Cold and Flu | Mount Sinai Today

Is It Worth It to Take Tamiflu?

Updated on Sep 7, 2023 | Cold and Flu, Your Health

This year’s flu season is expected to be among the worst in the last decade—with flu-related hospitalizations already higher than normal, according to the U.S. Centers for Disease Control and Prevention. One reason is that masking and social distancing requirements over COVID-19 have largely ended.

If you have not already gotten your annual flu shot, now is the time to do so. You can go to a Mount Sinai urgent care center for flu shots. Mount Sinai offers testing and treatment for those who show symptoms or have been exposed to the flu.

If you already caught the flu, there are ways to reduce its effects, such as taking antiviral medications like Tamiflu. However, managing the illness can be complicated, as some medical providers advocate the use of antiviral medications, while others treat flu symptoms and prescribe rest.

Joseph Feldman, MD

As an urgent care physician, Joseph Feldman, MD, Medical Director of Mount Sinai Doctors-Urgent Care, sees many patients with flu-like symptoms who have questions about how to treat their illness. In this Q & A, Dr. Feldman, Professor of Emergency Medicine at the Icahn School of Medicine at Mount Sinai, weighs the pros and cons of the ubiquitous antiviral medication and provides insight on how to best manage the flu so that you and your loved ones are healthy this flu season.

What is Tamiflu and when is it used?

Oseltamivir, also known as Tamiflu, is one of the more well-known antiviral medications that can be used to treat or prevent influenza. It is approved for use in adults, pregnant women, and children as young as two weeks of age. For patients who are otherwise healthy and who present with flu-like symptoms—these include painful body aches and fever coupled with sore throat, cough, congestion, headache, or even an upset stomach—Tamiflu may be an appropriate choice. If taken within 48 hours from the start of symptoms, it may provide some benefit by reducing the amount of time you feel sick.

Tamiflu can also be taken to help prevent the flu. If you or your child has been in close contact with someone who was recently diagnosed with influenza, it might be recommended to take Tamiflu—especially if you did not get the flu vaccine this year.

How effective is Tamiflu?

Unfortunately, the effectiveness of Tamiflu is marginal, as it cannot “cure” the illness. Most studies have shown that the medication will reduce the length of symptoms by only 12 to 24 hours, and if started after two days of symptoms, it does not help at all.

It is important to keep effectiveness in mind, as expectations for Tamiflu are often very high and, frankly, overhyped. The drug is usually taken for five to seven days and, if paying out of pocket, can cost more than $100. It can be challenging to find as it is often out of stock at multiple pharmacies given the high demand. Additionally, as with any medication, Tamiflu has potential side effects which may bring more harm than good. The most common of these are nausea, vomiting, and headaches that could exacerbate pre-existing conditions or lead to worsening dehydration. Other side effects, such as a severe allergic reaction, confusion, abnormal behavior, seizures, and life-threatening rashes, can occur but are extremely rare.

So, do I need the medication?

Maybe. The U.S. Centers for Disease Control and Prevention and the Infectious Disease Society of America recommend Tamiflu for patients who have a higher risk of developing complications such as pneumonia that may follow influenza.

These “at risk” patients include:

Those who are hospitalized
Pregnant women
Morbidly obese patients
Children less than five years of age
Adults older than 65 years of age
Patients with chronic heart, neurologic, or respiratory conditions such as asthma or stroke
Patients with immunosuppressing conditions such as HIV
Transplant recipients or those with diabetes and/or sickle cell disease

If you or your child fall within any of these categories, it is likely beneficial to take Tamiflu if you test positive for influenza. If you have been exposed to the flu by a close contact and have any of the previously mentioned conditions, it is also recommended that you start Tamiflu to help prevent getting sick.

For those who do not fall into a high-risk category, the decision to take Tamiflu should be made in conjunction with your health care provider. There are many times when it may not be worth the cost and the potential side effects.

