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We continue to be bombarded by media and hearsay about COVID-19 testing.  Hopefully this information may help offer some guidance regarding the testing issues and some direction for you to consider personal testing.  There are two types of COVID 19 tests available at this time, the molecular testing for active disease and the antibody test for the exposure to or recovery from the disease.

The molecular test looks for active disease.  This involves taking a cotton swab of one nostril for about a five second duration.  This sample is then sent to the lab to undergo a polymerase chain reaction (PCR).  This testing checks for the presence of the genetic material of the virus.  A positive PCR test identifies the presence of two specific SARS-CoV-2 genes.

If there is only one gene present, the test is reported as an inconclusive result.  This testing can only diagnose a current active case of COVID-19.  Common symptoms include a cough and/or shortness of breath.  At least two additional symptoms including fever/chills, muscle pain, headache, sore throat and loss of taste or smell are suspicious of disease.  Some individuals may have only a few or no symptoms whatsoever, but still be actively infected.   Negative test during the presence of acute respiratory symptoms indicates that the illness is not COVID-19.

False negative testing may occur if the test is collected too early in the exposure of the disease.  The usual period from catching the infection to developing symptoms averages 5-6 days, but may be up to 14 days.  During the “pre-symptomatic” period, some individuals may be actively spreading the infection.

At this writing, the only way to access local molecular testing is with a physician order through the Coconino County Health Department.  The collection sites for testing are at Fort Tuthill and their King Street building, but schedules may vary.  For more information and updates, visit www.coconino.az.gov/2294/COVID-19-Information.

Coronavirus COVID-19 SARS-CoV-2 Antibody IgG testing may show individuals who have recovered from exposure to COVID-19. This test searches for the presence of specific antibodies that the body has produced to fight the virus.  A blood sample is needed to run this test, and there are a number of commercial labs producing these serologic tests.  This testing should not be considered until at least ten days or longer after symptoms develop, as it can take one to three weeks for the body to develop antibodies.

A positive test shows that antibodies are present, a negative indicates no antibodies present.  There are some questions that arise about such testing.  By recent reports, some of these lab tests may be up to thirty percent inaccurate.  False positives may indicate antibodies, but may not be specific to SARS-CoV-2 as there are other common Coronaviruses including HKU1, NL63, OC43 and 229E.  There is also no distinction as to recovering from a present COVID-19 infection or a previous common non-SARS-CoV-2.

One needs to use some care in interpreting the value of antibody testing.  There is no assurance that antibody positive individuals may continue to be resistant to future exposures.  Or, if positive, for what longevity may their resistance be present.  That said, the presence or absence of antibodies should not be used to definitively diagnose or exclude COVID-19 infection or designate the status of infection.  Be careful about using these test results alone to make health related decisions.  Because of these problems, some medical clinics are not offering this test to their patients.  Consult your health care provider for guidance regarding testing during these challenging times.

Bradford Croft, DO

East Flagstaff Family Medicine

Not Virtually Impossible

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When I look back to when I was an 8-year-old boy thinking while talking on the phone to friends and family how amazing it would be to see their faces as we talked. At the time I never thought this was a realistic proposition for the general public. Now here we are in 2020 and you can have a comprehensive remote audio and visual visit with your medical provider via telemedicine! 


According to CMS (Centers for Medicare and Medicaid Services), telemedicine or telehealth refers to the exchange of information from one site to another through electronic communication to improve a patient’s health. Its use involves any interactive audio and visual telecommunications system that allows real-time communication between a medical provider and the patient at a remote site, such as a patient’s home, place of work, or even automobile. 


Telemedicine has become far more prevalent in the last few years. Its beginning dates back at least 70 years. In the 1940s and 1950s physicians in Pennsylvania and Canada started to send radiology images to other sites via telephone lines for shared care of patients. The first use of audio and visual telehealth dates back to 1959-1965 when the University of Nebraska established a two-way television for use in educating medical students and video consults with patients in a state hospital. In many rural areas of the US where certain medical specialties may not be available within a reasonable geographic traveling distance, telemedicine can help bridge the gap via a provider-to-provider consult or a provider-to-patient visit. 


