Last flu season was the mildest one in decades because of masking and social distancing, but health experts worry that with fewer people following these practices, the coming flu season could be more severe.
In Pennsylvania, there were just 3,664 flu cases reported the last season compared to the 2019-2020 season when there were 131,282 confirmed cases and 1.7 million to 2.4 million estimated cases, said Amber Liggett, spokesperson for the Pennsylvania Department of Health.
Dr. Jeffrey Jahre, infectious disease expert for St. Luke’s, said COVID-19 mitigation measures such as wearing face masks, staying home, hand washing, school closures, reduced travel and physical distancing all played a major role in last year’s flu season being mild. Because both the coronavirus and flu are spread person to person via respiratory transmission, the same methods to mitigate COVID-19 works against the flu.
People following COVID-19 mitigation measures may have played a bigger role in stopping the spread of flu than vaccines — flu vaccination rates last season were nearly the same as the rates in the 2019-2020 flu season, according to the Centers for Disease Control and Prevention.
But Jahre said this flu could be more severe because fewer people are masking or social distancing. Additionally, many are back to in-person work or school, and more people are going to crowded events.
Jahre pointed to the decline in adherence to people tried of masking up and social distancing, along with the CDC’s inconsistent guidance on masking.
“Back in the spring there was the advice that if you were fully immunized, you were basically home free,” Jahre said. “Unfortunately, that was the wrong advice and they should have known better because at that time, Delta was already making inroads in many parts of the world and we knew that it was already here. We should have known better than to sound the all-clear signal, because once you do that, it’s much harder to draw people back.”
Dr. Timothy Friehl, infectious disease expert for LVHN, said experts can usually look to countries in the southern hemisphere, which experience their flu seasons earlier than the United States, to help predict how flu season will go here.
He said Australia and New Zealand had mild flu seasons, which would normally be a good sign, but those countries have also been stricter about COVID-19 mitigation than the U.S.
“They have much more strict rules about masking, social distancing, limiting travel. All of those different factors have continued to keep both COVID at lower numbers, and certainly influenza at the same time. Because we’re in a different situation, we’re just not sure how things are going to progress throughout the season,” Friehl said.
For much of the pandemic respiratory syncytial virus, common cold, bronchiolitis and other non-COVID-19 respiratory infections were almost non-existent he said. But he said there was a resurgence that started in the summer and has continued into the present.
“RSV has come back this year with a vengeance,” Friehl said. “It started much earlier this year and is still a big problem our pediatric services right now are filled with folks with RSV infections. We’re seeing a lot of significant disease ultimately requiring hospitalization of children. We just don’t know yet if influenza is going to follow that same path.”
The possibility of high flu spread has some concerned about a “twindemic” where high spread of COVID-19 and flu during this fall and winter could lead to strain on hospitals. Jahre and Friehl said the last thing health care workers need this winter are beds filled with flu and COVID-19 patients.
Flu and COVID-19 have a number of potential symptoms in common including fever, chills, cough, shortness of breath, fatigue, sore throat, runny nose, muscle aches, body aches, headaches, vomiting or diarrhea. The only effective way to tell them apart is through testing and combination flu and COVID-19 tests are available.
Chrysan Cronin, director of public health and professor at Muhlenberg College, said it is known that flu and COVID-19 operate in a synergistic way when someone is infected with both at the same time.
“Having one along with the other one makes the illness much more severe than if you had just one by itself,” Cronin said. “That’s why it’s referred to as syndemic, because there’s a synergistic effect of having both of them at the same time.”
Cronin added people tend to underestimate how severe the flu can be.
“I’ve had students say ‘I don’t care if I get the flu.’ I tell them ‘You will once you’ve had it one time because it feels like a truck ran over you’,” Cronin said.
During most flu seasons tens of thousands of people in the U.S. die from flu and hundreds of thousands are hospitalized. Complications from flu include pneumonia, ear infections, sinus infections, dehydration and worsening of chronic medical conditions, such as congestive heart failure, asthma or diabetes.
Most of the people who experience the worst effects of flu are 65 years or older, have chronic conditions or compromised immune systems. People of all ages can die from flu-related complications though — 200 children in the U.S. died from the flu during the 2019-2020 season, the highest in recorded history.
But COVID-19 mitigation methods and the flu shot work — last year there were 700 deaths total and only one child death from flu last season, according to the CDC.
This flu season has yet to kick off in the Lehigh Valley so for now health experts are trying to get ahead of it.
Many officials hope the flu shot will play a significant part in controlling the spread during the upcoming season. Flu vaccines, like the COVID-19 vaccine, are effective at decreasing the spread and highly effective at protecting people from serious illness.
During the 2019-20 season, flu vaccinations were estimated to prevent 4.4 million illnesses, 2.3 million medical visits, 58,000 hospitalizations and 3,500 deaths nationwide, Liggett said. Jahre said they recommend that everyone six months and older get the flu shot.
St. Luke’s and LVHN both started offering flu shots at their hospitals, urgent care centers and doctors’ offices a few weeks ago and there are ample stocks of vaccines. Jahre and Friehl both said so far they have seen many people get the flu shots. Jahre added some people have inquired whether the flu shot will interfere with the COVID-19 vaccine or its booster shot but they have assured people it won’t.
LVHN will hold drive-thru flu shot clinics Nov. 6 and Nov. 7 throughout the areas they operate, including clinics at Coca-Cola park.
Morning Call reporter Leif Greiss can be reached at 610-679-4028 or [email protected].