Overlap with flu season looming

Experts worry hospitals might be overwhelme­d

- Karen Weintraub

Getting a flu vaccine this year is even more important because of the COVID-19 pandemic, according to public health officials.

“We should push for massive uptake of the vaccine this year,” said John Brownstein, who tracks outbreaks around the world as chief innovation officer at Boston Children’s Hospital. “Everyone who is eligible should get it.”

Producers are boosting supplies of the flu vaccine this year to meet what they expect will be higher demand. CVS stores have the flu vaccine in stock, and vaccines are available as of Monday at Walgreens.

Vaccine maker Sanofi plans to produce 15% more vaccine than in a normal year.

“Flu vaccines work, and they can take a big burden off our medical infrastruc­ture,” John Shiver, global head of vaccines research and developmen­t for the company, said last week. “Let’s keep people out of the hospital with flu while we deal with a likely upswing in COVID infections.”

The flu shot isn’t always effective, but it’s much better than nothing, said Shira Doron, an infectious disease physician and hospital epidemiolo­gist at Tufts Medical Center in Boston.

The U.S. Centers for Disease Control and Prevention recommends that everyone 6 months and older get a flu vaccine every year. The agency did not respond to a request for comment about this year’s situation.

The CDC recommends people get a flu vaccine by the end of October – because it takes a few weeks for the vaccine to become fully protective – but encourages people to get vaccinated later rather than not at all.

It’s hard to know how the flu will interact with COVID-19. The flu season has been mild in the Southern Hemisphere, which is usually six months ahead of the USA. It isn’t clear whether

that’s because of the flu strains circulatin­g this year or because the same public health measures that prevent COVID-19 – masks, social distancing and frequent hand washing – also stop flu outbreaks.

Not many people have contracted the flu at the same time as COVID-19. Those sick with both have mild to moderate symptoms, though at least two deaths have been reported.

“What will co-infection mean is a big area of concern,” Brownstein said. Research is underway.

In 2018-2019, there were about 490,000 people hospitaliz­ed because of the flu, and more than 35,000 died, in what was considered a “moderate” year for the flu. Since March, more than 345,000 Americans have been hospitaliz­ed and 170,000 have died from COVID-19.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Cardiology Magazine it’s hard to predict what this flu season will look like.

“The worst-case scenario is we have a very active flu season that overlaps with the respirator­y infection of COVID-19,” he said. “Worst-case because that would really complicate matters from a diagnostic standpoint, from a therapeuti­c standpoint and the standpoint of putting a lot of stress on the health care system.”

There are at least three reasons to get the flu vaccine this year, Doron said: for yourself, for others and to reduce fear.

If the surge in COVID-19 cases continues into flu season, it will be very hard to tell the two apart, she said, “because they look the same.”

Hospitals are at risk of being overwhelme­d by COVID-19 patients. Adding flu patients will risk everyone’s health, Doron said. “If we don’t have beds or ventilator­s, you’re going to wish you didn’t have the flu,” she said.

Steven Abelowitz, medical director of Coastal Kids, a five-office pediatric practice in Southern California, added another concern: getting students back to school. Reducing cases of flu should make it easier to reopen schools and keep them open, he said.

Most of the parents in his practice have been open to the idea of getting their children vaccinated, he said, though 20%-30% of his patients remain behind in their vaccinatio­ns because of closures this spring and avoidance of medical offices during the pandemic.

His practice has made a point of identifyin­g children who are behind and reaching out to their families with

“If we don’t have beds or ventilator­s, you’re going to wish you didn’t have the flu.” Shira Doron, an infectious disease physician and hospital epidemiolo­gist at Tufts Medical Center in Boston

emails, texts and calls, Abelowitz said.

Getting a flu shot may be a little different this year as some clinics move outdoors and shuttered workplaces won’t offer vaccines.

Doron said getting a flu shot at a pharmacy is just as good as anywhere else.

“Wherever the line is shortest and whoever has it first is the right place to get it,” she said.

Anyone looking to get a vaccine at Walgreens will need to be masked and checked for a fever, and pharmacist­s will wear face shields and masks, the drugstore chain announced Monday.

Though many hospitals make the flu vaccine a condition of employment, except in the case of a diagnosed allergy, Tufts has not, Doron said. But 97% of employees have been vaccinated in recent years.

There’s a theoretica­l chance that getting a flu vaccine when infected with COVID-19 could make the infection worse, but no one has seen this reaction, said Sanofi’s Shiver.

That risk is “not a good reason to avoid getting the flu vaccine,” Shiver said. It’s just as plausible that ramping up the immune system with a flu vaccine will help someone fighting COVID-19, he said.

Hopefully, efforts to contain COVID-19 will minimize the risk of flu this year, Doron said.

“I would totally expect that what we’re doing with distancing and mask wearing and hand hygiene and certain businesses being closed – it has brought down COVID in Massachuse­tts and elsewhere, and there’s no reason it won’t have the same effect on flu,” she said, adding that flu vanished earlier than usual during the lockdown in March.

Brownstein, of Boston Children’s, said people shouldn’t use that as an excuse not to get their flu shot.

“There’s no way we can rely on that,” he said. Contributi­ng: Nathan Bomey Health and patient safety coverage at USA TODAY is made possible in part by a grant from the Masimo Foundation for Ethics, Innovation and Competitio­n in Healthcare. The Masimo Foundation does not provide editorial input.

 ?? EVA HAMBACH/AFP VIA GETTY IMAGES ?? Public health officials urge people to get a flu shot this year as the flu season collides with the pandemic.
EVA HAMBACH/AFP VIA GETTY IMAGES Public health officials urge people to get a flu shot this year as the flu season collides with the pandemic.

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