After seven months (and counting) of life in the time of COVID-19, we have become accustomed to a new world, a new way of life. But we can’t relax. It’s still with us and will be for the foreseeable future. The virus will kill a thousand people this week; by week’s end, the national toll will hit 200,000. Now guess what’s just around the corner.
“We’re right at the beginning of the (flu) season,” said Dr. Jared J. Eddy, Infection and Prevention Officer at Denver’s National Jewish Hospital. Because it’s so early, he said, “It’s difficult to know what this one will look like.” But we do know how truly bad influenza can be. The Great Influenza, which hit the U.S. in 1918, killed an estimated 675,000 Americans and as many as 50 million worldwide. The country’s most recent bad year for flu deaths was 2017-2018 when 61,000 Americans died.
Right now, the biggest difference between the virus we’re currently fighting, C-19, and the one we know is coming, the flu, is that there already exists a vaccine for influenza. It’s been around and in use since the early 1940’s. It’s not perfect---none is---but it’s effective. The CDC rates it as 40 percent effective. And this, said Denver Health and Hospital’s Dr. Heather Young, is a good time to start thinking about getting vaccinated. “We’re encouraging it,” said the infectious disease specialist.
It might be too easy to look at the 40 percent effectiveness of the vaccine and choose not to get it. But a closer look indicates that the shot prevented the flu 40 percent of the time. In the 2018-19 season, the CDC said the vaccine prevented 4.4 million cases of the flu, 58,000 hospitalizations and 3,500 deaths. In that same year, the vaccine was judged to be only 29 percent effective.
Getting the vaccine too early, say, in mid-summer might dilute its effectiveness by the time the flu is in full swing. Getting it later---December or January---when the flu is in full swing presents a different conundrum. The vaccine usually takes from ten days to two weeks to begin building up the antibodies to fight the virus.
“Everybody over sixth months of age,” said Young, should get the vaccine though not everyone will. Among those who won’t include a growing number of anti-vaxxers and others who claim religious or philosophical exemptions. Many base their skepticism on a decades old, retracted paper in the Lancet, a respected medical journal, that said vaccines caused autism and other health problems.
Colorado Governor Jared Polis signed into law last summer legislation that tightens exemptions for vaccinations. Colorado currently ranks 20th in the U.S. for vaccination rates.
This season there are three flu strains that are likely to have impact, said Young. Hospitals are bracing for the H1N1 or Swine Flu, H3N2 and influenza B strain. Early indications are that this flu season, which peaks in December and January, may not be as harsh as others that preceded it.
Because flu generally follows a path from the south to north, indications of a milder season are looking up. “The southern hemisphere is what we use as a barometer,” she said. “The southern hemisphere had a lighter influenza year.”
But a lighter than average flu season holds little consolation for its victims. The flu usually comes with fever, chills, sweating, severe muscle pain and overall achiness, often at severe levels of each. For thousands of Americans, it can also be fatal.
“The biggest concern,” said Eddy, “is overwhelming our health system.” Lessons taught by Covid-19 early in the spring, especially in the greater New York City region, demonstrated the full impact and challenge of fighting a virus. Hospitals were pushed to the brink and forced to use areas never even thought of for treating patients, including hallways and waiting rooms.
The fall and winter, when people are more often clustered inside and in closer proximity, may also bring a spike in both viruses. “There’s going to be an overlap,” Eddy said. “For that reason, it’s more important than ever to get people vaccinated for influenza.”
Flu viruses, like COVID-19, spread similarly. Airborne droplets from an infected person “come out of the mouth when you talk or sneeze,” said Eddy. They land in the mouth or nose of a person standing nearby and the virus has a potential new victim.
As has been stressed in the Covid-19 era, the best advice is social distancing, maintaining a safe distance when at all possible. Six feet is generally what doctors recommend. Wearing masks and hand washing are also highly recommended.
For those who have an aversion to needles, there is also a nasal spray vaccine that carries the same effectiveness. But it is not recommended for those 65 and over. That group should stick with the needle and, adds Eddy, “The elderly should get a higher dose.” The higher dosage is more effective in older people because they tend to have weaker immune systems.
The CDC recommends a flu shot for everyone six months and older, including pregnant women. Also, there is not expected to be shortages of vaccine for any of the three types of influenza that are anticipated. Manufactures say they will produce up to 190 million doses for the 2020-2021 flu season.
At Denver Health everyone working in the hospital is required to get a flu shot. “It’s a condition of employment,” said Young. But the hospital does make exceptions for medical or religious opt-outs.
For those teetering and uncertain about the flu shot, speak with a medical expert. Also, doctors say don’t depend on second-hand or unverifiable information in deciding because the flu is coming whether you get a shot or not.