FELICIANO, Nathaniel C.

STEM 12 - I

GENERAL BIOLOGY 2
Journal Critique

Zayet, S., Kadiane-Oussou, N. J., Lepiller, Q., Zahra, H., Royer, P., Toko, L., Gendrin, V., & Klopfenstein,
T. (2020). Clinical features of COVID-19 and influenza: a comparative study on Nord Franche-Comte
cluster. Microbes and Infection, 22(9), 481–488. https://doi.org/10.1016/j.micinf.2020.05.016

Influenza and coronavirus disease are two respiratory infections that have had a significant impact
on the healthcare systems around the world. In the course of human history, pandemic influenza
outbreaks have occurred in 1918 (H1N1), 1957 (H2N2), 1968 (H3N2), and 2009 (H1N1); while two
severe epidemics caused by coronavirus have transpired in recent years, namely, the severe acute
respiratory syndrome (SARS) in 2003 and the Middle East respiratory syndrome (MERS) in 2012 (Lv, et
al., 2021). The COVID-19 outbreak marks the third time a large-scale coronavirus pandemic presented a
global health challenge that has led to widespread social and economic upheaval. Although different
viruses cause influenza and COVID-19, both are highly contagious and present similar clinical
manifestations. Influenza-like symptoms like fever, cough, and fatigue are manifested in most COVID-19
patients. This situation poses a challenge, especially since the SARS-CoV-2 virus (which causes
COVID-19) and the influenza viruses are expected to co-circulate (Chotpitayasunondh, et al., 2021). The
research article “Clinical features of COVID-19 and influenza: a comparative study on Nord
Franche-Comte cluster” by Zayet, Kadiane-Oussou, Lelpiller, Zahra, Royer, Toko, Gendrin, and
Klopfenstein (2020) compares the clinical manifestations of Covid-19 and influenza viruses and aims to
identify the differences between the two which could be helpful during the co-circulation of these two
respiratory disease viruses.

The researchers investigated the clinical features and outcomes of confirmed cases of COVID-19
and influenza A/B by conducting a retrospective and observational study of adult patients who have
consulted or have been confined in Nord Franche-Comte Hospital between February 26 and March 14,
2020. A total of 70 patients with confirmed COVID-19 and 54 patients with influenza were included in
the study. They collected demographic data, including patients’ comorbidities and characteristics of each
type of infection like its incubation period, clinical manifestations, progression of the symptoms, and
disease outcome. Data were compared and analyzed using different statistical procedures.

The results reveal that fever, fatigue, cough, myalgia (muscle aches and pains) were the
symptoms common to both diseases. However, patients with COVID-19 reported additional symptoms
like dry cough, anosmia (inability to smell), dysgeusia (altered taste perception), diarrhea, frontal and
retro-orbital headache, and bilateral crackling pulmonary sound. In the case of influenza, anosmia is
typically due to nasal obstruction, a condition that is absent in COVID infections. Hence, the researchers
hypothesized that the virus in COVID-19 might have caused damage to the sensory receptors. The
manifested symptoms may be attributed to the cellular receptor angiotensin-converting enzyme 2 (ACE2),
which mediates the entry of the coronavirus in different parts of the body, including the small intestine
and the nervous system.

On the other hand, sore throat, conjunctival hyperemia, tearing, sneezing, sputum production,
dyspnea (shortness of breath), vomiting, and ronchi (low pitched) pulmonary sound were found to be
indicative of influenza. These clinical manifestations might be because the human influenza virus binds to
the α2,3-linked stalic acid receptors, which are predominantly found in the respiratory tract. The
distribution of the receptors could also account for the short incubation period of influenza infection
compared to COVID-19. The research contends that the symptoms of the two diseases are similar during
the first five days but would evolve differently afterward. There are several differences among other
symptoms besides fever, cough, and pain. These differences may help in the early diagnosis of the
disease.

The research focuses on a topic of great interest amidst the prevailing confusion concerning
symptoms attributed to influenza and COVID-19. The objective of the researchers, which is to examine
the clinical manifestations of these respiratory infections to help in their early detection, is clearly stated
in the introduction and adequately discussed in the article. There is a distinct division between the
different sections of the paper (introduction, results, discussion), so it is not difficult to follow the flow of
the research. The results are discussed and explained using relevant studies, which are properly cited and
included in the references. Data from the cited sources give support to the claims of the researchers. The
use of tabular data and graphs helps the reader visualize and understand the data presented in the study.
Overall, the discussion is clear, coherent, and comprehensive.

The article is interesting to read; however, some words may be difficult to understand for those
not in the medical field. Perhaps it would be better if medical terms like myalgia, anosmia, dysgeusia,
dyspnea, and the like are defined (maybe in a separate part of the paper) to enable ordinary readers to
comprehend and appreciate the research fully. To aid in understanding, the author looked for the meaning
of these medical terms and put them in parenthesis after the words. Another limitation of the research is
the limited number of patients included in the study. Although significant findings were noted in the
study, it would be difficult to generalize because of the small sample size.

Admittedly, the article could increase awareness and understanding of the symptoms attributed to
influenza and COVID-19. This knowledge is essential because frontline physicians usually rely on the
symptoms experienced by the patient, and early detection can help them take steps to prevent
transmission of the disease and prescribe appropriate treatment. The article presents a clear, coherent, and
comprehensive discussion of the topic, and the results are adequately explained and supported by relevant
studies. However, the study would need to be replicated in other medical facilities to validate the results,
given the limited sample used in this research. Furthermore, although looking at symptoms may aid in
early detection, the Centers for Disease Control (2021) asserts that the difference between influenza and
COVID-19 cannot be made based on symptoms alone, and testing is needed to confirm the diagnosis.
 References

Centers for Disease Control. (2021). Similarities and differences between Flu and COVID-19​.
https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm

Chotpitayasunondh T., Fischer T.K., Heraud J-M., Hurt, A.C., Monto, A.S., Osterhaus, A., Shu, Y., &
Tam, J.S. (2021). Influenza and COVID-19: What does co-existence mean?. Influenza and Other
Respiratory Viruses, 15:407–412. https://doi.org/10.1111/irv.12824

Lv D-F, Ying Q-M, He Y-W, Lian, J., Zhang, J-H, Lu, B-b., Qian, G-Q, Chu, J-G., W-B, Weng, X-B.,
Chen, X-Q, & Mu, Q-T . (2021). Differential diagnosis of coronavirus disease 2019 pneumonia or
influenza A pneumonia by clinical characteristics and laboratory findings. Journal of Clinical
Laboratory Analysis, 35(2):e23685. https://doi.org/10.1002/jcla.23685