Flu and virus season is well underway, and local officials say they are here to help.

Across the country, flu mortality rates have passed the epidemic threshold. While Ohio remains below that line, hospitalizations — which is how flu numbers are tracked — still are significantly on the rise. Influenza A cases have been creeping up steadily and have spiked over the past few weeks.

According to statistics from Mahoning County Public Health, Ohio has seen 606 people hospitalized for the flu through Jan. 6. Mahoning County has seen 87 hospitalizations for the flu and 44 since the beginning of January. Twenty of the 87 were children.

Schools in the county have reported that 5.4% of students and 3.1% of staff from week to week are absent for flu-related illness, as of Jan. 13, and those percentages are down considerably just from the week before.

Erin Heckman, nursing director for the Trumbull County Combined Health District, said its most recent data shows about 38 influenza-associated hospitalizations in the county. Heckman said peak flu hospitalizations were reported for the weeks of Dec. 17 and Jan. 7.

She added that 23.7% percent of influenza-associated hospitalizations in the county this season have been under the age of 19, while 60.5% are age 60 or older.

But the flu is not the lone cause of illness this time of year. COVID-19 is widespread as well, although the virus can no longer be monitored as closely as it was two or three years ago. Respiratory Syncytial Virus also is making its annual rounds.

Officials say all of these viruses are similar in the symptoms they commonly present, and each of them has the potential to be dangerous or even deadly, depending on the patient.

The national mortality rate for pneumonia, influenza and COVID-19 is 8.6%, above the national epidemic threshold of 7.0%, and up a full percent from the week prior. Ohio is holding below the epidemic line, at 6.0%, but increased from 5.2% the previous week.

With so many viruses going around, representatives from Bon Secours Mercy Health and Mahoning County Public Health shared their advice on how to stay healthy.

PREVENTION

Dr. James Kravec is chief clinical officer for Mercy Health, which operates five emergency rooms in Mahoning and Trumbull counties, and 32 primary care practices, nine of which offer walk-in care.

“This time of year we’re seeing many reasons people get sick, whether it’s COVID, RSV, the common cold, or the flu, and it’s hard to know symptomatically what someone has. It’s almost impossible to tell without a test,” Kravec said.

But Kravec said it is not always important to get tested.

“If someone has an infection, and it’s very mild and they’re able and willing to stay home for five days, it doesn’t necessarily matter what is making them sick, so they don’t need to go out to get a test,” he said. “Every runny nose doesn’t need to be tested for COVID as long as they’re willing to act as if it is. This isn’t like 2020, when we had to go get tested. It’s much different now and more practical.”

Kravec said, at the bare minimum, if people have to leave home, they should wear a mask.

But if staying home full time is not an option, then it is more important to know what they have.

“The utility of a COVID test is to know it’s not COVID, which you might be exposing others to,” he said.

Kravec said those with low risk for complications should not worry about getting tested for their own sake.

“But, if you’re going to be around someone who is older or has comorbidities, an upcoming surgery, or immune issues, you should get tested, because the harm you could cause is great,” he said.

One of the challenges health care providers face this time of year is emergency departments getting backed up by patients with common symptoms. It can strain staff and tax resources, making it harder to provide care to patients with more severe problems.

In Mahoning County, the percentage of emergency room visits for respiratory illness peaked in late December at 27%, just down from last season’s peak of 28%, which came in about mid-November. The percentage for “constitutional syndrome” — a battery of symptoms that are common to diseases like flu, COVID, and RSV — also peaked in late December at 14%, down from last year’s peak of about 17%. As of Jan. 13, respiratory visits are at 20% and constitutional visits at 10%.

Kravec said it is important for patients to know when to go to the ER, see their doctor or go to a walk-in clinic.

“It’s truly best to receive care from your primary care physician because they know you best,” he said. “Then if you can’t get in to see them, you can go to a walk-in.”