Though telemedicine has been in use for a number of years, its use has increased significantly by providers in a great variety of medical specialties recently due to the current COVID-19 pandemic. As it has been strongly encouraged to stay at home as much as possible to prevent the spread of the virus, telemedicine provides an invaluable way to be able to communicate with your medical provider regarding any chronic or acute medical condition that needs treatment.  


As one may imagine, there can be some limitations to receiving care via telemedicine vs. an in-person visit. One is not able to provide hands-on listening to heart and lungs or examine a spine or extremity. However, with many chronic and acute conditions, an adequate examination may be performed with face-to-face telecommunications. During these very unusual conditions that the COVID-19 pandemic has presented, the benefits obtained by not delaying care with your medical provider for any medical condition that may present itself greatly outweighs any limitations that this mode of treatment may have.  


You will want to schedule a telemedicine appointment with one of your healthcare providers soon.  We highly recommend taking advantage of this technology to have such a visit with your doctor, nurse practitioner, or physician assistant while in the comfort of your own home.  All insurances now recognize and reimburse these visits.  There is no special equipment needed other that a smartphone or desktop/laptop or tablet that has a video camera and microphone.  If you need any assistance, offices are more than ready to help.  Hope to see you soon.   

Andy Conboy, PA -C

East Flagstaff Family Medicine


Going Viral

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As global economics sagged late in February, the worldwide impact of the Wuhan Corona virus (Covid-19) illness becomes apparent.  Having initially been localized to China since the discovery of the infection December 2019, there evolves a worldwide surge of infection with documented cases in all continents except Antarctica by the end of February.  At this writing, there are more than 82,000 cases and 2,800 deaths.  Some infections are easily spread with the ability of global travel as highly virulent strains.  Other infections may take their human toll as they may be extraordinarily deadly.  With the jury not yet back on Covid-19, the World Health Organization (WHO) and Center for Disease Control (CDC) can only attempt at this time to limit the spread with national and international cooperation.

Border closures and quarantine may initially be the preferred steps to prevent the entry of disease.  Once the illness becomes apparent in communities, the challenge becomes much greater. Consideration of work and school closures, restrictions of public events, self-imposed isolation of individuals who are ill may be collaboratively helpful.  The health care provisions to treat this disease are supportive treatments at best, as there is yet definitive treatment or immunization for this virus.  As reflected in the stock market changes, these can as well have significant economic impact for both health care costs and the worldwide economy as well.

If we need to put this epidemic in proportion, we should look at pandemics of the past century.  The Flu Pandemic of 1918 became a worldwide outbreak over two years, infecting one third of the world population and killing up to 500 million people with a mortality rate of up to 20%.  Perhaps with the development of modern medicine, no other epidemics have eclipsed this toll in the modern world.  Yet.

The Asian Flu of 1956 spread from SE Asia thru the US, killing 2 million.  The Hong Kong Flu killed one million from SE Asia thru Europe, Australia and the United States in 1968.  Other diseases have provided their epidemic influence over years and centuries, but may not have the impact to the “modern” world as we know it.  Those diseases that have influenced history include cholera, bubonic plague and smallpox.  Not to ignore their presence at this time, as they are persistently lurking.  A good example of this scenario is the current control of Ebola. The human to human contact is not easily spread, but up to 80% lethal once transmitted.

Concern for Covid-19 transmission has a few concerns.  Standard face masks may protect you from transmission of the virus. Covering coughs and sneezes with masks can minimize the aerosol spread.  The virus is highly contagious, although over eighty percent of the cases are mild, the remaining infections can be severe.   That said, the virus is spread from infected human contact, so preventive measures are important.  Avoidance of those already coughing and sneezing is commonsense.  Inactivation of potentially contaminated surfaces may be achieved with cleaning agents containing hydrogen peroxide, ethanol or bleach.  A common habit that many of us have involves touching eyes, nose, and mouth without any awareness of the action.  This single contact is the most likely way to inoculate yourself with the viral contamination on your hands.  Make an extra effort to keep hands away from face.  Which leads to the single most important prevention:  hand washing.   Frequent use of an alcohol based hand cleaner or twenty seconds minimum with soap and warm water are ideal. So if we can’t treat it, let’s beat it!

