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Comparing data from COVID-19, influenza and pneumonia

HIGHLIGHTS:

  • 1 in 3 patients with influenza contract a pneumococcus bacterial infection alongside the virus which can lead to pneumonia, and in some cases may develop sepsis, which can be fatal.
  • Pneumonia resulting from a pneumococcal infection is one of the leading causes of death among those over the age of 65.
  • Patients with congenital health conditions, such as heart disease, diabetes, and lung disease, are at a greater risk of losing their lives to COVID-19, influenza, and pneumonia than the general population.

 

 

COVID-19 Influenza Pneumococcal pneumonia
Rate of infection Patients aged between 15 – 49 make up 55.1% of all patients C1
  • 713 out of every 100,000 people worldwide contract influenza each year
  • In Thailand, the infection rate is 1,231 out of every 100,000F2
The older the person, the greater the risk of infection P1

  • 25 out of every 100,000 people aged 50 – 64 will contract the disease each year
  • 67 out of every 100,000 people aged over 65 contract the disease each year

The risk is heightened among older people who also suffer from congenital health conditionsP1

  • 187 out of every 100,000 people over 65 with diabetes contract the disease each year
  • 254 out of every 100,000 people over 65 with heart disease contract the disease each year
  • 398 out of every 100,000 people over 65 with asthma contract the disease each year

516 out of every 100,000 people over 65 with lung disease contract the disease each year

Virus or bacteria responsible for the infection
  • SARS-CoV-2
  • Influenza A(H3N2), A(H1N1)) virus
  • Influenza B virus
  • Streptococcus pneumoniae
Symptoms
  • 14-day incubation period
  • Around 97.5% of sufferers begin to show symptoms within 11.5 days

Symptoms are as follows:

  • Fever (98%), approximately 60% of which have been above 38C
  • Dry cough (68%)
  • Exhaustion (38%)
  • Breathing difficulty (31%)
  • Headaches, muscle pain or cold shivers are found in approximately 11–13% of casesC1
  • Fever of over 38C combined with cold shivers
  • Muscle pain and headaches
  • Dry cough
  • Exhaustion
  • Blocked nose
  • Sore throatF3
  • High fever and cold shivers
  • Breathlessness and difficulty breathing
  • Coughing up phlegm
Levels of Severity Severe cases (14%) – difficulty breathing alongside hypoxia

Critical cases (5%) – heart failure or organ failureC2

1 in 3 influenza patients also contract a pneumococcal bacterial infectionF1 that can lead to pneumonia, while some cases may develop sepsis, which can be fatal
  • Patients usually require a hospital stay to recoverP2
  • One of the leading causes of death among those over the age of 65P2
  • Some patients may develop sepsis or meningitis, which can be fatal, especially in those with congenital health conditions
Fatality Rates
  • 1.4 – 2.3% from all age groupsC3, C4 (the true fatality rate is expected to be lower than 1% due to asymptomatic cases not currently being factored into equations)
  • 14.8% for those over 80
  • For those with congenital health conditions:
    • Heart disease: 10.5%
    • Diabetes: 7.3%
    • Lung disease: 6%
  • Less than 0.1% from all age groupsF4
  • 11.4% for those over 65
  • For those with congenital health conditions
    • Heart disease: 11%
    • Diabetes: 10.6%
    • Chronic lung disease: 7.7%
  • 10% from all age groupsP3
  • 22% for those over 65
  • For those with congenital health conditions
    • Heart disease: 18%
    • Diabetes: 11%
    • Chronic lung disease: 10%
How the disease is spread Being within 1–2 meters of someone with the disease who is coughing or sneezing, or through contact with surfaces contaminated with the saliva of infected patients, which is transferred to the face, nose and mouth via the hands. There is currently no evidence to suggest that this virus can survive suspended in the air. C5 The influenza virus is present in the phlegm, saliva and nasal mucus of infected patients. It is spread via coughing, sneezing or through contact with contaminated objects. Pneumococcus bacteria resides within the nasal passage and throat of every person. It can be spread via air particles, coughing and sneezing.
Prevention
  • Frequently wash hands with soap and water, or with alcohol gels with an alcohol content no lower than 70%C6
  • Keep at least 1 meter away from infected patients, although 2 meters is advisable if they are coughing or sneezing
  • Avoid touching your face, nose and mouth, and cease greetings that involve bodily contact such as shaking hands or hugging
  • Wear a protective face mask
  • Avoid built up and congested areas
  • Thoroughly wash hands
  • Wear a protective face mask
  • Avoid congested areas
  • Receive an influenza vaccinationP4 (one injection every year)
  • Thoroughly wash hands
  • Wear a protective face mask
  • Avoid congested areas
  • Receive a pneumococcus vaccinationP4 ( a one-time injection for protection against 13 strains and another one-time injection offering protection against a further 23 strains, one year apart)

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References
  • C1. Guan 2020. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine February 28, 2020
  • C2. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020.
  • C3. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. Published online February 07, 2020.
  • C4. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020
  • C5. UpToDate. Coronavirus disease 2019 (COVID-19). Accessed 13 March 2020. https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19?topicRef=8298&source=see_link
  • C6. Department of Disease Control. https://ddc.moph.go.th/viralpneumonia/faq_more.php
  • F1. Klein et al. The frequency of influenza and bacterial coinfection: a systematic review and meta-analysis. Influenza and Other Respiratory Viruses. 2016; 10(5): 394–403.
  • F2. GBD 2017 Influenza Collaborators. Mortality, morbidity, and hospitalisations due to influenza lower respiratory tract infections, 2017: an analysis for the Global Burden of Disease Study 2017. Lancet Respir Med 2019; 7: 69–89
  • F3. Mayo Clinic. Influenza. Accessed 13 March 2020. https://www.mayoclinic.org/diseases-conditions/flu/symptoms-causes/syc-20351719
  • F4. 1.Weng T-C, Chiu H-YR, Chen S-Y, et al. National retrospective cohort study to identify age-specific fatality risks of comorbidities among hospitalised patients with influenza-like illness in Taiwan. BMJ Open 2019;9:e025276.
  • P1. Rhodes J, et al. PLoS One 2013;8(6):e66038. Shea KM, et al. Open Forum Infect Dis. Published online May 8, 2014. doi:10.1093/ofid/ofu024
  • P2. Ruiz LA, Zalacain R, Capelastegui A. Bacteremic Pneumococcal Pneumonia in Elderly and Very Elderly Patients. J Gerontol A Biol Sci Med Sci. 2014; 69(8):1018–1024.
  • P3. Backhaus et al. Epidemiology of invasive pneumococcal infections: manifestations, incidence and case fatality rate correlated to age, gender and risk factors. BMC Infectious Diseases (2016) 16:367.
  • P4. ตำราวัคซีนและการสร้างเสริมภูมิคุ้มกันโรค ปี 2562. กองโรคป้องกันด้วยวัคซีน กรมควบคุมโรค กระทรวงสาธารณสุข

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Payia Chantadisai, M.D. Summary: Internal Medicine Infectious Diseases