Flu season exceedingly mild, but experts urge caution
Residents urged to get the shot to fight risk of catching both flu, COVID
Following months of concern around the shortage of flu vaccine in Ontario, the province has reported remarkably few cases of influenza, with no evidence of any community circulation this season, according to the Public Health Agency of Canada.
There have only been 14 cases of the flu reported so far this season in Ontario, the Ministry of Health says. At this time last year, there were 8,000 reported flu cases in the province, data from Public Health Ontario shows.
But while provinces like Quebec have halted their flu vaccine campaign early due to the low number of cases, Ontario’s pharmacies are still stocking the vaccine and health experts are encouraging residents to get the shot, despite the exceedingly mild flu season so far.
They say it’s not too late for influenza cases to increase and it’s even possible to have the flu and COVID-19 at the same time, making it potentially even more difficult for the body to fight off the coronavirus. Limiting influenza as much as possible is crucial as intensive care units are being overwhelmed with growing numbers of COVID-19 patients.
“Flu does come in January, February and into March, so we recommend that those that still want a flu shot to call ahead to your pharmacy,” said Justin Bates, chief executive officer of the Ontario Pharmacists Association.
From October through December, Ontario scrambled to provide more doses of flu vaccine due to unprecedented demand in the midst of the COVID-19 pandemic. The province and infectious disease experts had put out public health messaging encouraging residents to get their shots to avoid a “twindemic,” in which hospitals could be inundated with COVID-19 patients and those with the flu at the same time.
Major pharmacy chains like Rexall paused their vaccine program in early November due to a vaccine shortage they blamed on supply chain issues. At that time, Health Minister Christine Elliott said the province had reached out to the federal government and suppliers about the high demand and that flu vaccinations were up 400 per cent over the previous year.
Ontario has distributed more than six million doses of flu vaccine as of Jan. 12, which is 1.2 million doses more than what was sent out at this time last year, the ministry said in a statement.
There has been an “excellent” response from the public this season to seek out the flu vaccine and demand came earlier and higher compared with the same time frame in past years, they said.
While uptake is at around 30 per cent of the population — similar to last year— the ministry says uptake may be slightly higher this year, and final data will be available in September.
The surge in demand for the vaccine resulted in 1.8 million doses being administered in Ontario during the current flu season in pharmacies alone. Last season, 1.6 million residents were vaccinated in pharmacies before the season ended abruptly in mid-March, due to COVID-19 public health restrictions implemented by province, said Bates. More Ontario residents have been vaccinated at doctors offices, he said.
There are about 138,000 doses of flu vaccine remaining at Ontario pharmacies for residents who still want one.
Usually, pharmacies would see a second wave of vaccinations in January with a rise in flu cases, he said.
“This year, however, we saw a spike in demand in the early part of the season in a way we’ve never seen before,” said Bates, attributing the increase to public health messaging.
“So there’s been less demand since Christmas with pharmacies, but we have some supply left,” he said, adding the province supplied more of the nasal spray version of the flu vaccine in December as well.
Flu season in Ontario typically lasts from late fall to early spring. But this year, the number of cases is drastically lower than the past six flu seasons.
For instance, between Dec. 13 and Jan. 2, out of 36,902 tests for the flu nationally, only 0.01 per cent came back positive. Usually during that period, the test positivity rate has been at about 22.8 for the last six seasons, according to the Public Health Agency of Canada (PHAC).
Throughout the flu season so far, Ontario only reported localized levels of the flu during the week of Oct. 18-24 and only in central Ontario, and mainly in outbreak settings like schools, hospitals or nursing homes.
Otherwise, Ontario reported sporadic cases during seven weeks between the end of October and the start of December. The rest of the season so far has seen no flu activity reported.
That data has been presented while testing for the flu has
been up to 2.5 times higher than it has been for the last six seasons, PHAC says.
“Each year, before the pandemic, we’d have almost 12,000 hospitalizations in Canada due to influenza and almost 3,500 deaths,” said Wasem Alsabbagh, an assistant professor at the University of Waterloo who specializes in pharmacoepidemiology.
“Now we understand the burden is much lower ... it’s very low. And this is probably because of the social distancing that we are doing,” he said.
But he warned low reported levels of the flu could also be attributed to changes in healthseeking behaviour among Ontarians. “You are probably more reluctant to go and see your physician or go to the emergency room because of the pandemic. So we have to take those low levels with caution,” said Alsabbagh.
He recommends those who haven’t received the flu shot yet, specifically vulnerable people over age of 65, book an appointment.
Along with simply protecting oneself and others and reducing the burden on the health system, it’s possible to be infected with COVID-19 and the flu at the same time, he said.
“We want to reduce the risk of co-infection, because this will put them at a higher risk of severe clinical adverse outcomes,” he said.
The unprecedented 2020-21 flu season has also had some influence on how the COVID-19 vaccine will be rolled out to the general public, said Alsabbagh.
The online registry system was put to use at higher rates than ever and will likely continue when the COVID-19 vaccine is widely available, he explained.
Even with low levels of the flu, influenza seasons are unpredictable and cases could rise, even at this point, said Dr. Susy Hota, an infectious disease specialist at the University Health Network and an associate professor in the department of medicine at the University of Toronto.
“We just can’t handle having additional burden from influenza cases coming into hospitals … so it’s still important for people to get the vaccine if they haven’t yet,” said Hota.
David Hammond, a professor in the School of Public Health and Health Systems at the University of Waterloo, said he believes this flu season in Ontario is an indicator that the COVID -19 vaccine should be readily accepted by the population.
While there is concern about anti-vaccine groups that have continued mobilizing using social media platforms, the majority of Canadians follow public health guidelines and that should continue, said Hammond. Most want to do whatever possible to combat COVID-19 and the burden on public health — whether that’s getting the flu shot, or receiving the COVID-19 vaccine, he said.
“There’s such an overwhelming desire to put this behind us that a lot of folks who would normally be hesitant ... the motivation is going to be that much greater,” he said.