Bradford Croft, DO

East Flagstaff Family Medicine

What You Should Know about Coronavirus

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With the increasing concern of COVID-19 in our communities, our first and foremost concern is for the health and safety of our patients and our people. We want you to know what you can do to prepare for the coronavirus at home and if you need to visit a healthcare center.

What you should know
• COVID-19 is a respiratory disease caused by a novel (new) coronavirus that was first detected in China. It is now being spread from person to person in multiple locations across the U.S.
• Health experts are still learning the details. Currently it is thought to spread:
o Between people who are in close contact with one another (within about 6 feet).
o Via respiratory droplets produced when an infected person coughs or sneezes.

Personal precautions
Here are a few tips to help prevent infection:
• Wash your hands often with warm, soapy water for at least 20 seconds and/or use hand sanitizer.
• Cough into your elbow. Cover your mouth and nose with flexed arm or tissue when coughing and sneezing. Clean hands with hand sanitizer or wash hands thoroughly after.
• Avoid touching your eyes, nose and mouth.
• Clean and disinfect high touch areas such as desks, doorknobs, keyboards, phones, etc.

Medical care
• If you are sick and have a fever, or signs of cough/flu/pneumonia, shortness of breath, or other respiratory conditions please stay home from work or school.
• Call your primary care provider before traveling to a care center to understand the appropriate plan of care if you know you have been exposed to somebody with the COVID-19 virus or if you have a fever above 100.4 associated with a cough.
• Consider a telephone visit for simple illness if possible.
• If you arrive at a care center with respiratory symptoms, ask for a mask to wear.

More information and resources
• For all that you need to know, including travel advisories: www.cdc.gov/coronavirus/index.html
• For specific questions, see the CDC’s FAQ section: www.cdc.gov/coronavirus/2019-ncov/faq.html
• For information about COVID-19 in your state, search your state’s health department, which works with the CDC to monitor and implement all recommendations: www.cdc.gov/public…/healthdirectories/healthdepartments.html

Say Again??

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Have you ever experienced difficulty in hearing after a night at a concert?  Have you had an exposure to a sudden loud noise that caused reduced hearing in one or both ears for any period of time?   How about a buzzing or ringing in your ears after noise exposure?  If any of those rings a bell (which you may or may not be able to hear), you may be experiencing Noise Induced Hearing Loss (NIHL).  In fact, about fifteen percent of Americans between twenty and seventy may have hearing loss from exposure to noise at work or in leisure activities according to the National Institute of Deafness, https://www.nidcd.nih.gov/.

There is not one simple situation that causes NIHL.  The damage to hearing after loud noise exposures may not be immediately apparent.  Commonly it is a subtle, progressive damage caused by repeated exposure to loud noises, many times from varying sources over years.  The individual may not even be aware until family members or friends point out the concern.  The repeated damage from loud noise even from short exposures over time may progress to permanent loss.  It is important to wear hearing protection when you anticipate such exposures.

Excessive noise exposure in the workplace is readily recognized as a potential hazard for as many as 30 million Americans.  Employers are required by law to evaluate and monitor noise exposure levels that identifies workers at risk.  The threshold to provide an OSHA Hearing Conservation Program is that of 85 decibels (dB) or above averaged over an eight hour day. But as damage may also occur accruing from sporadic and intermittent noise, the range of exposure must be monitored from 80 dB to 130 dB.  Employers must provide hearing protection in the workplace for these individuals, the type and extent of such can be calculated from the average noise exposure level.  Baseline and annual hearing tests must also be provided to these individuals to assure adherence to the Hearing Conservation Program, that progressive hearing loss does not occur.  Prevention is paramount, as NIHL is progressive and permanent.

