Health experts jittery about autumn ‘twindemic’
As a physician at a Boston community health center that serves a large minority population, Dr. Julita Mir has had a close-up view of the coronavirus pandemic’s impact, even beyond the obvious.
Mir tells of the patient from Guatemala who tearfully begged for a letter authorizing her to work despite having COVID-19 symptoms, and of a patient from Vietnam who postponed his liver ultrasound for six months as he sheltered in place, only to find out in midAugust that he had a fairly large tumor. Mir also knows of people taking Tylenol before a temperature check so they can pass and get the OK to work that day.
But as the U.S. approaches 200,000 deaths from COVID-19, more than any other country, what troubles Mir most is what she envisions for the coming months as a combination of factors threatens to negate recent gains – and result in a deadly autumn.
“My main fear is we will see cases of maybe influenza, maybe COVID, maybe some of the other respiratory viruses,” Mir said, “and because rapid testing is not available on a widespread basis, we will be in front of the people and we won’t know what they have.”
The return of students to schools and colleges amid the coronavirus pandemic, combined with the approaching flu season and easing of restrictions after a second round of tightening, makes for a worrisome scenario for publichealth specialists.
Dr. John Swartzberg, professor emeritus of infectious diseases and vaccinology at the University of California-Berkeley, said he expects the current national trend of decreased coronavirus-related deaths to continue through September, but then pick up gradually in October and more in November. Deaths from COVID-19 typically trail infections by about a month.
“It’s hard for me to think of a positive scenario where things are going to get better in October and November,” Swartzberg said. “I don’t see behavior changing adequately. I don’t see testing ramping up. I see political winds continue to be oppressive to doing the right things.”
Swartzberg said it wasn’t hard to diagnose the flu through a phone call or in-person consultation with a patient. That changed with the arrival of COVID-19, which presents symptoms similar to the flu and other diseases caused by respiratory viruses that flourish in the fall and winter, when cold weather prompts people to move indoors.
Absent coronavirus testing with quick results – still a major hurdle across much of the country – the resulting confusion and proliferation of cases of COVID-19 and the flu could result in what some are calling a “twindemic,” which could overwhelm the health care system.
According to the Centers for Disease Control and Prevention, the flu has killed an average of 37,000 Americans per year since 2010. CDC Director Robert Redfield said he’s worried about the impact on the coronavirus crisis of an early peak to the flu season, which typically begins late October, gathers steam and crests in January and February.
With children and young adults back in classrooms for the first time since the hurried shutdown of schools and colleges in March, the chances for disease transmission are enhanced, even when it’s not certain how much kids spread the coronavirus. Recent studies indicate they can be transmitters even if asymptomatic.
“There’s a question about ... COVID, but there’s absolutely no question what role schools play with influenza,” Swartzberg said. “Schools are the breeding ground for influenza. The kids bring it home to mom and dad and grandma and grandpa.”
Older populations are at higher risk for the harshest effects of COVID-19, and developing the illness at the same time or successively with the flu could be fatal.
School reopenings have already yielded clusters of coronavirus cases in several states, at times forcing a return to remote learning. Colleges have been a bigger trouble spot, reporting more than 10,000 positive tests from the beginning of the fall term through the end of August, and more than a dozen colleges across the country have reported more than 1,000 cases.
A New York Times survey of more than 1,500 institutions of higher learning revealed at least 88,000 infections and 60 deaths since the pandemic began.
Dr. George Rutherford, an infectious disease specialist at UC-San Francisco who heads California’s contact tracing program, said middle schools, high schools and universities are “big incubators of COVID-19.”
Given the early results in the U.S., the prospects for the coming months are not encouraging.
“To have the fate of the western world resting in the hands of 12- to 22year-olds, it’s a little scary,” Rutherford said.
Rutherford finds a sign of hope in Australia, where flu season precedes and often serves as a harbinger for the one in the U.S. Australia’s winter concluded Aug. 31, and Rutherford said the country of 25 million experienced its mildest flu season in five years.
There might be other reasons at play, but it appears measures taken to keep the coronavirus at bay were a contributing factor.
“The smart money says there’s been much less circulation of influenza in Australia over this winter and it may well be a secondary effect of increasing respiratory precautions, like wearing masks and social distancing,” Rutherford said.