Many unanswered questions as New England nears flu season amid coronavirus pandemic
As New England faces the first flu season during the coronavirus pandemic, health-care leaders issued an urgent plea for residents to get vaccinated against influenza.
Although they hope strategies to limit the spread of the coronavirus — mask wearing, social distancing and hand washing — will have similar effects on influenza, they warn that, even so, significant numbers of flu cases will take up precious hospital beds, healthcare workers’ time and coronavirus testing supplies.
And doctors confess that they just don’t know how severely ill someone infected with both viruses will become.
“It’s kind of hard to predict what’s ahead of us,” said Dr. Jose Mercado, associate hospital epidemiologist at Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire.
But epidemiologists get clues about the flu season by looking to the Southern Hemisphere, which, because its winter is during the Northern Hemisphere’s summer, provides a hazy preview.
“The evidence we have from the Southern Hemisphere is that these interventions appear to have reduced seasonal influenza,” said Dr. Leonard A. Mermel, medical director of epidemiology and infection control at Rhode Island Hospital.
“It’s no reassurance to me that the Southern Hemisphere had a mild flu season,” said Dr. Dora Anne Mills, chief health improvement officer at MaineHealth. “They were in lockdown during their entire winter. We’re not in lockdown.”
That concern was shared by Dr. Ali S. Raja, executive vice chair for the Massachusetts General Hospital emergency medicine department.
“I worry that the flu risks may not be as mitigated by the COVID procedures,” Raja said. “What we know is the flu shots work.”
“This is a really important time for us,” said Dr. Brian T. Garibaldi, medical director of the Johns Hopkins Biocontainment Unit in Baltimore. “This is the year that everyone needs to step up and get vaccinated. We need to recognize that we’re in this together.”
Several of the doctors questioned whether relying on masks to slow the flu is a sound strategy.
“If that was the case, we wouldn’t have COVID — if everybody was doing what they were supposed to do,” said Mermel. “We don’t eat with our mask on or drink with our mask on.”
And keeping up with mask wearing and social distancing may be difficult in the winter, said Mills. “The strategies that have been effective the last several months will become less and less effective.”
She added: “I worry about the holidays coming up, people gathering indoors. The usual gathering with family and loved ones is just not a good idea.”
The doctors, who were interviewed over the last week, said that flu shots will protect in four ways:
They will keep individuals from getting sick.
They will keep doctors offices, clinics and emergency rooms from getting swamped.
“That’s the fear, and that’s the concern,” said Mercado. “You don’t want it to get to the point where it would overwhelm the health-care system.”
“We cannot let our emergency departments and our healthcare system get overrun by waves of people dealing with the flu while the healthcare system is also trying to deal with patients with COVID-19,” said Joseph Wendelken, spokesman for the Rhode Island Department of Health.
Flu shots will keep open hospital beds to treat patients with COVID or other conditions.
“We have to try to stay open and provide health-care for the other problems people have,” said Garibaldi.
“Even in a mild flu season, hospitals will become nearly full or full,” said Mills.
“If we have fewer people with the flu, we’re going to have fewer hospitalizations and more beds open for COVID,” said Mermel.
Flu shots will also protect the supply of tests for COVID.
“The symptoms of flu and coronavirus are exceptionally similar,” said Raja. “There is no way to tell the difference without testing them for both.”
That means anyone presenting with symptoms such as cough, shortness of breath and fever will have to be tested for both viruses because, while their symptoms overlap, their treatments don’t.
“It’s going to be almost scary to think,” said Mercado, “you’re not going to be able to clearly identify one or the other by symptoms alone.”
If a vaccination prevents a case of the flu — as it does 40% to 70% of the time — those people won’t need a COVID test to rule out that disease.
“We’re not going to be using up more coronavirus tests,” said Raja.
“What if we run out of tests?” said Mermel, invoking the nightmare scenario that faced health officials last spring, when testing equipment and materials were in short supply.
The doctors also expressed concerns about children, who are better carriers of influenza than they are of COVID.
Children are significant spreaders of the flu each year, said Mills. “It’s very important to get kids vaccinated against flu.”
And what of people who contract both illnesses?
“You don’t want to be the person who gets COVID and influenza at the same time,” said Garibaldi, “because we don’t know what’s going to happen to you.”
“We don’t fully know, but certainly a double whammy,” said Mills.
“We all worry that it will be much more severe,” said Raja.
“In general, it leads to worse outcomes,” said Mermel, who pointed to a study at Rhode Island Hospital of patients who contracted two viral infections, though this had been done before COVID burst on the scene. The study found that infection by two viruses made patients more susceptible to further infection by bacteria, such as staph infection. “You don’t want to get infected with the flu and COVID.”
So the doctors recommended everyone who can should get a flu shot, and everyone should prepare for more months of pandemic precautions.
“Get the flu shot as early as you can,” said Raja. “Don’t try to game this or increase the flu shot’s effectiveness.”
Said Mermel: “Why take a chance?”
“I know people are tired of the pandemic, but it’s not tired of us,” said Mills. “It could be a long winter, but we do know spring will come.”
— pparker@providencejournal.com
(401) 277-7360
On Twitter: @projopaul
