Seasonal flu vaccines more urgent as COVID combo threatens ‘twindemics’

Experts say flu shots are more important than ever this fall and winter as COVID-19 threatens "twindemics" that could occupy medical resources and staff typically dedicated to fighting seasonal influenza. Marko Geber/Getty Images

Most years, Michelle Houser of Columbia County has her three children vaccinated for the flu at the end of October or early November, but this year she made a point to get them their annual shots as soon as she could.

“I wouldn’t even let them go to church until they were vaccinated,” she said. “It was more important this year because of COVID. My 9-year-old tends to get the flu every year. I wanted to get early protection.” 

Her oldest daughter, who is 18, contracted COVID-19 over the summer and had to quarantine. Her husband, a senior machine operator, has had to self-quarantine pending the results of COVID-19 tests as well, keeping him off the job.

Those experiences make Houser more anxious about the upcoming flu season, when a sore throat and stuffy nose could mean either influenza, COVID-19 or both.

“With the flu, you wait it out with meds and no quarantine. With COVID, there are no prescribed meds initially, and you need to quarantine. When my husband has to quarantine he misses work. I’m terrified of any of us being hospitalized.”

Her children will continue to study from home, but getting them the flu vaccine will mean less uncertainty if one of them does develop symptoms.

“It’s peace of mind that they are at least protected against the flu– hopefully– allowing potentially for a process of elimination in the event they become symptomatic,” she said.

Michelle Houser of Columbia County got her kids vaccinated early this year. Some health workers worry “twindemics” of COVID-19 and influenza could strain the state’s health care system. Photo courtesy of Michelle Houser.

More Georgians should be like Houser and get their families vaccinated as soon as possible, said Georgia Public Health Commissioner Dr. Kathleen Toomey, or risk “twindemics,” which could complicate the yearly flu season and strain the health care system by increasing the need for medical staff and testing supplies.

“This is particularly important this year,” Toomey said Wednesday at a Capitol press conference. “We’re trying to prevent twindemics of COVID plus influenza, which could be devastating. We don’t know what the presence of influenza may do to a COVID infection. At the same time, flu itself can be very deadly and can lead to hospitalization, it could fill up our hospitals and then not have capacity for COVID patients when and if that increase may occur.”

The state health department now has 300,000 flu shots on hand and is working to get another 400,000 distributed to the state’s 18 regional health districts, Toomey said. Most local health departments offer drive-thru clinics so patients can get the seasonal shot without leaving their car.

The Georgia Department of Public Health is set to release its first weekly influenza report on Friday, an account of how many people report flu-like symptoms across the state. An average of 36,000 Americans die in a typical flu season, and more than 200,000 are hospitalized.

An unusual flu season

The virus that causes influenza is present all year, but mid- to late-November is when doctors in the southeast typically see an influx of patients with flu-like symptoms, said Dr. Danny Branstetter, medical director of infection prevention for WellStar Health System.

“If it’s flu season and we know that flu is circulating and someone comes in presenting with sore throat, body aches, fevers, chills, and maybe even congestion either in their chest or their sinuses, then we’re going to say, yeah, you have a viral infection,” he said.

Further evaluation is usually reserved only for patients who are sick enough to be hospitalized, but this year, a viral infection could be COVID-19.

COVID-19 and influenza have similar symptoms, and it’s very difficult to tell them apart without a test.

For patients who are otherwise healthy, the medical advice will be similar whether they were diagnosed with COVID-19 or influenza: stay at home, treat your symptoms and call back if you get worse. Most patients will recover in a week or two.

Still, it’s important to distinguish betwen  the two diseases, said Dr. Isaac Chun-Hai Fung, associate professor of epidemiology at the Jiann-Ping Hsu College of Public Health at Georgia Southern University.

“We don’t do contact tracing for influenza, and you won’t be asked to stay home for 14 days for influenza, but if somebody is COVID-19 positive, they have to be isolated, close contacts have to be put into quarantine, so there’s a huge difference,” he said. “From the patient’s perspective, that is probably the most important part, whether they have to be isolated and their family members quarantined.”