Although the higher pitches of hearing (frequency) are usually the first lost, it is the volume (amplitude), of sound, measured in decibels (dB), that causes damage.  Examples of common volumes are: whisper at three feet = 30 dB, conversation at three feet = 60 dB, vacuum cleaner at three feet = 70dB, busy road at fifteen feet = 80 dB, diesel truck at thirty feet = 90 dB, concert three feet from a speaker = 100dB, chainsaw at three feet = 110dB, ambulance siren at 100 feet = 130 dB.  The OSHA standard for the work environment is 85 dB averaged over eight hours of exposure.  For every three dB of volume increase, the “safe” exposure time is cut in half.  At 88 dB, the limit of exposure is now cut to four hours before hearing will become further damaged.

As the work environment is only responsible for about eight hours of our daily living (for most of us), consider the cumulative effect of noise exposure throughout the twenty-four hour day.  What is the “safe” level of noise exposure then?  According to hyperacusisresearch.org the only evidence-based safe noise level for hearing is a surprisingly low 70 dB when it is averaged over twenty-four hours.  Consider personal hearing protection when working with power tools or at sporting events.  You may want to turn down the volume on your headphones or earbuds.  At maximum volume, you may be generating 100 dB volume, loud enough to begin causing hearing damage at only fifteen minutes of exposure per day. Additional information on NIHL may be obtained from the Occupational Safety and Health Administration link: https://www.osha.gov/Publications/osha3074.pdf  or your PCP.

Bradford Croft, DO

East Flagstaff Family Medicine

Take It to Heart

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In addition to St. Valentine, February helps to remind us of other things that impact the heart. Multiple factors can influence your risk of heart disease that include several health conditions, your lifestyle, age and family history.   It is important to know your risk factors as some can be changed, others cannot.  As heart disease is still the number one killer of both men and women in the US, these are issues that should truly be taken to heart.

According to the Center for Disease Control, almost half of the US population have at least one of three main risk factors of cardiovascular disease: high blood pressure, elevated cholesterol and smoking.  High blood pressure can silently damage the heart, kidneys and brain among other systems over time.  When the damage comes, its first symptom will usually be a heart attack, kidney failure or stroke.   As there are rarely any physical complaints associated with untreated hypertension, the only way to determine the problem is to check your blood pressure.  If elevated, treatments may include lifestyle changes as well as medication.

Cholesterol is a natural substance in the body, but with elevated levels may cause deposits in the blood vessels over time.  As these plaques occur, circulation can be compromised to organ systems, again leading to damage to brain, heart and kidneys.  And again, its first symptom may present as a stroke, heart attack or kidney failure.  The two major cholesterol subgroups include HDL (good cholesterol), the higher the better, and LDL (bad cholesterol), better lower.  Depending on risk factors, the goals for the cholesterol components may vary among individuals.  A simple blood test can determine your values and imply your risk.

Smoking is well known to increase the negative effects of both hypertension and hyperlipidemia.  The effects of nicotine, either smoking or vaping, will further heighten blood vessel resistance, contributing to worsening hypertension and vascular damage.  High cholesterol will be adversely affected by further lowering HDL, further increasing plaque formation.

Diabetes will compound the likelihood of cardiovascular death.  Management of diabetes is critical to decreasing the risk of cardiovascular disease.  The impact of obesity further worsens adverse cholesterol and elevates blood pressure.  Poor dietary habits, sedentary lifestyle, excessive alcohol intake and uncontrolled anger or stress all are additional contributors as risk factors.  As difficult as it may be, however, all of these risks can be modified and improved with lifestyle and medical intervention.

Some risk factors can’t be changed including family history (following genetic blueprints), age (risk increases with age), gender (males more likely than females, but the odds equilibrate after menopause), and race (African American, Native American and Hispanic American are at higher risk than Caucasian).  Even though these risks cannot be changed, the spectrum and contribution of the additional treatable risks can be addressed and monitored over time to improve the outcomes and minimize the cardiovascular consequences.  If you are not aware if you have any of these risk factors, this would be the month to visit with your primary care provider for screening.  If you do have any of these risk factors, this would be the month to visit with your primary care provider for treatment.  Take it to heart.