At Mount Sinai Urgent Care, we are always available to answer any questions so that you can make the most informed decision for yourself and your family.You can walk in without an appointment during our convenient daytime, evening, and weekend hours. We accept most insurance providers.

Visit a Mount Sinai Urgent Care location

Will Using A Steroid-Based Nasal Spray Increase My COVID-19 Risk?

Updated on Jun 30, 2022 | Allergy, Cold and Flu, COVID-19, Ear Nose Throat, Health Hub, Your Health

The Centers for Disease Control and Prevention considers those who are actively being treated with high-dose corticosteroids to be immunocompromised. Most nasal sprays for allergies do not fall into this category. Consult your primary care physician regarding the specific medication you are taking.

Allergy sufferers are hyperaware of every cough, sneeze, and sniffle entering the height of this allergy season. Those with allergies are not only concerned with distinguishing their allergy symptoms from the novel coronavirus that causes COVID-19, but many are now worried that the medications they take to manage their symptoms might put them at increased risk.

Steroid-based nasal sprays have come under particular scrutiny because the active ingredient—corticosteroids—can reduce the strength of the body’s immune system, which is concerning during a pandemic. Fortunately, nasal spray users need not worry. Anthony Del Signore, MD, PharmD, Director of Rhinology and Endoscopic Skull Base Surgery at Mount Sinai Downtown-Union Square, explains why allergy sufferers should keep using their medications.

Should I stop using my steroid-based nasal spray?

If patients are getting the relief that they usually receive from taking these medications, I typically say to continue using them. Often, symptoms of nasal drainage, nasal obstruction, or sinus infections will increase if you come off of the medications.

It is also important to remember that with topical intranasal sprays, as well as topical nasal rinses with steroids in them, the absorption of the steroid is quite low. And, there is conflicting evidence as to whether or not steroids taken this way will actually cause any decreased defense against the virus.

A lot of the data and recommendations that we’re getting is for systemic steroids, which are steroids taken by mouth or administered intravenously. That’s where we are seeing the decrease in the immune system.

As a result, I am staying away from prescribing oral steroids for the time being. But topical nasal sprays, as well as topical rinses, I’m okay with.

I take an allergy pill. Are there steroids in my medication?

We do not typically give oral steroids to patients complaining about the typical symptoms of seasonal allergies. Instead, we recommend nasal rinses/netipot, oral antihistamines, and intranasal antihistamines as well as intranasal steroids, with pretty good effect and results.

Oral steroids are usually reserved for more serious conditions like asthma, lupus, or severe systemic allergic reactions. And, if you have a more serious condition that requires the use of these oral steroids, you have to weigh the risks and the benefits. I would counsel these patients to practice social distancing, good hygiene, and taking other precautions. These preventative measures can often tip the scale so that the benefits outweigh the risk of the steroids.

What should patients do if they are concerned that their medications will decrease their ability to fight off COVID-19?

There’s a lot of information out there, and patients may be having a tough time finding the right answers. If patients have any questions during these tumultuous times, they should consider setting up an in-person or telemedicine appointment to talk with their health care provider. After getting a global view of the patient and seeing what other risk factors they have, proper recommendations can be made that may at least help to put fears at ease at a time that’s very uncertain for many.

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What Parents Should Know About the Novel Coronavirus and the Flu

Mar 4, 2020 | Cold and Flu, COVID-19, Your Health

The outbreak of a viral infection known as COVID-19, caused by a newly discovered coronavirus, is dominating the news, and governments, public health experts, and doctors are preparing for a growing number of cases around the world and in the United States.

The possibility of a coronavirus outbreak in the New York region, as well as the seasonal outbreak of the flu, pose special concerns for children. “There is a lot of anxiety out there and a lot we don’t know,” says Roberto Posada, MD, a pediatric infectious disease specialist in the Jack and Lucy Clark Department of Pediatrics at Mount Sinai Kravis Children’s Hospital and an Associate Professor of Infectious Diseases, and Medical Education, at the Icahn School of Medicine at Mount Sinai. “Fortunately we are learning from cases in China that most children don’t seem to get very sick from the coronavirus. But we also know that youngsters are one of the ways that viruses travel from one household to another.”

