Public health experts, researchers and manufacturers warn that the coming flu season will bring a “double barrel” respiratory disease outbreak in the United States, just as autumn and winter are expected to increase the spread of Covid-19.
At the same time, researchers said that the strategies now being used to prevent Covid-19 transmission – namely hand washing, mask wear and social distance – could also help reduce flu outbreaks, if Americans are willing to exercise them.
“We will be dealing with a season of double-barreled respiratory virus, both influenza and Covid,” said Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases and a professor of medicine at Vanderbilt University School of Medicine in Tennessee. .
Influenza season typically peaks between December and February in the northern hemisphere. It caused an estimated 61,000 deaths and 810,000 hospitalizations in the U.S. in 2019, according to the U.S. Centers for Disease Control and Prevention (CDC).
By comparison, Covid-19 killed more than 166,000 people in the U.S. with months to go before the end of the year, according to the Johns Hopkins University Coronavirus Resource Center. The disease hospital estimates 293,000 people just between March and May 2020, according to the health care advisory bureau Avalere. Those deaths and infections also occurred despite enormous efforts – such as the closure of large parts of the U.S. economy – were put into action to pave the way for the virus.
Although the seasonal range of the flu is not clearly understood, the way it spread is well documented. Influenza is transmitted in the same way as Covid-19 spreads: coughs, sputum and sneezes close by in confined spaces and in crowds. For these reasons, social distancing measures are effective against flu like Covid-19 and were practiced during the deadly 1918 flu pandemic.
When the spread of the Covid-19 community began in March in the United States, widespread shutdowns shook “four to six weeks” of the flu season in 2020, said Dr. Richard Kennedy, co-director of the vaccine laboratory of ‘e Mayo Clinic.
That was “probably as a direct result of the social distance and wearing masks and the shutdown,” Kennedy said. A similar phenomenon is taking place in the southern hemisphere, where the winter flu season is now declining. Countries like Chile have seen historically low impacts.
‘Shall we see the same thing here? The answer is, if we wear our masks and social distance, yes. If we stay shut down, yes, “Kennedy said. “But I do not know if Americans will do any or all of the above.”
“We see groups that want to open up the economy, despite the risks. Then we see people say, ‘No, we want to quit and we’re not worried if the economy crashes,’ Kennedy said.
But unlike Covid-19, the world has another tool to combat seasonal influences: flu vaccines.
Each year, public health officials select a maximum of four flu strains to include in the following year’s vaccine. The one-year delay is necessary for manufacturing, but is also what makes the vaccine so incomplete.
During this time, circulating strains can evolve, a phenomenon known as ‘drift’. A pandemic flu, such as the 1918 pandemic that killed an estimated 675,000 Americans, is the result of a major genetic change called a ‘shift’. These important genetic changes would render a seasonal flu vaccine useless against a pandemic flu.
“Bad” flu years are often the result of drift or mismatch, when the strains selected for the seasonal vaccines do not match those in circulation. Due to drift, flu vaccines are generally between 10% and 60% effective, according to the CDC.
However, even if mismatch occurs, researchers believe that the vaccine still provides protection. People who are vaccinated are less likely to develop severe symptoms or be hospitalized, even if they are infected.
For that reason, U.S. health officials are making a huge effort to spread the flu vaccine to more Americans. Fax manufacturers sent the first doses this August and are expected to produce up to 198m fax doses just for the US. Health officials hope this will translate into more than a 10% increase in production for an additional 20 million Americans who are vaccinated.
But even this extraordinary pressure assumes that an enormous portion of America’s 328 million people will be left out. In 2019, less than half of adults received flu vaccination, according to the CDC. Black and Latino Americans were less likely to get a flu shot than their white counterparts.
Young and old are falling behind on routine vaccinations because of the pandemic. GlaxoSmithKline reported that one of its fax machines, called the Sister for Pendulums for Adults, experienced a 67% drop in April and May of 2020.
Furthermore, many common avenues for Americans to get faxes remain closed. People who work or learn from home will often be carried out in offices and schools without the flu clinics on site. More may be afraid to go to the doctor in the middle of a pandemic.
“It’s a potential disaster and public health crisis,” said Dr. Leonard Friedland, director of scientific affairs and public health at GlaxoSmithKline’s North American vaccine department and member of the U.S. National Advisory Committee on Faxes.
A severe flu outbreak would force already thin supplies of medical equipment, tests and manpower, all of which are needed to combat Covid-19. It could also sow confusion, as patients with fever and cough from flu escape to hospital emergency rooms in fear of Covid-19.
“We do not have any therapies to treat or prevent Covid, and we do not yet have vaccines to prevent Covid,” Friedland said. “But what we have are vaccines that can help protect against flu, and flu vaccines make a huge difference in reducing stress on our hospital system.”
When Americans seek flu vaccines, their practical experiences can provide an example of the future with a Covid-19 vaccine, if and when one is approved. Any approved vaccine with Covid-19 is likely to give only temporary immunity, requiring a booster as an annual shot.
In addition, approved Covid-19 vaccines should be at least 50% effective, per the U.S. Food and Drug Administration, not too different from the vaccine’s 45% effectiveness in 2019.
“If it’s any better than that, we can all celebrate,” Schaffner said. “We have promised too much and we are at risk of underdelivery because we hyped the vaccine so much and talked about it ‘We can eliminate Covid in essence.’ And I do not think there is any expert who thinks that. “
Similarly, influenza vaccine researchers hope that efforts to develop a coronavirus vaccine could translate into a ‘universal’ influenza vaccine, the kind that can provide long-lasting immunity and can be produced during a pandemic influenza.
One of those researchers, Dr Emily Erbelding, director of the microbiology and infectious disease division of the National Institute of Allergy and Infectious Disease, said she believes new technology developed for Covid-19 holds promise.
“Things are moving faster in fax development than they ever have before,” Erbelding said. “I hope we have an efficient vaccine by 2021. That is certainly faster than any flu vaccine ever developed.”
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