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Flu vaccine vital as COVID-19 deaths rise and America tries to avoid dueling winter crises

The flu is on a collision course with the worst infectious disease outbreak we’ve experienced since the 1918 pandemic.
Image: NYC Subway
The combination of COVID-19, influenza and a panoply of acute and chronic illnesses could paralyze our existing health care system this fall and winter.John Minchillo / AP file

As many as 34 million people sick from a respiratory virus. 490,000 hospitalizations. 34,000 deaths.

Are we talking about the coronavirus?

Nope. “Just” the flu. And it’s lurking just around the corner. In the United States, influenza (aka the flu) season typically starts in September or October and peaks between December and February, although viral activity can begin as early as September and as late as May, according to the U.S. Centers for Disease Control and Prevention. And it’s on a collision course with the worst infectious disease outbreak we’ve experienced since the 1918 pandemic.

As bad as this all sounds, in a matter of a few weeks, life as we know it will become drastically worse if we don’t act now.

For the past seven months, the attention of the world has been monopolized by COVID-19. It is now the beginning of September and the novel coronavirus has infected over 27 million and killed over 832,000 worldwide at the time of publishing. The U.S. — close to five percent of the world’s population — comprises nearly one-quarter of all cases and deaths: surpassing 6 million and 190,000, respectively.

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New cases and deaths are increasing in multiple states nationwide, as well as in Puerto Rico. The ripple effects of this health crisis have been unprecedented: record high unemployment; widespread school and university closures; staggering food and housing insecurity; escalating depression and other mental health issues; and unrelenting fatigue and burnout among front-line health care workers.

As bad as this all sounds, in a matter of a few weeks, life as we know it will become drastically worse if we don’t act now. This means focusing on stopping the spread of the coronavirus while also using all of our preventative measures to prevent the spread of other respiratory illnesses such as pertussis and RSV (respiratory syncical virus), in addition to influenza. The combination of COVID-19, influenza and a panoply of acute and chronic illnesses such as heart attacks, strokes, cancer and accidents may, and likely will, paralyze our existing health care system.

The flu comes every year, but that doesn’t make it any less deadly. The CDC estimates that over five consecutive fall-winter seasons, from 2014-2015 to 2018-2019, influenza was associated with nearly 207,000 deaths — of which, 81 percent were among people ages 65 and older. The widely publicized 1918 influenza pandemic was associated with 675,000 deaths in the U.S. and 50 million worldwide.

Like COVID-19, influenza can also cause a whole host of nasty complications. While most people who get influenza will recover in less than two weeks, others can experience life-threatening conditions such as pneumonia, myocarditis, encephalitis and multi-organ failure.

Also like COVID-19, the flu disproportionately impacts racial/ethnic communities. Between 1929 and 1931, the influenza mortality rate per 100,000 was 30.3 among whites and 71.3 among nonwhites. By 1950, the influenza and pneumonia mortality rates were 44.8 and 76.7, respectively.

But unlike COVID-19, which seems to have mostly milder effects on children, healthy kids are at higher risk of complications for influenza, according to the CDC. (However, infants and children with underlying conditions are at increased risk for both viral infections.)

Unfortunately, influenza and COVID-19 are not the only respiratory viral infections that will tax our health care system and use competing resources such as point-of-care testing, hospital beds, ventilators and supportive medications. Many other viruses cause infections deep in the chest. Layered atop widespread COVID-19, these infectious pathogens will likely wreak havoc on an already overburdened health care system.

In addition, the fall and winter of 2020 will bring us another complicated seasonal respiratory infection: enterovirus D68. Although rarely seen in the U.S. prior to 2014, we’ve been seeing this infection circulate over the past several years. The good news? It usually causes a mild to moderate respiratory infection in children. The bad news is that enterovirus D68 can lead to acute flaccid myelitis, a rare but serious neurologic condition that can evolve over hours to days. Health officials are concerned that parents may hesitate to take their children for evaluation and treatment of mild neurologic symptoms out of concern for COVID-19 infection risk.

Let’s focus on the infections we can mitigate at this point. The good news with influenza? Unlike with COVID-19, we have:

Rapid testing that, while not sensitive, remains a helpful specific tool. There are also multiple available — and safe — treatments. Four FDA-approved antiviral drugs have been approved just this year: oseltamivir (Tamiflu), zanamivir (Relenza), peramivir (Rapivab) and baloxavir (Xofluza). There are also multiple FDA-licensed vaccines produced each year, not to mention the decades of information that scientists are always consulting to make sure we have data to track flu mutations and adjust treatment and prevention methods.

Despite the availability of a flu vaccine, at best an estimated 40 to 50 percent of the population opts for this preventive measure. But now more than ever, the medical community is united in its support of this vaccine.

As with the coronavirus pandemic, we will need strong leadership from our elected officials — including massive funding of public health agencies, consistent messaging rooted in science and targeted outreach to our most vulnerable communities — in order to avoid a tsunami of medical crises this fall and winter.

Is it possible that current mitigation efforts against COVID-19 will reduce the anticipated burden of influenza infections? Yes, and that would be a welcome outcome to all health professionals, especially those working on the front lines. So let’s do everything we can to soften the blow of COVID-19 and the flu.