In this Q&A, Dr. Posada offers some basic advice for parents in the New York area.

What general advice do you have for parents who may be worried about their children?

The most important prevention strategy is to get your flu vaccinations. It’s not too late, and every child should be vaccinated every year. We are still seeing a lot of cases of the flu in the community, and some of these children need to be hospitalized. With all viruses in general and with respiratory-borne illnesses, everyone should wash hands frequently, with soap and water or with an alcohol-based sanitizer—especially before eating, after blowing your nose, and after entering your home from the outside. There is no difference between soap and water and a hand sanitizer when it comes to most viruses. Soap and water is preferable for eliminating gastrointestinal pathogens—infectious agents like viruses and bacteria that cause disease in your digestive tract—so that’s best after using the bathroom.

Also, teach children the proper etiquette for coughing or sneezing. They should use the inside of their elbow or blow into a tissue, and then wash their hands.

Are kids more at risk from viral outbreaks generally?

Kids tend to get more viral infections than adults, partly because their immune systems are not fully developed. How sick they can get depends on their age. Kids less than two years old are at higher risk for many infections like the flu.

How much of a risk does the coronavirus present for children?

We know from the data so far that the coronavirus seems to result in a very mild infection for children. Most of the patients that have been hospitalized or have died are older adults. Also, it is important to note that about 80 percent of people who have gotten the coronavirus experienced a very mild illness and did not need to be hospitalized. Unfortunately, about 20 percent of infected people develop more significant disease, and about 1 to 2 percent of all of those infected have died, again most of them older adults.

Should parents keep children out of public spaces, maybe off the subway?

At this time, I would suggest people in the United States go about life as normal, so long as they are washing their hands frequently. For example, if you take the subway or public transportation, or if you have been around people who are coughing or sneezing, it’s a good idea to wash your hands. Avoid as much as practical being in close proximity to people who are sick. You should also follow the news, as the recommendations from public health officials may change rapidly depending upon the cases we see. As always, the Centers for Disease Control and Prevention (CDC) and your local health department are the best sources of information.

The CDC recently said that if a widespread outbreak occurred in the United States, schools could be closed. Why is that an effective step?

If public health officials see the virus is spreading fast, and believe schools may be playing a role in facilitating the spread of the illness from household to household, closing of schools may be warranted.

How do children help transmit viral infections?

What happens with the flu or any virus is that young children pass them to their classmates. Young people are in such close contact with each other, especially if they are at day care, and it’s not uncommon for their saliva or mucus to mingle. They share toys, maybe even eating utensils. When kids get sick with an infection, they can pass the causative virus or bacteria along to other kids, and those kids then can bring it to their parents. That is how an illness crosses from one household to another and contributes to the spread of the viral infection.

Should we wear face masks?

At this point we are not recommending you or your children wear face masks to avoid getting sick. Face masks are mostly for health care workers who are in close proximity with people who are sick. And it can be helpful if someone who is already sick wears a face mask when in public spaces to prevent infecting others.

When should parents call the pediatrician if their child is sick?

My recommendations for the flu and other viral infections is the same as for illnesses in general. If your child’s symptoms are mild and in the respiratory tract, like a runny nose and sneezing, and if they are continuing with their other normal activities and these symptoms have lasted less than 24 hours, I would not worry or call. But if symptoms last more than 24 hours, if children also have a cough and fever, if they are not eating or drinking enough, and if they are disinterested in normal activities and look tired or sleepy, I would call your pediatrician. And let your pediatrician know if there is any history of travel or interactions with people who have been sick.

How Important Is Getting the Flu Shot?

