Dr. Nicole Ascanio, aspireMD
It’s hard to believe it has been about a year since the pandemic really took hold in the US. We might not be out of the woods yet, but I do believe we are starting to see the beginning of a return to normal life now that vaccine rollout is picking up and warmer months are here. One interesting and positive thing to come from the COVID-19 pandemic is a historic 2020-2021 flu season. Flu season usually spans from October to March and 10 million to 45 million people in the US get infected each year including 10,000 to 60,000 deaths depending on severity. The very young and the very old are at highest risk of severe influenza infection and death, but I have seen otherwise healthy people of all ages die from influenza every year. As of 3/13/21, there have only been 1,561 confirmed influenza cases in the US. This is staggering. We have essentially “missed” an entire flu season. This lends itself to the a few questions…. why did this happen while so many people were still getting COVID and can this be the new norm?
There are a few answers to the question why:
- The influenza virus is less contagious than the virus that causes COVID-19. It is similarly spread from respiratory droplets but takes a larger exposure to infect someone. This means that the things we are doing to prevent COVID-19 infection (more handwashing, masks, social distancing, not gathering indoors in large groups, etc) work even better to prevent influenza.
- People are actually staying home when they are sick. In years past, it was more common than not to go to work, school, daycare, or social events when you had mild viral symptoms. People were always told to “stay home if sick” but this was rarely followed if someone had a little runny nose, cough, or sore throat. The pandemic has caused (forced?) people to follow this advice, and it works. Workplaces have also had to become far more accommodating to those employees with viral symptoms staying home.
- When you get infected with the influenza virus, your symptoms appear rather quickly – usually within a day or two. This helps eliminate the longer period of viral spreading prior to symptom onset that we see with COVID-19.
- School closures/remote learning, less travel/airport traffic, and fewer large social gatherings have kept all sorts of viruses from spreading like they normally would.
- Influenza survives better on surfaces than COVID-19. The pandemic has dramatically changed how people clean and sanitizes their homes and workspaces which has indirectly combated the flu.
- An unprecedented number of people got the flu vaccine this year. 15.5 million more this season than last.
Can we keep the burden of influenza illness and death low in the future (without going into lockdown)? Yes.
- In the post-pandemic world, it (should) be much easier to actually stay home when sick. Work should no longer be viewed as universally “critical” when an employee is sick.
- Masking when travelling, shopping, working, and gathering during flu season won’t be required, but will be a much more common and acceptable practice
- Close exposure to someone who has the flu should prompt someone to stay home for a few days to ensure they do not have it and spread it.
- Workplaces have adapted well to remote opportunities and this will likely continue
As always, the best protection you have against a serious influenza infection is to get your flu shot early in the season.
Other, more likely explanations are that because hospitals got paid for COVID-19, the never did influenza tests until they had a negative COVID test, since the CDC would pay the hospital 13-39K for a COVID case even if there were no symptoms, unlike influenza where you had to have both, and couldn’t report it as influenza with a + COVID test. This is the morel likely explanation, since a previous randomized trial showed no effect on flu transmission, cases or death whether masking and quarantining were practiced or not. Another explanation is that the word got out that Vit D prevented and cured COVID, and as previous studies had shown the same was true of influenza (reasonable, since both viruses cause disease the exact same way, by making starting an inflammatory response in an immune-dysregulated person), flu got prevented by the Vit D. We know Vit D sales skyrocketed this seaon.
To combat this mentality….I have ordered influenza on most of my symptomatic cases. Covid has been used in screening transfers/admissions for other reasons so many patients got just covid. However if they were influenza symptomatology I ordered both and strep. I have seen Strep and covid but not influenza. SO it is not just a money base line at least on my watch.
Yes, influenza testing has always been part of my work-up. Thanks for the comment!
Thank you for your comment! I will start by saying even if we believe what you are postulating about lack of influenza testing because of hospital payments for COVID+ (I don’t), I still think the other explanations are much more sound and likely. At the beginning of the pandemic, I worked for one of the largest hospital systems in Nebraska and nationwide with 137 hospitals serving 21 states. From the start of testing guidelines and throughout the numerous changes as supply chain changed and data evolved, testing for influenza was always the FIRST step in evaluating a possible COVID+ patient. I did more influenza testing than I ever had in the past (2 positives) because our nationwide guideline (as determined by the admins and infectious disease department) was to always test for influenza first. I think everyone’s experience during the pandemic is different, but that is what I saw first hand.
Vitamin D supplementation likely did play a (small) role — I should have included that, but I would wait for high-quality evidence to that effect before making any large claims.
Forgot to mention, that since the COVID tests were never properly validated, and subsequently even the CDC admitted that the 40 cycle count cut-off had a high false + rate (25-50% in most studies), the hospitals had a good chance of scoring coin with FP tests, and influenza cases got reported as COVID. CDC changed the reporting criteria for COVID only, leaving every other disease reporting criteria the same (and did so in violation of federal law, I might add) so the disease interaction would screw the data up.