Kravec noted that the out-of-pocket cost of going to a walk-in clinic is about the same as seeing one’s primary doctor, and considerably less expensive than going to an urgent care practice or an emergency room.

“You go to the emergency department when it is truly an emergency,” he said. “If you have severe abdominal pain, stroke symptoms, trouble breathing, chest pain, very high fevers. That’s when you need immediate medical attention.”

Kravec said primary physicians and walk-ins are best for treating illnesses such as run-of-the-mill upper respiratory infections, mild shortness of breath, urinary tract infections and low-grade fever.

He also said people should not be afraid to go to their doctor or the walk-in clinic to get the care they need for fear of catching something. He said wearing a mask and washing or sanitizing hands are reliable ways to avoid viruses.

Prevention is exactly what Erica Horner, director of nursing and community health at Mahoning County Public Health, emphasized too.

“From a public health standpoint, our role is prevention,” she said. “We want prevention and education. So, how do you prevent the spread of a respiratory disease, how can the community take care of themselves? Prevention is: stay at home when you’re sick, good handwashing, cough and sneeze into your elbow, and get vaccinated.”

Awareness and concern for others is critical, Horner said.

“Any time people gather together indoors because it’s colder outside, respiratory viruses love that. People are close together, sneezing, coughing, respiratory secretions — that’s how they are transmitted.”

DIFFERENT DANGERS

Like Kravec, Horner said it is important to understand that not everyone has the same risk factors. Respiratory viruses affect people and groups differently and to greater or lesser degrees.

COVID-19 and RSV are known to be particularly dangerous to elderly people as well as anyone with immune diseases, diabetes, chronic lung disease and heart conditions. RSV is especially dangerous to those groups as well as to infants, especially premature infants and those with other serious health conditions.

Horner agreed with Kravec that getting tested is much more about keeping others safe than it is about determining what virus is causing certain symptoms or reporting illnesses to the state. But she said it can also help doctors determine how to treat what’s ailing a person or if treatment is needed.

“If you go to a health care provider and they do a test, then there are different treatments, like antivirals, between COVID vs influenza. We have Paxlovid for COVID, and Tamiflu for influenza.

Most of it is supportive treatment for any of these respiratory viruses.”

Of course, it is better to avoid being sick at all, and Horner said that along with common sense tactics like masks and hand washing, vaccinations are an important line of defense.

“Each one of these viruses we’re talking about has a vaccine,” she said.

NEW TREATMENTS

Updated COVID and flu vaccines were released in the fall, along with a brand new RSV vaccine for senior adults and pregnant mothers called “Abrysvo.”

“This is the first time we have a vaccine for RSV for adults 60 and over and pregnant women of 32 to 36 weeks gestation,” Horner said. “Then we also have the newest RSV monoclonal antibody vaccination for infants; that came out in late fall.”

That vaccine, nirsevimab, is for very young infants and those that meet high-risk criteria like congenital heart disease, lung disease and other such problems. It is given during RSV season. Horner said women should discuss the RSV vaccines with their OB-GYN or their baby’s pediatrician.

Horner said that the department recommends getting a flu vaccination in October, but it is not too late to get one and the vaccines usually take about two weeks to build the body up to maximum immunity. She said vaccinations can be obtained at the health department, pharmacies or from a primary care provider.

“At Mahoning County Public Health we have immunization clinics for anybody,” she said. “You do not have to be a Mahoning County resident, and you can have private insurance or be uninsured.”

Mahoning County Public Health is located at 50 Westchester Drive, behind Denny’s on Mahoning Avenue in Austintown.

Erin Heckman said Trumbull County offers immunization clinics for adults on the first Tuesday of every month at the main office on Main Street in Cortland, and the same for children on the second Tuesday. Clinics for adults and children are held on the third Tuesday at West Farmington Fire Department, and the fourth Tuesday at Mesopotamia Road Department.

Flu and COVID-19 clinics also are held every Thursday in Warren.