Updated on Jun 30, 2022 | Cold and Flu, Infectious Diseases, Your Health

Despite all the media attention about the novel coronavirus, now known as COVID-19, influenza is currently a much bigger risk for most people in the United States. Yet many people do not plan to get a flu shot this year. You may be busy, or perhaps you think you might get sick from the shot, or that it’s not necessary. Matthew Weissman, MD, MBA, a primary care doctor with the Mount Sinai Health System, explains why you shouldn’t put it off.

Why should I get the flu shot?

The flu shot is extremely important. It not only prevents you from getting sick from flu, but it can lessen the severity of flu even if it’s not a perfect match for the type that is going around. For instance, my own daughter got the B strain of the flu. Luckily, she had a much milder case of it because she got the shot.

People forget that the flu is a deadly disease. Each season, tens of thousands of people die from the flu, and hundreds of thousands are hospitalized, according to the Centers for Disease Control and Prevention (CDC). Most of the people who died were not vaccinated. If you’re overweight, pregnant, elderly, or a child, or you have other diseases, you’re in a high-risk category. When you add all those up, you’re talking about a wide swath of New Yorkers.

Keep in mind that the flu shot doesn’t just protect you; it protects your co-workers, your classmates, your parents, and your grandparents—including people whose immune systems may not be good enough to build up their own defenses. It’s like a ripple effect, or herd immunity. It would be a great idea to have a workplace event for people to get vaccinated. It’s a smart idea for businesses to help cut down absenteeism this way.

Some people don’t get the shot because they think they’re going to feel sick for a couple days. Is that true or a myth?

People’s responses vary. Some people do feel a little feverish, get a sniffle, or have a sore arm for a bit. That’s actually a good sign, because it means their immune system is revving up to combat the flu. I think that’s a fair price to pay for not being incapacitated for over a week or being at risk of death from a vaccine-preventable illness. And these side effects don’t happen to everybody, and it doesn’t happen every time.

People have all kinds of excuses why they can’t get the flu shot. People are sometimes worried that the shot may cause a bad reaction because they have an egg allergy. But there are lots of ways to deal with that, including some vaccines that were not created using eggs. People should ask their doctor to find out what’s right for them.

Bottom line, the benefit of the flu vaccine outweighs the risk for most people, by far.

Is it too late to get a flu shot this season?

Definitely not. Flu season doesn’t appear to have peaked yet. The flu season is generally during fall and winter. The CDC recommends that everyone six months or older get the flu shot. You can get it any time up until spring, so don’t wait.

Matthew A. Weissman, MD, MBA, is Chair of Medicine at Mount Sinai Downtown and Associate Professor of Medicine (General Internal Medicine), and Pediatrics, at Icahn School of Medicine at Mount Sinai

I Feel Sick. Should I Stay Home or Go to Work?

Updated on Jun 30, 2022 | Cold and Flu, Your Health

You wake up in the morning and you know you don’t feel right, but you can’t afford to be sick. Meetings to attend, deadlines to meet, kids to get to school—it’s not going to go away because you don’t feel good. Matthew Weissman, MD, MBA, a primary care doctor with the Mount Sinai Health System, offers some common-sense advice about when to stay home, and when to keep your kids home.

As New Yorkers, we feel this drive to keep going all the time. So many of us feel compelled to go to work even when they don’t feel well. When should people stay home from work?

Lots of us feel this pressure to show up to work, be tough, and work through it. But we’re doing a disservice to our colleagues and ourselves by doing that. Helping each other as good New Yorkers means that if you have symptoms such as fever, sneezing, runny nose, muscle aches, or fatigue, you should stay home. You should give your body—and your colleagues—a break and stay home.

How long should you stay home?

If you have a fever, you should stay home at least 24 hours after the fever goes away. And when flu symptoms are present, you should probably stay home for a week from the time the symptoms start. Maybe you can find an alternative way to work, like working from home, but that’s not an option for everyone. Perhaps you can find time to work when others aren’t around, or find a space that’s a bit secluded. But pushing yourself is never a good idea. It will just take that much longer to recover.

