What’s worse than a pandemic? A twin
Mankind has grown so accustomed to the annual waves of influenza that this was the baseline comparison when Covid first arrived. (It’ll be just another flu, we said.) The implication was that the flu, hospitalization and death levels were acceptable, if not inevitable.
I was certainly guilty of that thought. Although my employer offers an annual flu shot, sometimes I didn’t bother to get it. But the pandemic has exposed the weakness of our attitudes and policies towards influenza. We now have the opportunity to do things differently. This is not an argument for flu-related lockdowns or national paranoia about a bug. But we can build better defenses against influenza relatively inexpensively, and to save lives and health care capacity.
One of the reasons to be more serious about the flu is its cost, both economic and human. The annual costs of treating influenza (which commonly exceed $ 10 billion in the United States) are significant, even when one considers only hospital expenses for those most severely affected.
Influenza epidemics in the northern hemisphere affect 5 to 15% of the population each year. On average, about 8% of the American population becomes ill with the flu each season. For the most part, this is usually a mild, if not unpleasant, experience. But for some, it can be fatal.
The U.S. Centers for Disease Control estimates that, on average, 36,000 people have died from the flu each year over the past decade, with 61,000 deaths during the 2017-18 flu season. In the UK, the average is around 17,000 deaths annually. Obviously, Covid is an order of magnitude different, but the costs to the healthcare system of the flu are not negligible.
The elderly are most vulnerable to the flu, as are pregnant women, very young children and people with other health problems and a weakened immune system. Some who contract and recover from the flu end up with post-viral symptoms that go on and on. Long Covid has shown us how debilitating these can be.
What happens when you superimpose the flu on the Covid-19? We don’t really know, as last winter saw an incredibly mild flu season, mostly due to measures like containment, social distancing and masking. Influenza infection rates were two-thirds lower than in the 2011-2012 season, which had recorded record rates.
You can’t count on a repetition. The low prevalence of influenza last year makes it more difficult to predict which strains to include in this winter’s vaccine. We might get lucky again, or things could get worse: Reduced levels of natural immunity after a few seasons of low flu could make it easier to install new variants.
Britain, with its overburdened national healthcare system and gargantuan backlog of surgeries and other procedures, can hardly afford a bad flu season. Consultations for influenza-like illnesses take up considerable time and hospital capacity in a typical year. High rates of influenza in addition to Covid would be too great a strain, requiring substantial new government resources and leaving many people without treatment.
But it’s not just the heightened health burden that should make us rethink the flu. The point is, we’ve been way too complacent about the flu for too long. Many flu deaths are preventable thanks to the injections and the kinds of behavioral changes we’ve become accustomed to from Covid.
Social distancing measures imposed during the pandemic not only decreased the spread of the flu, but it is also estimated that they resulted in a 20% drop in respiratory syncytial virus (RSV) common in the United States. RSV accounts for 5% of deaths in children under five worldwide. The problem now, however, is that the recent lifting of Covid restrictions has coincided with abnormally high RSV cases in the United States.
Higher levels of flu shots would be a game-changer. Britain’s influenza vaccination hit record levels last winter, with the National Health Service immunizing more than 80% of people over 65, 10% more than the previous year and surpassing for the first time the World Health Organization’s 75% target.
But the vaccination rate drops with young people. Less than 45% of people under 65 with one or more underlying risk factors get vaccinated. Although more than 2.5 million children have been immunized through school programs, this still represents well under half (47.5%) of all children. Adoption also varies among ethnic groups, with some minorities being late to get vaccinated. In the United States, black communities (where vaccination rates are around 41%) had the highest flu hospitalization rate of any ethnic group.
A study at the University of Bristol is currently looking to determine the side effects people experience when they receive the recommended influenza vaccine along with the Oxford / AstraZeneca or Pfizer / BioNTech vaccines. Getting a Covid-19 booster shot and a flu shot together could ensure increased flu shot coverage.
Of course, the effectiveness of flu shots can vary from season to season and from person to person. They are normally between 40 and 60% effective when they correspond well to the variants in circulation.
We would therefore be well served to also apply our Covid habits to diseases like the flu. That could mean more hybrid work during peak flu months or during an outbreak. Masking at times, while not mandatory, also makes a lot of sense.
If Covid-19, like the flu, is going to be a recurring seasonal affliction – as seems likely – we will need to better manage the strain on health systems during the winter. It means being prepared to fund higher levels of care during these times of crisis or to do more to reduce the strain on the system. We’ll probably never wipe out the flu and other viruses, but we can make winters less expensive and less painful by raising the bar for an illness that many of us treated so casually.