Weathering the Omicron Surge, Explaining "Flurona"

Los Angeles County is reporting record numbers of COVID-19 cases as the omicron variant continues to spread. To help the community navigate this current pandemic surge, Cedars-Sinai experts shared updates on the most important things Angelenos need to know.

First on the list: Get vaccinated and get a booster shot if you qualify.

“Just as we saw this past summer, most of the patients being admitted to our hospital are unvaccinated,” said Caroline Goldzweig, MD, chief medical officer of the Cedars-Sinai Medical Network. “Our best defense against this relentless virus remains vaccination.”

A handful of children also are being hospitalized with COVID-19, said infectious disease specialist Priya Soni, MD, assistant professor of Pediatrics. These children are primarily unvaccinated, either because they are too young or because their families chose not to vaccinate, and some have underlying health conditions such as asthma or obesity. “The best defense is the vaccine, and we at Cedars-Sinai strongly, strongly recommend vaccinating children ages 5 and up,” Soni said.

Rare cases of myocarditis, an inflammation of the heart muscle, have occurred in ages 12 and up, but the condition is actually more common among those infected with COVID-19 than among those receiving the vaccine, said Soni.

What Do We Need to Know About “Flurona”?

The media has recently been reporting on something they are calling “flurona,” a new term for someone who has COVID-19 and flu at the same time. Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai, stressed that this is not a new variant of COVID-19.

Grein said that it is possible to be infected with both viruses at the same time, and Cedars-Sinai has seen at least one mild case among its patients.

“It has not been a big issue for us because of the low levels of influenza circulating in the community,” he said, adding that co-infections could increase if flu cases increase, but that little is known about what that would mean for patients.

“It’s obviously not good to be infected with two viruses rather than one, but there’s no clear indication that this is a particularly bad combination,” Grein said. Treatment for mild combination symptoms would be the same as home treatment for either virus individually.

Grein also stressed that, as with COVID-19, we have a vaccine against influenza, and that getting a flu shot is the best way to prevent infection.

What About Booster Shots?

The Centers for Disease Control and Prevention (CDC) recently extended Pfizer-BioNTech booster recommendations to ages 12 to 15, meaning they are now recommended for everyone ages 12 and up, Goldzweig said. (Ages 5 and up can receive two doses of the Pfizer-BioNTech vaccine, but no booster is yet recommended for ages 5-11.)

Booster timing for the Pfizer-BioNTech vaccine has also changed, with the CDC now recommending it be given five months after the two-dose series is complete. Timing remains six months for those receiving the Moderna vaccine, and two months after the single-dose Johnson & Johnson vaccine.

 “Anyone eligible should get a booster,” Goldzweig said. “We know that immunity from the vaccines starts to decrease over time, but studies show that the boosters are preventing hospitalizations and deaths.” 

Who Should Get Tested?

Because even those who are vaccinated can develop COVID-19, anyone in unmasked, close contact with someone infected with COVID-19 for 15 minutes or longer should get tested five to seven days after that exposure—even if they don’t have symptoms, Goldzweig said.

“Influenza and other viruses are circulating, but the likelihood right now is that anyone with symptoms has COVID-19, particularly in Los Angeles, where it's estimated that 1 in 5 people are infected,” Goldzweig said. “Treat yourself as if you have COVID until you get those test results.”

Testing appointments are available throughout L.A. County via the county COVID-19 testing website. Pharmacies and other locations also offer testing, and Goldzweig stressed the importance of visiting one of these, or using an at-home test kit, rather than visiting an urgent care center or emergency department, as many are at full capacity caring for ill patients.

Those who test positive might qualify for one of the newly available COVID-19 treatments. “A positive result also gives you an extra push to isolate yourself and make sure that you protect others from getting COVID-19,” said Goldzweig, adding that with so much virus circulating, any positive test result should be considered accurate.

Who Should Stay Home?

 Anyone with COVID-19 symptoms or a positive test result should isolate, and CDC guidelines on that have recently changed. For everyone except healthcare workers, the isolation period is now five days.

“The five days begins the day after you first experience symptoms, or the day after your positive testing date,” Goldzweig said. “Your fever and other symptoms should be gone or greatly improved before you end your isolation, and you still need to wear a mask at all times around other people for a full 10 days.”

This advice to isolate and mask extends to everyone in the household, because if one person has COVID-19, everyone else was exposed. “The person who has COVID-19 should isolate, in their own bedroom with their own bathroom, if possible, until they are completely recovered,” Goldzweig said.

As schools reopen after winter break, it’s uncertain how the new CDC guidance will play out in children, as some campuses are allowing students who are exposed to COVID-19 but test negative to return to classes right away.

“Our local health departments have provided more detailed guidance prior to schools reopening, and some schools have already adjusted protocols in preparation,” Soni said. “We want kids to be able to attend school without having long periods of quarantine. And we hope that, as with the delta variant, younger children will not be the big drivers of this pandemic.”

How Should COVID-19 be Treated at Home?

Because the omicron variant now accounts for most cases of COVID-19, and because the variant seems to cause milder illness—particularly in vaccinated and boosted patients—Goldzweig said most people who develop symptoms can care for themselves at home.

“If you have relatively mild symptoms and aren’t high-risk because of your age, a chronic illness or impaired immune system, you can take an over-the-counter medication like Tylenol or Motrin for fever and muscle aches, and push fluids the way you would with any other viral illness,” Goldzweig said.

This advice also applies to children, and Soni said children with COVID-19 shouldn’t need antibiotics or any additional medication unless their pediatrician is concerned that they also have a concurrent ear infection or pneumonia.

Who Should Go to the Hospital?

For more serious symptoms, Goldzweig and Soni recommend seeking medical care right away.

“If you're feeling very short of breath, have a persistent fever, you're very weak, you can't keep up with fluids, or you're getting dizzy when you stand up, that would be a time to seek help,” said Goldzweig.

In older children and teens, the virus seems to behave much as it does in adults, but for infants, parents should watch closely for signs of trouble, Soni said.

“They might be feeding poorly or not waking up to feed at their usual times. You might see them breathing faster than normal or appear to be working harder to breathe, and those are signs your baby may be in trouble,” she said.

Goldzweig added that a video visit might be a good place to start for someone who wants guidance about their or their child’s relatively mild symptoms, and that the best way to keep the whole family out of the hospital is for everyone eligible to get a booster. 

“The booster is important to rev your immune system back up and give you protection from these newer variants,” she said. “You might still get COVID-19, because we know that even boosted people are getting omicron, but you will have far fewer symptoms and you're much less likely to be hospitalized. You also will clear the virus faster, so your period of being infectious to others is greatly reduced.”

How Else Can We Protect Ourselves?

Along with vaccination and boosting, the other health habits we’ve adopted throughout the pandemic—masking indoors, frequent and careful hand-washing—offer an added layer of protection against all variants of COVID-19 and other winter viruses circulating, Goldzweig said.

She also offered a reminder that large gatherings put everyone at risk.

“Be smart,” she said. “Right now, we're in this surge. When we're in a surge, don’t go get a COVID-19 test just so you can go to a big party or go to a club. We’re all tired of staying home, but these are the things we have to do to protect ourselves and others from this virus.”

Read more on the Cedars-Sinai Blog: COVID-19 Update for Patients