Bradford Croft, DO

East Flagstaff Family Medicine

The Eyes Have It

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Over ten million Americans suffer from vision loss secondary to macular degeneration, more than glaucoma and cataracts combined.  The retina is the back lining of the eye, responsible to receive images projected by the lens.  The central portion, or macula, is where the ability to focus central vision occurs.   As that lining deteriorates, the ability to read, recognize faces or colors, drive a car and see objects in fine detail becomes compromised.   In the early changes of macular degeneration, the individual may not yet be aware there are any changes in vision.  As the disease progresses, there may be wavy or blurred vision.  With additional change, there becomes a loss of the center of the visual field.  Imagine looking at a photograph with the center of the picture erased.

Macular degeneration is a little known disease, but research continues.  There is evidence that lifestyle, genetics and environment all contribute to the development.  People with a family history are at greater risk.  Whites are also at greater likelihood than Blacks or Hispanics/Latinos. Those with light colored eyes are more prevalent, as are those with long term UV exposure over time without protection.   Those with cardiovascular disease, overweight, eat high fat diet or are females are at greater risk.  Smoking doubles the risk of macular degeneration.  The threat increases with aging, particularly over age 60.

Because the disease most commonly occurs with age, it is referred to as Age-related Macular Degeneration (AMD).  The early stage of AMD may not be evident to the patient.  A careful eye exam may identify the initial presence of drusen, the degenerative deposits found in the retina as the disease is diagnosed.  Intermediate AMD develops as the number and size of drusen increase, which may provide some degree of visual changes, but still may not necessarily be apparent to the individual.  A comprehensive eye exam along with additional testing should show larger and increasing drusen or changes in the retinal pigment.  Late AMD has established apparent vision loss.  There is another form of macular degeneration known as Stargardt disease. This type is genetic in nature and commonly presents in young individuals, earning the name of early onset or juvenile macular degeneration.

Dry degeneration (atrophic) is far the more common type of macular degeneration (85-90%) while the balance is wet degeneration (exudative).  Although both are problems, the wet form is a much more aggressive form of the disease.  Dry degeneration involves the proliferation of drusen, where eventually the macular cells will thin and die, causing loss of central vision.  Wet degeneration involves overgrowth of blood vessels in the eye, causing bleeding and fluid in the retina, eventually causing scarring and vision loss.

At this time, macular degeneration is an incurable disease.  There are opportunities to reduce your risk and slow the progression once diagnosed.  Risk reduction may include exercise, diet changes, protecting your eyes from UV exposure and not smoking.  Regular eye examinations may be the single most important factor in intervention, especially if you have risk factors or a family history of macular degeneration.

Bradford Croft, DO

East Flagstaff Family Medicine

Vaping – Our New National Nemesis

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As of end-October 2019, there have been 1888 lung injury cases associated with the use of e-cigarettes, with thirty-seven confirmed deaths in 24 states.   There are some common findings that are associated with lung damage from e-cigs or vaping, but there are many variables that may contribute to the damage.  All patients reported the use of vaping as a common denominator.  Both the exclusive use of nicotine in some patients along with the combined use of nicotine with THC have been reported by others.  According to the CDC, the latest national and state findings suggest that products containing THC, especially those obtained off the street or other informal sources are linked to most of the cases and play a major role in the outbreak.  But as some patients had reported only using nicotine and still experienced lung damage, nicotine should not be excluded as playing a role as an antagonist as well.

To date, the FDA and the CDC have not isolated specific agents producing the lung injuries in these cases.  There may be multiple substances that are contributing to the outbreaks as many product sources continue to be investigated.  As there are currently no ingredient requirements or contaminant controls imposed on vaping fluids, there are no required quality guidelines or measures imposed on manufactures at this time.  Home based fluids can be exceptionally risky, particularly those with THC.