The other thing is that people are contagious 24 hours before they start showing signs of the flu. So that’s even more reason to practice good hand hygiene all the time, get your flu shot, and don’t share drinks, food, or toothbrushes with other people. You really have to be on alert all the time—not just when someone near you is coughing or sneezing.

What about keeping my kids home from school?

I know it’s tough on kids to miss school, so perhaps checking with your pediatrician is a good idea. If it’s just the sniffles and no fever, it may be okay for them to go. Or perhaps they can find a way to video chat into some classes. You certainly want to help prevent spreading colds and flu around the class. That’s why it’s important to teach kids about good hand hygiene, and to cover their cough with their elbow instead of their hands.

Sometimes when you’re sick, you are a bit torn. You wonder if it’s in your head, and you think about all the stuff you have to do.

It’s a balancing act. But think about it as an investment in the future. If you get some rest now, you’ll be more productive at work in the future. It may not be in our nature to slow down, and it may not seem like it’s what everyone else is doing. But it’s really important to protect our ability to function down the line. Because the flu will wipe you out for a week, at least, and then you’re really playing catch up.

The flu isn’t always just a few days of being under the weather. People forget that it’s a deadly disease, and can lead to other complications like pneumonia. So if you’re going to err, it might as well be on the side of safety.

Another thing that people wrestle with is, “Is this just a cold or is it the flu?”

That’s true. Many people confuse the flu with a cold, so it’s important to know the difference and to get checked out when appropriate, since the flu can be deadly. Colds tend to come with just runny noses, sneezing, and head symptoms, while influenza tends to have more bodily symptoms like muscle aches and fever. If it is the flu, treatment like Tamiflu is most effective in the first few days of symptoms. If it’s a bacterial infection, you may need antibiotics. If it’s a cold, the best thing you can do is rest and get plenty of fluids. Many times people come to us and feel they should have antibiotics. It’s important that doctors only prescribe antibiotics when needed; otherwise, patients may experience unnecessary side effects, or the antibiotics may not be as effective when you really need them.

And of course, you have New Yorkers who don’t want to give up their workout. Is it a bad idea to work out when you don’t feel well?

If you really have the flu, you’re going to feel debilitated and not feel like working out anyway. But if you just have the sniffles, you might feel better after a little exercise. Certainly you don’t want to contaminate people. But if you have a slight cold, it might feel better to get the blood pumping and your airways opened up. And you definitely want to wipe down the treadmill with an antiseptic wipe, and wash your hands before and after your workout. The gym is one of those places where you can come into contact with all kinds of germs.

Always listen to your body and let that (and your doctor) be your guide.

A New Yorker’s Survival Guide to the Cold and Flu

Updated on Jun 30, 2022 | Cold and Flu, Your Health

You’re on the bus or subway during your morning commute. A fellow passenger near you starts sneezing and coughing. You eye them suspiciously. Are you at risk for catching something?

Matthew A. Weissman, MD, MBA, of the Mount Sinai Health System offers some street-wise strategies for beating the cold and flu in New York City.

As New Yorkers, we ride subways, buses, and elevators—does that increase our risk or build immunity?

I think it does both those things. There’s data that says being exposed to a lot of germs over time increases your immunity to disease. So in general, people who live in New York are more immune to stuff than people who live by themselves on a farm somewhere.

We’re tough here in New York!

Absolutely. The problem is, there are lots of different types of colds and viruses. And the flu virus mutates and changes every year, so even if you have immunity built up, it doesn’t mean you’re not going to catch something. So yes, we’ve got tough exteriors and a tough immune system, but we’re still at risk of catching diseases.

Should people worry about riding crowded subways and buses? If one person coughs in a subway car, are we all going to get sick?

