vaginal, vision or dental symptoms.

Patients using the mobile app initiate visits by entering their medical concerns and, for first-time users, providing demographic information. An expert AI model conducts a structured dynamic interview, gathering symptom information and medical history. On average, patients answer 25 questions in five minutes.

An algorithm uses the patient’s answers as well as data from the patient's electronic health record to provide initial information about conditions with related symptoms. After presenting patients with possible diagnoses to explain their symptoms, the mobile app allows patients to initiate a video visit with a physician.

The algorithm also suggests diagnosis and treatment recommendations that can be viewed by the Cedars-Sinai Connect treating physician, though during the time of the study, Cedars-Sinai Connect required physicians to scroll down to view them.

“The major uncertainty of this study is whether physicians scrolled down to view the prescribing, ordering, referral or other management suggestions made by AI, and whether they incorporated these recommendations into their clinical decision-making,” said Caroline Goldzweig, MD, Cedars-Sinai Medical Network chief medical officer and co-senior author of the study. “The fact that the AI recommendations were often rated as higher quality than physician decisions, however, suggests that AI decision support, when implemented effectively at the point of care, has the potential to improve clinical decision-making for common and acute conditions.”

The AI system used for Cedars-Sinai Connect is developed by K Health, which created the technology to reduce the burdens of clinical intake and data entry, allowing doctors to focus more on patient care. K Health and Cedars-Sinai developed Cedars-Sinai Connect through a joint venture and collaborated on the research study. Investigators from Tel Aviv University, including first author Dan Zeltzer, PhD, also participated in the study.

“We put AI to the test in real-world conditions, not contrived scenarios,” said Ran Shaul, co-founder and chief product officer of K Health. “In the reality of everyday primary care, there are so many variables and factors—you’re dealing with complex human beings, and any given AI has to deal with incomplete data and a very diverse set of patients.”

Shaul said the investigators learned that if you train the AI on the treasure trove of de-identified clinical notes and use day-to-day provider care as an always-on reinforcement learning mechanism, “you can reach the level of accuracy you would expect from a human doctor.”

Other authors involved in the study include Dan Zeltzer, PhD; Zehavi Kugler, MD; Lior Hayat, MD; Tamar Brufman, MD; Ran Ilan Ber, PhD; Keren Leibovich, PhD; Tom Beer, MSc; and Ilan Frank, MSc.

This work was supported with funding by K Health.

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.

Parents of children 3 to 17 years old can now access Cedars-Sinai healthcare providers for urgent issues, including cough, cold, flu or rash.

• Parents can choose on-demand visits 24/7 or a scheduled visit 7 a.m.-9 p.m. on weekdays and 8 a.m.-4 p.m. on weekends for their sick child.
• A child’s existing pediatrician is kept in the loop through the Cedars-Sinai electronic health record.

Spanish-speaking adults and parents of children 3 and older can now choose a Spanish-language app experience.

• Spanish-speaking healthcare providers are available for scheduled visits 7 a.m.-9 p.m. on weekdays and 8 a.m.-4 p.m. on weekends.
• Translators can support patients seeking on-demand care 24/7 if a Spanish-speaking provider is not available.
• Spanish-speaking adults can access primary care in their preferred language to manage chronic conditions, such as high blood pressure, anxiety, depression and obesity.

“Cedars-Sinai Connect has already helped thousands of new and existing patients easily access the high-quality care for which Cedars-Sinai is known, from home,” said Jill Martin, executive vice president of Cedars-Sinai Medical Network. “The platform is helping us extend that opportunity to even more people throughout California who are coming to Cedars-Sinai for convenient acute or chronic care. These patients also gain access to our broad network of specialists through referrals when appropriate.”

The new care options for children and Spanish speakers build on Cedars-Sinai Connect’s initial success. Since the platform launched in fall 2023, it has helped more than 8,000 patients from San Diego to Sacramento access Cedars-Sinai care through more than 10,500 virtual visits.

“Patients have come to rely on Cedars-Sinai Connect as a convenient way to access Cedars-Sinai expert care and a comprehensive primary care experience,” said Caroline Goldzweig, MD, chief medical officer of Cedars-Sinai Medical Network. “Our unique hybrid model not only offers high-quality virtual care, but it is fully integrated into a top-tier academic health system, making it easier to coordinate care and share a patient’s health records with all of their providers.” 

Cedars-Sinai Connect harnesses AI technology developed by K Health to reduce administrative burdens such as data entry, freeing doctors to focus more time on patient care. K Health helps patients manage their acute, chronic and preventive care needs through its platform that harnesses medical knowledge and real patient experiences.