The CDC data reports seventy percent of e-cigarette/vaping lung injury (EVALI) patients are male.  The median age of patients is 24, ranging from 13 to 75 years old, with 79% of patients under 35.  Of 864 patients with established disease report using the following within three months from the onset of their disease:  86% with THC containing products, 34% exclusively THC, 64% with nicotine containing products and 11% exclusively nicotine.  Listing patients by age group category: 14% of patients are under 18 years old, 40% are 18 to 24, 25% are 25 to 34, and 21% are 35 or older.

Symptoms of EVALI can be very nonspecific and vague.  Listed complaints of the disease include cough, shortness of breath, or chest pain; nausea, vomiting, abdominal pain, or diarrhea; fever, chills, or weight loss.  The onset of symptoms can be as brief as a few days after exposure, others have taken weeks to develop.  A common acknowledgement is that lung infections do not appear to be the underlying cause of symptoms, rather it is the vaping products themselves.

As you would expect, the CDC recommendations include not using vaping or e-cig products, especially those that contain THC.  Given no product quality controls, you may reconsider buying any type of commercial products, especially off the street.  If you are using vaping as an alternative to smoking, please do not go back to cigarettes.  Consider using FDA approved nicotine replacement therapies.  If you are trying to quit tobacco products and need assistance, contact your health care provider.  The Arizona program ASHLINE is a free nicotine cessation program at www.ashline.org  and has a helpline 24/7 to get started at 1-800-55-66-222.  For youth or adults with marijuana addiction, support and treatment is available through the Substance Abuse and Mental Health Services Administration (SAMHSA) Flagstaff Office at (928) 774-7128.

Should you need additional support or information regarding vaping or e-cigarettes, search https://www.cdc.gov/tobacco/basic_information/e-cigarettes/severe-lung-disease.html or contact your health care provider.  The urgent message regarding vaping – don’t start, quit if you do!

Bradford Croft, DO

East Flagstaff Family Medicine

The Common Cold is Indeed

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As we approach the colder, shorter days of winter, it is not unusual to “catch a cold”.  There are over two hundred viruses that cause the common cold, the most common being the rhinovirus.  At the beginning of infection of the nose and sinuses, the body produces increasing clear mucus to try to wash out the germs (rhinorrhea).  After a few days, the mucus thickens and changes to white or yellow as the immune system kicks in.  As the natural bacteria reestablish themselves, the mucus may turn greenish, which is a normal finding.  It also occurs as the mucus thickens from the significant dryness of our region in winter, known as inspissation.

As the virus continues to grow, it will increase mucosal inflammation and produce complaints including low grade fever, sneezing, stuffy or runny nose, sore throat and painful swallowing, coughing, watery eyes, headaches and body aches.  The best treatments for the common cold are rest and lots of fluids.  Over-the-counter (otc) medications may help to make you feel better in relieving the symptoms.  However, the virus will run its course, typically over a period of days to a week or so.  If you use the otc medicines, make sure to use them only as directed.  These medicines will list the symptoms that they treat, so read the labels and pick the appropriate medicine for your complaints.  You may want to avoid multi symptom treatments, as they often contain treatments for symptoms you don’t have or need.

Antihistamines such as Claritin (loratadine), Zyrtec (cetirizine) or Allegra (fexofenadine) may help to reduce the inflammatory response.  Guaifenesin such as Mucinex or Robitussin helps loosen and thin mucus. Dextromethorphan – commonly seen as “DM” in the medication name (Robitussin DM) may help control the cough.  You may want to avoid decongestants, as their drying effect may worsen symptoms.  Tylenol or ibuprofen may help the fever, aches and pain with plenty of hydration.

Antibiotics do not help get a common cold better, as these medicines do not affect viruses.  In fact, using antibiotics may actually worsen the infection from a virus. These meds may kill the bacteria that normally would compete with the virus, allowing your infection to worsen.  Unnecessary antibiotics may increase complaints from the medicine itself, including gastrointestinal effects, skin rashes, and increase the risk of acquiring an allergic reaction to the medication.

