Specter of ‘twindemic’ puts focus on flu shots
Amid COVID-19, doctors urging parents to make sure their children are up to date with immunizations
In decades of giving flu shots, Kris Magnussen, Ledge Light Health District’s supervisor of communicable diseases, has developed a profile of those most willing — eager, even — to roll up their sleeve.
“I always found that the people who didn’t get the shot and then got the flu were the first ones in line the next year,” she said. “Getting the flu is no fun.”
This year, amid COVID-19, doctors are taking pains to stress the importance of flu shots and are urging parents to make sure their children are up to date with mandatory and recommended immunizations that protect them against such diseases as diphtheria, pertussis (whooping cough), tetanus, polio, measles, mumps, rubella (German measles) and influenza (flu).
But it’s the specter of a “twindemic” of a COVID-19 resurgence and a severe outbreak of flu
that’s most concerning, said Dr. Richard Martinello, associate professor of medicine and pediatrics at the Yale School of Medicine.
“That’s a nightmare scenario,” he said.
Seasonal flu always poses a threat, Martinello said, and getting a flu shot is the single most important thing an individual can do to combat it. Doctors worry a flu outbreak that burdens a health care system dealing with COVID-19 could cause problems.
It doesn’t help, he said, that the diseases’ chief symptoms — fever, cough, runny nose — are so similar.
“When people come in with the flu, we’re going to need to treat them like they have COVID, because they might,” Martinello said. “That gets to be challenging. We have to use more protective equipment and isolate more patients. We only have so much equipment, so many rooms. That’s why it’s really important that we control flu in the community.”
Magnussen said she struggles every year to persuade people to get their flu shots. One of the enduring knocks on the shot is that it doesn’t always work, its effectiveness dependent on how well the vaccine matches the strain of the virus circulating that year.
Still, she said, even a 60% chance of success is a far cry from zero, and people who get the shot and still get the flu tend to get less sick than those who don’t get the shot and get the flu. And avoiding a hospital that’s treating COVID-19 patients can reduce a flu sufferer’s exposure to the coronavirus disease.
Dispelling myths about flu shot
Dr. Ekta Khanna, a pediatrician with Pediatric Associates of New London, said some people avoid getting a flu shot because they think it can give them the flu.
“It’s a common myth,” she said. “The shot doesn’t give you the flu. Some people can have a low-grade reaction to it, a little fever, achiness, but the shot doesn’t give you the flu.”
Lately, Khanna has been focused on ensuring her young patients’ immunizations are up to date, again because of the acute need to keep them as healthy as possible with the coronavirus lurking. During the pandemic, providers’ limited office hours and parents’ anxieties about exposure to COVID-19 caused some scheduled immunizations to be postponed.
Khanna said her office has taken steps to accommodate patients’ fears.
Patients arriving for appointments wait in their cars rather than in an office waiting room. They call from the parking lot to let the office know they’re there, and the office calls back when it’s ready to receive them. Patients have their temperature checked and are whisked into an examination room. Only one parent is allowed to accompany a patient.
Some practices are separating sick and healthy patients, seeing one category in the morning and the other in the afternoon, or, in the case of practices with multiple offices, seeing them in different locations.
Hoping for mild flu season
Khanna said she urges parents to get flu shots for all children 6 months and older.
Data kept by the state Department of Health’s Connecticut Immunization Program show the number of vaccine doses supplied to providers around the state nosedived this spring before bouncing back. In April, the program distributed 51,077 doses, a 43% decline over the 90,217 doses it sent out the same month in 2019. After another big year-over-year dip in May doses, the program distributed 90,366 doses in June and 106,312 in July.
“We’ve rebounded really well,” said Mick Bolduc, vaccine coordinator for the program and an epidemiologist. “The credit has to go to the provider community — the physicians, the school nurses, the local health departments. We’re waiting to see August’s numbers but feel pretty confident our kids are back on track.”
The program has sent out 60,000 pediatric doses of flu vaccine in the last three weeks, Bolduc said, the most it’s ever distributed in August. Such demand may be a sign that people are serious about flu shots this year.
At the same time, providers are concerned that people’s coronavirus-related aversion to doctor’s offices and hospitals could extend to their approach to flu shots.
“We’ve seen real change in behaviors over the last several months,” said Martinello, the Yale professor. “Disturbingly, we’ve seen a decrease in people coming in with heart attacks and strokes simply because they’re staying home, with the result that their outcomes aren’t as good.”
A similar reluctance to get a flu shot would be a bad thing, he said, particularly among older people and those with conditions that make them more vulnerable to the flu’s effects. Good evidence exists to suggest that the flu vaccine provides older people with some protection against heart attacks and strokes.
Unfortunately, there’s no medical evidence the flu shot offers any protection against COVID-19, Martinello said.
One reason for optimism is that much of the Southern Hemisphere — Australia, South America and South Africa — has experienced a mild flu season, an indication that the U.S. might, too. Efforts to contain COVID-19 — wearing masks, social distancing, hand-washing and the like — also could have an impact on the flu, “but we really don’t know,” Martinello said.
In any event, everyone is encouraged to get a flu shot starting next month.