There is an amazingly simple and clever step that the US federal government could take to counter a possible COVID-19 surge this fall and winter: a national crash program for flu shots. So far, the Trump administration has not embarked on such a program.
Since the start of the pandemic, public health experts have voiced the fear that the coming weeks and months could yield a “twindemic,” as the coronavirus crisis overlaps with the spread of seasonal influenza. A June editorial in Science raised the prospect of a “convergence” that could become a “perfect storm.” Scientific American reports that epidemiologists worry the United States could “soon face two epidemics at the same time…and this combination could precipitate a crisis unlike any other.”
The problems are obvious. COVID-19 and the flu share symptoms (fever, muscle aches, respiratory problems) and can be hard to tell apart. People who contract the flu might believe they have the more deadly COVID-19. Those who become sick with COVID-19 might assume they have the flu. Without clear and quick test results, doctors might not know what advice and treatment to provide. “Family doctors and even fancy infectious diseases experts will have trouble differentiating between patients who you treat for the flu and those who you hospitalize for COVID,” says Dr. William Schaffner, a professor of medicine in the Division of Infectious Diseases at Vanderbilt University School of Medicine.
Most important, a rise in the number of flu patients will place additional pressure on hospitals and medical facilities dealing with COVID-19. “People get sick and end up in the hospital and compete for the same beds,” notes Dr. Nahid Bhadelia, associate professor of medicine at Boston University School of Medicine and an infectious diseases physician at Boston Medical Center. “Extra tests and extra PPE will be needed.” Health care professionals dread the possible return of the COVID-caused crush on the medical system that occurred this spring. (During the 2019-2020 flu season, there were between 410,000 and 740,000 hospitalizations for flu and between 24,000 and 62,000 flu deaths, according to the Centers for Disease Control.)
Bhadelia also points out that there’s no telling yet how the flu and COVID might interact for patients who are exposed to both: “We don’t have a good sense of what co-infection looks like. Does it make either of the illnesses more severe? And some people who survive COVID have a long recovery. If they get the flu, is their flu worse because architecturally their lungs are different?”
Doing everything possible to reduce the flu this winter would certainly assist the fight against COVID-19. But that has yet to become a priority for President Donald Trump, who continues to host campaign events with super-spreading potential and who mocks mask-wearing social distancing.
There is yet no vaccine for COVID-19, but one does exist for the flu—and it’s a powerful tool: One CDC study found that increasing flu vaccination coverage by five percentage points could prevent between 4000 and 11,000 hospitalizations. And the CDC has long taken the flu season seriously. Each year, it purchases flu shots and disseminates them to state and local immunization programs, many of which also buy doses on their own.
This year the CDC has procured 9.3 million “supplemental” adult flu vaccines for distribution—far more than the 500,000 the agency typically obtains and hands out—and it has requested that state and local health entities focus on delivering these shots to underserved communities, including Black and Latino populations, according to a CDC spokesperson. The CDC also is sending $140 million in funding to state and local health departments to plan and implement vaccinations and to target minority communities, adults with underlying conditions, and essential workers. This money supports mass vaccination events, vaccine strike teams, and curbside vaccination clinics. (The effectiveness of the flu shot varies form year to year, depending on that year’s influenza strain, but the more people who are vaccinated, the greater the collective protection.)
The CDC effort is only a slice of the overall flu immunization effort. Flu shots are manufactured by private companies. (According to the CDC, these firms expect to produce about 194 to 198 million doses of influenza vaccine this season; as of early September, 47.6 million shots were distributed.) And the shots are provided to Americans by a hodgepodge of medical facilities, drug store chains, doctors’ offices, local health agencies, employers (for their workforces), and federal agencies, with different sources, including private insurers, Medicare, Medicaid, and customers, covering the tab. “It’s a bit of a quilt work,” says Schaffner. “There may well be a lot of people who need it and who don’t get it.”
There is no national immunization system to swing into action. Yet a national initiative is needed. Though the supply of flu shots is usually not a problem—and the costs are not too high—many Americans still do not obtain the vaccination. “Kroger grocery stores give free flu vaccines, and there are various means to get it,” says Schaffner. “But you have to be motivated to get it.”
A CDC study of the flu season of 2018 to 2019 noted that 62.6 percent of children in the United States (6-months to 17-years old) had received a shot. Coverage among adults was less than half: 45.3 percent. And the numbers varied widely between states (between 46 and 81 percent among children; from 34 to 56 percent among adults). Which means there is plenty of room for widely promoting and distributing flu shots. Schaffner points out that there is a need to push out the vaccine into various communities, but state and local health departments “tend not to have the budgets for something like this. We need to expand current programs and communications methods to reach out to people.”
Infectious disease experts in the United States recently spotted encouraging news in the Southern Hemisphere, where the flu season this summer (when it was winter down below) was mild. That could be because anti-COVID measures—wearing masks, socially distancing—also work to slow the spread of influenza. But in Australia, for example, these steps were more widely embraced than they have been in parts of the United States.
“Offering a free flu shot to everyone is a no-brainer,” Bhadelia says. Yet she notes that “a lot of national health care is not national,” so there are plenty of cracks in the system. Low-income people without insurance, she adds, are often not aware of immunization programs that will provide a flu vaccination with no charge. And there are people in all income brackets who don’t see the need to get a shot.
As the nation heads into flu season with the deadly coronavirus pandemic still untamed, a comprehensive flu shot campaign that makes the vaccination available to all and that mounts wide-ranging and creative efforts to promote and distribute flu shots (door-to-door flu shot teams?) would be a straightforward way to address this double-threat and bolster a health care system still coping with COVID-19. It also could be something of a test run for what happens should a coronavirus vaccination be developed.
“We are all anticipating a stressful winter coming up,” Shaffner says. An extensive flu shot blitz could mitigate that: “It couldn’t be simpler. Just roll up your sleeves.” Funding for such a program would certainly be crucial. But this is largely a question of national leadership, Schaffner contends. Imagine if Trump said everyone should get a flu shot. “That would be very important,” Schaffner remarks. “That could have a huge effect. It’s the best thing that we can do.”
But as Trump has refused to embraced the basic steps necessary to contain the pandemic, he has also not yet demonstrated an interest in such an elementary and effective public health project. Could that be because of his antivax past? Whatever the cause, he is letting an opportunity slip by. As the COVID-19 death count approaches 200,000, Trump—and the nation—is running out of time to implement a damn easy way to assist an embattled health care system and to reduce suffering and death.