Possible COVID, flu ‘twindemic’
Impact depends on how Ohioans prepare, react
Widespread influenza will in all likelihood return this year, but local experts say its severity is hard to predict and will likely depend on how Ohioans prepare and react.
Going into flu season, which typically runs from late September to late May, there may be more unknown factors than ever before, said Dr. Bill Miller, senior associate dean of research and professor of epidemiology at Ohio State University’s College of Public Health.
The continuing COVID-19 pandemic is to blame, he said.
In 2020, the flu was essentially squashed by masking and social distancing mandated to prevent the spread of the new coronavirus. With 193.8 million doses administered, a record number of flu vaccines were given during the 2020 to 2021 season, according to the Centers for Disease Control and Prevention.
In Ohio, 122 flu-related hospitalizations were reported last season compared with 11,005 the previous season, according to the Ohio Department of Health.
During the 2020 to 2021 flu season, no pediatric deaths were reported in Ohio while five were reported the season prior, data shows.
In the U.S., 1,675 of 818,939, or 0.2% of respiratory specimens tested by clinical laboratories last flu season were positive for an influenza virus. By comparison, during the last three seasons before the COVID-19 pandemic, the proportion of specimens testing positive for flu peaked between 26.2% and 30.3%, according to the CDC.
With less natural immunity in the community because fewer people were exposed to the flu last season, it’s possible cases of the flu could rebound dramatically this year, Miller said.
“It sort of sets us up for an increase this year,” Miller said. “I think a significant return of influenza this year is a real possibility.”
With the flu season approaching this year, there is no state-mandated COVID mask requirement and distancing rules as there were last year. So unless they’re put back in place in individual communities as they have been in Columbus and several Greater Columbus suburbs, they could allow the flu to run rampant, Miller said.
Typically, American epidemiologists track the flu on the eastern side of the world to gauge how the season may play out in the U.S. But, with other countries following stricter COVID precautions still, it’s hard to know whether the same pattern will show up in the western hemisphere.
It’s impossible to know for sure, but Miller said respiratory syncytial virus (RSV) may be a good model for the flu this year. RSV a disease that often causes the same symptoms of a common cold, but it is particularly dangerous to infants and the elderly and can lead to bronchitis and pneumonia, according to the CDC.
This summer, unseasonable cases of RSV swamped Nationwide Children’s Hospital. Surges of RSV were thought to be showing up early because it didn’t circulate as much while COVID precautions were being followed more strictly.
“So much depends on what happens with COVID and when we say in different parts of the country that it’s back under control,” Miller said. “... It’ll depend on when people let their guard down.”
One possibility, Miller said, is that places with masking and social distancing requirements may see their flu season delayed until COVID again recedes and mask mandates are again eased. For some places that could be February or March, Miller said.
Columbus re-implemented an indoor mask requirement Sept. 10 and a few of the surrounding suburbs followed suit. Columbus Public Health Commissioner Dr. Mysheika Roberts hopes masking and vaccinations will stave off the worst of the flu season in the greater Columbus area.
Roberts recommends Ohioans get their flu shot in late September or early October. People who get their shot too early run the risk of its effectiveness wearing off by the late months of the flu season, Roberts said.
“The key is to make sure that if you’re doing anything around the holidays, that you get that vaccine at least two weeks before,” Roberts said
Eligible Ohioans will also be able to get their flu shot while getting a COVID-19 booster this fall, which Roberts said could help streamline the vaccination process for both viruses. COVID-19 boosters are currently available to some older Ohioans and could eventually be available to everyone.
The annual flu shot is typically available through most local health departments, doctors’ offices and pharmacies and depending on a person’s insurance may be free.
The one thing both Miller and Roberts fear is the possibility that the flu could spiral out of control this winter and if COVID does the same, doctors could be dealing with a “twindemic.” A twindemic is a situation where there are two pandemics or epidemics going on at the same time, such as the flu and COVID-19.
In such a scenario, the flu could reach historically high levels and along with COVID could swamp hospitals even more so than last year when the flu was kept at bay.
While that scenario seems more likely this year, it’s not inevitable, both Roberts and Miller said. While the trajectory of COVID and flu are difficult to predict, they’re now both preventable diseases and the havoc they wreak all depends on what people do in the coming days and weeks.
“The fact that the virus took a break last year means it’s hard to say what it’s going to be like ... there’s just so many unknowns,” Roberts said. “We don’t know what we’re walking into this season with the flu.” mfilby@dispatch.com @Maxfilby