“Cedars-Sinai Connect is one of the first integrated clinical care apps of its kind that is successfully using technology and care model innovation to address significant pain points—particularly access and quality—in healthcare in the U.S.,” said Ran Shaul, co-founder and chief product officer of K Health. “By combining K Health’s virtual care model with Cedars-Sinai’s high-quality clinical care, our partnership gives Cedars-Sinai greater digital capability while expanding access to expert care across California.”

Martin added that with pediatric care and Spanish-speaking doctors now available, “Cedars-Sinai Connect is furthering our collective goals of tying together in-person and virtual care, reducing wait times and addressing primary care needs for as many Californians as possible, helping Cedars-Sinai advance health equity.” 

Read more on the Cedars-Sinai Blog: Women’s Heart Health | The Virtues of a Virtual Second Opinion

“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

Through the new virtual healthcare option Cedars-Sinai Connect, healthcare professionals are available 24/7 for urgent issues, and same-day appointments are accessible for primary care—reducing wait times for those seeking medical attention.

“Cedars-Sinai Connect is a natural extension of the high-quality care Cedars-Sinai already provides to patients in person,” said Jill Martin, executive vice president of Cedars-Sinai Medical Network. “What could be more convenient than getting the care you need when you need it—in the palm of your hand—in your home or office?”

The new mobile app harnesses AI technology developed by K Health that empowers physicians by reducing the burdens of clinical intake and data entry, allowing doctors to focus more on patient care. K Health helps patients manage their acute, chronic and preventive care needs through a platform that harnesses medical knowledge and real patient experiences. K Health and Cedars-Sinai developed Cedars-Sinai Connect through a new joint venture.

The partnership gives new and existing patients expanded treatment options for a broad range of medical conditions from a dedicated team of virtual care providers. The app’s chat feature gathers health details and symptoms from patients to help assess their medical concerns and  presents that information to a clinician for review. This streamlines the intake process so providers can focus more on patient care. After the guided intake, patients can choose to connect with a clinician for an appointment via video call.

Cedars-Sinai Connect will accept all forms of insurance that Cedars-Sinai takes, including employer-provided plans.

“Patient care plans and visit information are integrated into the Cedars-Sinai health record, making it easy for patients to move between online and in-person care in a coordinated way, and for patients to access our broader network of specialists when needed,” said Caroline Goldzweig, MD, chief medical officer of Cedars-Sinai Medical Network. “This new platform will help us expand and enhance care for patients across California.”

K Health’s founders said the partnership with Cedars-Sinai will give patients greater access to world-class medical expertise, empowering people to take charge of their health by choosing when and where they get care.

“We’re excited to work with Cedars-Sinai, an esteemed institution that shares our vision to provide people with unfettered access to exceptional medical care around the clock,” said Ran Shaul, the company’s co-founder and chief product officer. “By fusing K Health’s technology with Cedars-Sinai’s renowned care, we are advancing primary care delivery by extending essential services to a wider spectrum of people in need while alleviating physician burnout.”

Read more on the Cedars-Sinai Blog: Virtual Second Opinion | Here’s What to Know

“Calcium is a token to get different body organ systems to work, and it forms and maintains healthy bones, since most calcium is stored in your bones,” Kang told Runner’s World. “Calcium also helps your heart muscles pump and transmits signals to your nerves so your muscles contract.”

Based on guidelines from the Institute of Medicine, part of the National Academies of Sciences, Engineering and Medicine, adults should get 1,000 milligrams (mg) of calcium per day. However, Kang suggests that if you’re pregnant or breastfeeding, you should increase your daily intake to 1,200 mg to 1,300 mg. For context, milk contains 305 mg of calcium per cup, Parmesan cheese has 331 mg of calcium per ounce and 8 ounces of plain, full-fat yogurt has 274 mg of calcium.

If individuals are low on calcium for an extended period, it can lead to weakened bones and an increased risk of fractures. Although most people will not notice immediate symptoms of a calcium deficiency, but the longer the deficiency lasts, the more severe the symptoms will become.

The first common symptom is experiencing frequent muscle cramps. Because calcium helps with muscle contraction, low levels of the mineral means you might experience more muscle cramps than usual, Kang says, specifically in your back and legs. Other symptoms include brittle fingernails, bone-related injuries, irregular heartbeat and tingling in arms and legs.

Click here to read the complete article in Runner’s World, including how to get more calcium in your diet.