I don’t think so. A lot of fresh air gets into the subway. Doors open all the time. You’re not in an airtight capsule. You might want to give yourself as much space as possible. And if possible, you might want to alter your commute during cold and flu season to a time or a line that’s not as crowded. It’s also a great time of year to bundle up and walk part of the way to work or school. Enjoy the fresh air! But I ride the subway all the time.

What’s the best way to cover your cough?

People should cover their cough with their elbow, not their hands. Because if you cough into your hand, and then grab onto the subway pole that’s not helping anybody. And part of being a good New Yorker is helping each other by not riding the subway or going to work when you’re contagious, which can last 24 hours after your symptoms and fever go away. On the subway, I’m thinking about airborne germs and picking something up with your hands from the subway pole. So keep your hands away from your face while you’re on public transit, and when you get to work, it’s a good idea to wash your hands (and maybe even to carry some hand sanitizer with you).

Why is handwashing so important?

Handwashing is key. It’s one of the most important things you can do, other than get the flu shot. We come into contact with so many contaminated things in the city. And when you touch your face or rub your eyes, that’s a problem. Of course, you should wash your hands before you eat and after using the restroom. But after your commute, or any time you come into contact with dirty things is a good idea. Frequent handwashing throughout the day is smart. We don’t think about all the things we touch that are frequently handled, like computer keyboards, phones, door knobs, or office kitchen appliances like microwaves or refrigerators. When you go to the gym, you should wash your hands after using the treadmill or using weights. At the salad bar, no matter how clean, the utensils are used by a lot of people. In public restrooms, I try to always use paper towels to dry my hands instead of the air blowers, which tend to just spray germs around.

Use soap and warm water to wash your hands. Twenty seconds of scrubbing vigorously on all surfaces is key. Keeping Purell or another alcohol-based hand sanitizer is good, too. That would be convenient after your commute even though it doesn’t kill all kinds of germs.

Is wearing a mask on the subway effective against germs?

It may reduce your exposure but I think masks are actually more useful in preventing your own germs from spreading, since they’re not really air-tight around the sides. A lot of people don’t use them correctly and keep taking them off or reaching underneath with their hands. Is it worth the trouble? Maybe, but I’m not convinced that it’s as effective or useful as the other things we’ve talked about.

How about cabs and car services like Uber? How risky are they?

You’re probably better off in a cab or ride-sharing service than a subway in terms of avoiding germs. I try to keep the windows open as much as possible. And seatbelt buckles and door handles are more things that are frequently handled that we don’t think about. So minimize touching them and wash your hands after.

What about public restrooms? Are they safe during cold and flu season?

Sure, public restrooms are safe. I use them all the time. I think it’s very hard to get anything from a toilet seat, so laying down toilet paper or sanitary guards isn’t really that helpful. Hand dryers are another story. The evidence is that they just spray germs around. I’d much rather use paper towels, given a choice. And once you wash your hands, opening the door with a paper towel is a good idea.

What about salad bars?

While studies show that salad bars may have bacteria, it is not clear how often they actually cause disease. My suggestions are that you want to have a sense that the salad bar is well maintained. The cold food should be kept cold and the warm food kept warm. Is it being replenished regularly, or has it been sitting there for a long time? Does it have a sneeze guard on top? Of course, you can’t avoid using the serving utensils that lots of other people have touched. So especially during cold and flu season, I make sure that washing my hands is the last thing I do before I eat.

Any other advice for New Yorkers?

Living in New York is stressful, and that’s not good for your immune system. We’ve got emotional stress, we’re rushing, we’re busy, we don’t sleep enough—and all of it takes its toll on our immune system. And then you have our exposure to airborne pollutants. It’s always important to get exercise, to eat healthy including lots of fruits and vegetables, to sleep well at night, and to reduce stress as much as you can.

Matthew A. Weissman, MD, MBA, is Chair of the Department of Medicine at Mount Sinai Beth Israel and Senior Faculty in Internal Medicine and Pediatrics at Icahn School of Medicine at Mount Sinai