Fall could bring ‘twindemic’ of flu and COVID-19
Listen to this interview as a recording on our podcast page.
This is The Nation’s Health podcast, I’m your host, Aaron Warnick.
As fall approaches, public health officials are gearing up for another infectious disease threat: the flu. COVID-19 protections such as masking and distancing contributed to a mild flu season last year. But with more schoolchildren together in person and safety recommendations relaxing in some places, what will this flu season look like? In this episode, The Nation’s Health reporter Jaqueline Yao talks to Robert Kim-Farley — a UCLA professor and communicable disease expert — about what we might expect.
As September approaches, we're coming up on what would usually be a flu season. However, we didn't have much flu activity in the U.S. last year. Could you tell us a little bit why that was the case?
You’re right. We can have up to 12,000 to 61,000 deaths in the United States annually due to influenza. Last year there was 22,000 estimated. I think there were a number of factors at play that made it a lower flu season than usual. There's a lot of non-pharmaceutical (COVID-19) interventions that we used that influenced the number of cases of influenza: wearing masks, staying home, hand-washing, school closures, reduce travel increased ventilation, physical distancing — all of these things also have an impact on the respiratory disease of influenza as well.
Should we expect something similar this year? Why or why not?
I think that it's possible that we will also see this as a relatively lower year for influenza. The situation is really in our hands. It's the degree to which we continue to practice things like hand-washing, covering our mouths when we cough and sneeze. These things we’re learning from COVID play into also reducing transmission for influenza.
But one thing I have learned about influenza is that the only one thing predictable about influenza (is) that it is unpredictable. You'll always be surprised. You know the virus is constantly mutating. It depends on the match that we have between vaccine and the circulating strains, it depends on these mixing factors of how much people are getting together in enclosed spaces where transmission is higher, all of these things can influence the pattern of influenza that we see.
You mentioned masking, hand-washing. What are some other things that we're doing right to prevent the flu, and what are some other things that we should do to prevent it even further?
I think the most important thing that we can be doing for influenza is vaccinate. And actually we did have higher rates of vaccination last year than we have had in a while, it was some 50-55% of adults got (the) vaccine last year versus 48% than the year before.
I think that's one take-home message: Influenza vaccine, although it's not as effective as our COVID vaccines — probably more in the 40-60% reduction of people going to see a doctor. But it is very effective in terms against severe disease like we find with our COVID vaccines — an 82% reduction in ICU admissions with influenza vaccine, for example.
The real take-home message, again, is roll up our sleeves and get vaccinated. And then also practice just good respiratory hygiene. This is the things, like, again, washing hands frequently; making sure that if we are ill, we don't go out and be in the workplace or in the school environment. If we have to be out, wearing a mask if you have an illness, so that you're not spreading respiratory droplets to others.
And do we know how COVID-19 and flu interact? Can someone get sick with both?
Yes, it is possible to get sick with both. That's one of the things that we want to avoid, a “twindemic,” if you will: people coming down with influenza and COVID. Again, probably the best way to avoid that is vaccination with both vaccines — a COVID vaccine as well as influenza vaccine.
Are there any known side effects or interactions between a flu shot and the COVID-19 vaccines?
Fortunately, it doesn't appear that there is anything that is worrisome about administering COVID vaccine together with other vaccines. It is suggested that the vaccine will be administered in a different area — one arm versus in the other another arm, that sort of thing. But it's felt that that's not a contraindication to get either simultaneously or within the first 14 days or anytime between the two.
There's some speculation that COVID-19 ,like the flu, may be an annual sickness, like H1N1, for example. What is the current thinking on this? Are we going to be at risk for COVID-19 and influenza twindemics for the foreseeable future?
With COVID, we are learning more and more about it as time goes on. It’s a wily adversary in the sense that it's mutating — as we have seen now with the rise of the delta variant. It’s constantly seeking to become more transmissible. Evolutionarily, that's what a virus is trying to do — to infect more people. The fact that it's probably twice as transmissible means that, again, it's going to be around for a while.
In one sense, the answer lies in our own hands, again. Even here in the United States for those who have been vaccine hesitant, and have not rolled up their sleeves, stepped up to the plate and gotten vaccinated. This is a real petri dish. We just need to really get our vaccination levels up high, but I do anticipate there may see still some low level circulation of the virus, especially to those people who still remain unvaccinated. If you are unvaccinated. This virus will find you.
What are your thoughts about how back to school would affect the spread of both the flu and COVID-19?
I anticipate that when we move back into more in-person settings — hopefully with masking — when there is higher levels of community transmission going on, we are still going to start seeing some outbreaks in schools. I think it's pretty much inevitable.
However, I think that we can really limit these by having regular testing of students, requiring and mandating vaccination of teachers and staff, and for those students who are eligible for vaccinations, mandating vaccines for schoolchildren.
These will have great impacts on preventing outbreaks or at least the impact of outbreaks.
We can limit the degree of spread and workplaces and in the school setting, but I do anticipate that when we start getting more people together, that we will be seeing some increases.
We thank Dr. Kim-Farley for his time and expertise.
For more news on the COVID-19 pandemic and the upcoming flu season, visit www.thenationshealth.org. Thank you for listening to The Nation’s Health Podcast.