If you go to the doctor or urgent care center this fall and winter, you may be tested for both flu and COVID-19.

There are several tests that can distinguish among multiple viral infections like COVID-19 and influenza, including tests produced by the Centers for Disease Control and Prevention, LabCorp and Quest Diagnostics.

With one nasal swab, doctors can test for up to 18 viruses, Branstetter said. Some doctors may instead order two separate tests depending on their supply or in order to get the results back more quickly. A single test for multiple viruses will make life easier for doctors, patients and public health officials tracking the diseases, and, critically, it may also lower the burden for the scientists that process the tests.

Potential shortages

But some worry a bad cold season could stretch providers’ capacity to produce and process tests, as well as to provide hospital beds, ventilators and other medical equipment.

Health care systems around Georgia are sometimes overwhelmed during a typical flu season, said Georgia State University public health professor Dr. Harry J. Heiman, and COVID-19 could make things worse.

“We already have major hospital systems where critical care beds are filled with COVID patients, among other patients, and we haven’t even gotten into the flu,” he said. “So, if we have even an average flu season, and we haven’t been able to dramatically reduce the burden on the health care system that we’re currently seeing with COVID, even with our significant reduction of cases, that’s a very worrisome scenario.”

As of Wednesday, Georgia’s hospitals were on average slightly over 80% capacity for inpatient and intensive care beds and just under 50% capacity for emergency department beds, according to state data. Just under 30% of the adult ventilators available in Georgia are in use.

Branstetter said he is less concerned about a lack of medical facilities and equipment, thanks in large part to efforts by the state’s hospital systems, its health department and the Georgia National Guard to increase capacity. He is more worried about medical workers who can’t do their jobs because they are sick, quarantined or caring for family members.

“My concern this winter, if there’s going to be a limitation on something, it would be staff, the medical personnel, particularly nursing and respiratory therapists,” he said. “Health care workers are not immune to these things.”

Some flu seasons are worse than others. The severity depends a lot on which strains of the influenza virus are circulating, and it’s not yet clear what this season could look like, but peoples’ behavior and their reaction to the past half-year of pandemic will likely have an affect.

The optimistic view is that people are accustomed to wearing masks, washing their hands and avoiding gatherings, which could lead to less spread of influenza this year.

There is reason to believe the safety measures Georgians took at the beginning of the COVID-19 pandemic may have also slowed down the flu, Branstetter said.

“At the beginning of the pandemic, back in February, March, we were still in influenza season in the southeast, and if you look at our numbers of influenza, despite a massive increase in testing for influenza over our previous baseline, we actually saw a decrease in influenza cases,” he said. “So these measures to prevent coronavirus are effective, not only shown here from the previous flu season early in this calendar year, but also across the world, it’s been shown.”

That’s what Fung is hoping will happen, but a more worrying scenario is also possible, he said.

“In the event that is the opposite, where people are tired of these interventions, and they stop adopting them, they do not social distance, put on masks and so on, that would be why some public health professionals are worried about having a double epidemic with both influenza as well as COVID-19 going on,” he said.

It is possible to have multiple respiratory illnesses at the same time, including the flu and COVID-19. While that would clearly be bad for a patient, it’s not yet clear how bad it would be, because it simply has not happened enough, Heiman said.

“The other thing that we don’t know is whether other kinds of respiratory illnesses that people get, like the common cold, may in fact, also increase the risk for contracting COVID, because we haven’t been through a flu season with COVID before,” he said. “We don’t know what the impact of colder temperatures is going to be on COVID. So there are a lot of unknowns that make me worried, and at the same time, make me recognize that our state still has a long way to go, in terms of putting the public health infrastructure in place to manage both COVID and flu.”

Children

After an at times challenging start to the school year, Georgia school districts that began the year online are increasingly moving to in-person education.

Schools are often breeding grounds for flu and other infections, and nobody knows yet what affect COVID-19 could play on the flu season.

