There's a bit of good
news, but the US may still suffer a particularly nasty winter.
Sara Chodosh August 26,
2020
Now is about the time that the annual flu shot
reminder articles start popping up. It’s rarely on people’s minds in late
August or even in September, but that’s actually the perfect time to get
vaccinated. It takes a few weeks for immunity to build, so by the time the
virus really starts circulating you’re already protected.
This year, though, we all have another disease
on our minds, and the growing awareness of two overlapping, widespread viruses
circulating at the same time has epidemiologists and other public health
experts concerned.
“I’m very worried about this,” says Eleanor
Murray, an epidemiologist at Boston University School of Public Health. “I
would feel more secure if we were taking strong COVID-19 precautions, but with
schools and universities and many workplaces opening back up, I’m not at all
optimistic about the fall and winter.” Here are the reasons Murray and others
are so concerned.
COVID symptoms might be
mistaken for the flu
There’s a lot of overlap between the
symptoms that each virus causes. Both can give you a fever, cough, fatigue,
sore throat, stuffy nose, muscle pains, shortness of breath, and headaches. But
the outcomes of each disease are very different—COVID-19 is much deadlier than the flu (some evidence suggests as
much as 50 to 100 times deadlier). One reason for that is that very few people
have any kind of immunity to it.
The current advice for people who think they
might have COVID-19 is to self-isolate, then go to a hospital if they start
exhibiting serious symptoms like shortness of breath which could be life
threatening. . But as flu season ramps up, folks who come down with COVID-19
symptoms might brush it off as “just the flu.” They might not take proper
precautions and then spread the coronavirus to others. They also might be less willing
to see a doctor for the flu, which could put them at a higher risk of
experiencing a dangerous case of COVID-19.
Already overloaded testing
systems are going to get even farther behind
The logical way to differentiate influenza from
COVID-19 would be to get tested. Self-isolation in combination with easily
available testing could be an excellent way to tamp down both viruses—according
to epidemiologists, proper testing is a big factor in helping us return to
relative normality.
But the United States doesn’t currently have
that capability. We were already behind on COVID-19 testing in February,
and in the first two weeks of August we ran fewer tests than the
week before. Nonprofits, philanthropists, and healthcare professionals have
tried filling in the gaps where the government has largely
So when a flood of people start getting COVID
and flu-like symptoms and want to get tested to see if they’ve been infected
with the novel virus, the system isn’t going to be able to help them. “If
people are going to get tested or self-isolating for any fever then the testing
systems are going to become overloaded,” Murray says. Testing is the most basic
form of pandemic control—it enables us to isolate the sick from the well—and
it’s not a good sign that we’re already behind.
Healthcare systems could
get overloaded, too
On top of a breakdown of the testing systems,
there’s a serious concern that an influx of people with severe influenza could
push healthcare systems over the edge too. Despite much drum-beating on the
topic, much of the public is still unaware that seasonal flu is a serious
affair.
“One of the common refrains we’ve heard from
people is ‘isn’t COVID-19 just like the flu, and therefore no big deal?’ but
the flu is actually a pretty big deal,” Murray says. “A lot of people get sick
and die from it every year and this year is likely to be no different. Add that
on top of COVID-19 and our health care and public health systems which are
already overtaxed are likely to completely break down.”
Co-infections might be an
issue
Diseases usually strike one at a time, but it is
possible to get infected with two viruses at once. Having influenza and
COVID-19 at once—both respiratory viruses—would be nightmarish. The real
question is how likely that is to actually occur.
Co-infections are pretty rare in general, and in
some cases being infected with one virus can have a protective effect
against others (for instance, having influenza A seems to reduce the
chances of having a rhinovirus), though virologists aren’t exactly sure why
that is.
“I do think it’s reasonable to be concerned that
co-infections could be more deadly, although we have no evidence either way as
far as I’m aware,” Murray says. Unfortunately, says Murray, this is something
we’ll have to wait and see on.
The good news: COVID
precautions are also influenza precautions
One small glimmer of hope comes from the
southern hemisphere: Flu cases were at historic lows this year. Australia,
which has already been through the worst of this year’s winter season, had 925
cases in 2018, then 9933 last year, but in 2020 only saw 33. A similar pattern
has occurred in Argentina, Chile, and South Africa. All of those countries had
over a thousand cases in 2019 and at least 700 the year before, but have had
less than 55 cases this season.
Though it might be that people are simply not
showing up to hospitals and therefore not being counted, it’s more likely that
those countries ended up with low flu counts due to the social distancing
measures they put in place for COVID-19. “In general, we’re very good at doing
flu surveillance so I believe that the reduction in flu is real,” says Murray.
“It seems reasonable to attribute that to the precautions we are taking against
COVID-19 also being effective for the flu.” The US was at the tail end of what
should have been a severe flu season in 2020, but when the pandemic was
declared there was a precipitous drop in cases.
But that doesn’t mean this winter is going to be
an easy one.
“It’s important to note that the precautions
that many Southern hemisphere countries have been taking against COVID are
stricter than the precautions we are taking in the US,” Murray notes. “We can’t
necessarily rely on seeing a similar decrease in flu here.”
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