In a few months, the U.S. will be battling both the seasonal flu and COVID-19 epidemic at once.
While the collision is inevitable, disaster is not: experts of all stripes told TPM that public health officials and health care workers face a grave challenge. The fear and social distancing inspired by the pandemic will make it extremely difficult to deliver the seasonal flu vaccine. And the small, local public health departments typically responsible for managing the flu vaccine are already overwhelmed with the fight against COVID-19.
When the vaccine becomes available later this month or in August, health officials will have to figure out how to convince a country with already dismally low vaccination rates to leave the safety of their homes and proactively seek out the shot. Otherwise, the double wave of disease could spell disaster as people seriously ill with flu take up hospital ICU beds and ventilators, just as the country faces an anticipated fall wave of COVID-19 likely to put pressure on the same stress points in the health care system.
Dr. Howard Koh, Health and Human Services assistant secretary for health under President Obama, told TPM that the pandemic had placed the ”minor miracle” of the flu vaccination campaign under threat.
“Trying to coordinate this is going to be even more challenging, but even more critical,” he said.
Yet Another Burden On Hospitals
Simultaneous flu and COVID-19 outbreaks would further stress hospital resources. Both diseases present with similar symptoms, making it difficult for doctors to diagnose and isolate patients before they infect others.
According to Dr. Bill Schaffner, professor of preventive medicine at Vanderbilt University, anything less than the national average of around 45 percent of adults vaccinated against the flu could drag down hospital emergency departments around the country.
“It’s the clinical impact of influenza, people going into doctors’ offices, going into emergency departments and needing to be hospitalized, that could further jam up our capacity to provide medical care,” Schaffner said.
The problem threatens to place real, additional stress on the country’s public health infrastructure, Adriane Casalotti of the National Association of County & City Health Officials told TPM.
“A lot of people who work in local health departments on the annual flu campaign are the same people pulled off to do coronavirus response,” Casalotti said.
Koh, the former Obama HHS official, added that small-town health departments consist of a handful of people responsible for a large portfolio of health concerns: opioids, restaurant inspections, the fly — and now the coronavirus.
“They’re expected to do everything, so they always have a widening list of responsibilities,” he added.
Casalotti added that the “traditional mechanisms” for flu vaccination — getting a shot at an annual check-up, requiring inoculation for schooling and making it available in people’s workplaces — have all been limited by the pandemic.
And medical experts are already seeing this dynamic play out with routine vaccinations for children.
“Although it is hard to get data in real time, medical groups have noted that the combination of restricted clinic access and fears about going to an office where sick people might result in lower routine vaccination rates,” Dr. Tony Moody, director of the Duke CIVIC Vaccine Center, told TPM. “This will likely be compounded during influenza season when people will have two reasons to want to avoid doctor’s offices or vaccination clinics.”
CDC data shows that around 40 percent of Americans get vaccinated for the flu in a doctors office, while an additional 15 percent get inoculated at work.
“If you add that all up, that could be disruptive,” Koh said.
Heading Off The Disaster
The situation requires creativity, said Litjen Tan, chief of public strategy at the Immunization Action Coalition.
“We need to take any opportunity to get people vaccinated efficiently while the weather is still good through at least October, even later in the South” he told TPM. Tan suggested “mass immunization clinics” in outside spaces everywhere from church parking lots to pharmacy curbsides.
Schaffner, the Vanderbilt doctor, added that while pharmacies would likely play a larger role in vaccination this year, it comes with a trade-off: many vaccination strategies rely on intercepting people at doctors offices or their workplace, whereas pharmacy-based vaccination drives require people to be proactive.
He added that starting next month, the CDC and National Foundation for Infectious Diseases would begin a campaign linking flu vaccination to COVID-19 in a bid to make getting a flu shot a way of fighting against the coronavirus.
It will take cohesive national messaging to convince people that while they must stay home and limit their exposure to others to tamp down the spread of COVID-19, it’s also important for them to venture out and get the flu vaccine.
“Those two behaviors are in opposition to one another, and my personal take, based on very limited data, is that the people most likely to get the vaccine will be the ones least likely to want to go out,” Moody said.
Other countries have threaded that needle successfully.
In Australia, where the flu season is happening now, officials hammered the message that even amid a strict lockdown, people must get their flu shot. The record number of immunizations, plus mitigation of flu spread from COVID-19 social distancing measures, has left the number of flu cases there extremely low.
“There’s no vaccine for COVID, but getting vaccinated against the flu can take that off the table for you,” Tan said. “You can’t protect yourself against COVID, but you can be proactive about the flu — for us, that requires heavy messaging from our national leadership.”