The diagnosis of the viral sore throat (pharyngitis) does have challenges.  Our environment will contribute to a sore throat due to allergies, pollution and smoking or smoke exposure.  Another common culprit in the winter is the cold, dry air so common in Northern Arizona. The viral sore throat typically includes low grade fevers of under 101F as a common symptom of a “head cold”.  However, with persisting sore throat, high fevers, skin rash, redness or pus in the throat, the infection may be the bacterial Group A Streptococcus (or “strep”).  Strep infections can only be determined by a lab test, as the infection cannot be diagnosed on appearance alone.  Strep infections are important to diagnose, and DO need treatment with antibiotics.  Strep is a highly infectious disease, and is readily spread.  If you do have a diagnosis of strep and are treated with antibiotics, please stay home from work, school or daycare for at least 24 hours after starting the Rx in order to not spread infection to others.

Some important things to do stay healthy are to wash your hands often, either with soap and water, or waterless antibacterial such as Purell.  Avoid close contact with others who have a sore throat or head cold.  Stay home and away from others if you are already sick.  Avoid smoking or vaping and avoid second hand smoke.  And, of course, seek care with your primary care provider if you have any concerns or questions regarding your proper care.

Bradford Croft, DO

East Flagstaff Family Medicine

Flu Season 2019-2020 – It’s that Time of Year Again

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Last year was a much better influenza season compared to the 2017-18 epidemic, causing record death and disease.  There were improved influenza protections with the seasonal vaccines.   As well, the viruses were not as virulent, which all may explain the milder season.  The following is some disease information that you should be aware as we approach this year’s flu season.

Influenza is a respiratory infection that causes fever, cough, sore throat and nasal congestion.  Additional symptoms include headaches, muscle aches and fatigue.  Although these complaints sound similar to the symptoms of the common cold, the severity commonly is much worse.  Not only can the intensity be serious enough to cause weeks of lost work or school, but the infectiousness can be so powerful as to infect the majority of a workplace or school from a single source.  Influenza can cause complications which kills thousands of Americans every year, more commonly those with chronic health problems, the elderly and very young.  However anyone can suffer a complication of this illness, sometimes requiring hospitalization with significant lost time from daily routines, or even resulting in death.

A severe outbreak may commonly last up to eight weeks regionally, and can often infect one out of every three people in a community.  Hand washing and hygiene are always important, but the single best prevention of influenza is the seasonal immunization.  Appropriate for almost everyone six months or older, it is especially important for those with any chronic disease such as asthma, COPD, diabetes, heart, kidney or liver disease, and any kind of cancer.  Also, those who are overweight or 50 and older are at a significant risk as well.

The influenza immunization recommendation from the CDC for the 2019-2020 season again includes trivalent and quadrivalent injectable vaccines.  This year vaccines have been updated to match the expected circulating viruses, and are most commonly provided as the inactivated influenza vaccine (IIV) and the recombinant influenza vaccine (RIV).  The nasal spray / live flu vaccines (LAIV) are again available but may be limited.  The CDC does recommend LAIV as an alternative choice for children who would not otherwise receive a conventional vaccine.

For those interested, the protections for this year’s likely infections are designed to include:

A/Brisbane/02/2018 (HINI) pdm09-like virus (changed from A/Michigan)

A/Kansas/14/2017 (H3N2)-like virus (changed from A/Singapore) and

B/Colorado/06/2017-like (Victoria lineage) virus (unchanged) in the trivalent vaccines.

B/Phuket/3073/2013-like (B/Yamagata lineage) virus (unchanged) is added to quadrivalent.

Annual flu vaccines are commonly covered by most health insurance programs at no cost to patients.  These immunizations are usually readily available at county health clinics, most retail pharmacies and many family doctor offices.  Nobody knows when the flu will show up in the community, but is often seen as early as October.  Of course, the sooner the administration, the more effective the immunization for the entire influenza season which may go well into the spring.  It can take up to two full weeks to acquire immunity from the shot.  Now is the time to prevent the flu!  Immunize, and don’t let the flu get YOU!

Bradford Croft, DO

East Flagstaff Family Medicine