Dr. Kathleen Toomey, head of Georgia’s Department of Public Health, joined Gov. Brian Kemp at a Thursday news conference to urge Georgians to get a seasonal flu shot this fall. Stanley Dunlap/Georgia Recorder

“Like many other things in this pandemic, we don’t know,” Toomey said. “This is still new. This is the first time we’ve experienced COVID plus influenza, but we’ve had many, many years with flu increases in schools, where in some cases we had to close schools because so many teachers were ill or so many students were ill. We’re going to work and really encourage the school superintendents to continue to work closely with the local health directors to monitor them very very closely.”

With both diseases potentially spreading in schools, it’s vital that parents keep an eye on their children and keep them home from school if they don’t feel well, Branstetter said. Symptoms to watch out for include lethargy, loss of appetite, chills, fever or bellyache. Stuffy or runny noses, ear aches or sore throats are common signs of respiratory viral illnesses, and viruses can also sometimes show up as rashes, particularly in children.

Influenza causes more hospitalizations and deaths among American children than any other vaccine-preventable disease, and though pediatric deaths from the flu are relatively rare, children die from influenza every year.

Parents should make sure their children stay hydrated, keep them home until they are fever-free for at least three days and check with their doctor if they have any concerns.

That advice applies to parents as well, and employers should plan for logging more sick days than normal during this flu season.

“If you’re running a fever, please stay home,” Branstetter said. “I think employers and workforce planners need to put that into their thought process, that they may have more people staying out a little more frequently because of the extra precautions and want to be prepared for that.”

Prevention

The best way to avoid spreading the flu is with a flu vaccine. Once a patient receives the vaccine, it takes at least two weeks for the immune system to gain full protection, so Branstetter recommends people get it by mid-October so they will be protected before the big spike in cases that usually happens in November.

Nearly everyone can get vaccinated. The flu shot is approved for people six months and older, and a nasal spray flu vaccine is approved for healthy people between two and 49 years old who are not pregnant.

For Kim Shaw Ball of Augusta, getting the flu vaccine became more important when she learned of her son’s intense food allergies, including to eggs. Most flu vaccines are produced using chicken eggs and contain a small amount of egg protein.

The CDC recommends people with severe allergies to eggs to talk with their doctors before getting a flu shot. Most people, even those with severe allergic reactions to eggs, can still get the shot under the supervision of an allergist or other medical professional qualified to manage severe allergic conditions, but Ball’s son’s allergic reactions are so severe that his doctor recommends against it, Ball said.

“He can’t eat out in restaurants or eat lunch at school,” she said. “Most people don’t understand the severity of his allergies, but even touching an egg can send him into anaphylactic shock.”

So when the rest of the family gets their annual shot, they feel like they’re not only protecting themselves, but him as well, she said.

“In the past, we would usually get the vaccine, but didn’t really worry if we didn’t get around to it,” Ball said. “My son’s doctors have always advised our immediate family and his grandparents to make sure we got the flu vaccine since he could not, and we have always gotten the shot ever since.”

Ball said she hopes more Georgians consider the very young and those with severe allergies and decide to get the shot, even if they are at low risk themselves.

“Even a young, healthy person who will be fine after a few days of being sick with influenza could spread the flu virus to an elderly grandparent or someone who might not be fine,” she said. “I always encourage everyone to get a flu shot unless there is some underlying reason they can’t, because every flu shot helps reduce the spread of the flu virus.”

The vaccine is not 100% effective, but research shows that those who happen to get the flu after receiving it have less severe symptoms, Branstetter said.

Mild side effects are possible, but the flu vaccine cannot cause the flu. There is no vaccine ready for COVID-19.

Ross Williams
Before joining the Georgia Recorder, Ross Williams covered local and state government for the Marietta Daily Journal.Williams' reporting took him from City Hall to homeless camps, from the offices of business executives to the living rooms of grieving parents. His work earned recognition from the Georgia Associated Press Media Editors and the Georgia Press Association, including beat reporting, business writing and non-deadline reporting. A native of Cobb County, Williams holds a bachelor’s degree in English from Atlanta's Oglethorpe University and a master’s in journalism from Northwestern University.