(Bloomberg Opinion) -- This upcoming winter has the potential to be one of the deadliest on record in the U.S., especially if influenza imposes an additional burden on patients and a health-care system already overwhelmed by the Covid-19 pandemic.
Reports of low flu rates in other parts of the world, attributed to social distancing practices taken up for the coronavirus, suggest that we could be in for a mild flu season too — if we take the right steps this winter. But many communities around the country are considering restarting in-person schooling. Even with the best distancing measures, this would bring children and adolescents in close contact with one another. Although kids under 10 may not be major spreaders of Covid-19, they are known to spread influenza throughout entire communities — so much so that closing schools is an internationally-accepted, effective strategy to stop the spread of influenza among kids and adults.
Like any precaution, of course, keeping schools closed involves tradeoffs, from potentially hurting children’s development to preventing an economic recovery. Recognizing that in-person education will likely resume in some schools this fall, we urge officials to mandate influenza vaccination for students and staff, just as many other vaccines are already mandatory to attend school. Not only would such a measure protect communities from the flu, it will also help hospitals maintain their capacity to treat Covid-19.
To get a sense of the potential burden of influenza, consider what the U.S. Centers for Disease Control and Prevention estimated happened last flu season: Influenza was responsible for 39 to 56 million illnesses, 18 to 26 million doctor’s office visits, 410,000 to 740,000 hospitalizations, and 24,000 to 62,000 deaths — including 186 confirmed pediatric deaths.
Cases of flu were slowing down by the time the coronavirus began surging in many American cities this year, and the flu season may have even ended earlier than it otherwise would have due to social distancing. Although deaths from influenza this past season amounted to fewer than the 150,000-plus deaths thus far from Covid-19, the prospect of having high rates of flu during the pandemic is highly concerning.
In typical winters, hospitals and intensive care units can be stretched as older and vulnerable patients fall ill from influenza and other respiratory viruses. “Even in the best of times, a bad flu season can push hospitals to the limits of their capacity,” says Dr. Kathryn Hibbert, a critical care doctor and Director of the Medical Intensive Care Unit at Massachusetts General Hospital in Boston. “It’s important to remember that hospital floors and intensive care units were almost always full before the coronavirus pandemic — the potential combination of flu season with ongoing Covid-19 cases has been concerning to us from the beginning.”
In a recent interview with PBS about the pandemic, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, made it clear that control over influenza will be critical this winter to handle Covid-19. “What we should be doing,” Fauci said, “is making sure that as we get into the fall, we get as many people vaccinated as we possibly can against influenza, to try — to the extent possible — get that off the table.”
If schools do open for in-person teaching, maximizing vaccination against influenza, along with implementing effective social distancing and infection control measures in schools, will lighten the burden of both the flu and Covid-19 for patients of all ages and ensure more hospital capacity this winter.
While we don’t yet have a vaccine to slow the spread of Covid-19, we will have one to slow the spread of influenza. But vaccinating as many children and adults as possible will be harder than ever to do. In recent flu seasons, the CDC estimated between 5.5-7% of children aged 5-17 were vaccinated at school and 15.5% of adults were vaccinated at work — locations that may not be able to offer similar numbers of vaccines this year because of increased remote learning and working.
Limited access will be superimposed on top of longstanding difficulties in vaccinating the population, such as fear of vaccines, deliberate misinformation campaigns and difficulty obtaining or affording a vaccine even among those who want one. Combined, these barriers result in less than half of Americans receiving the flu vaccine every year, despite it being recommended for everyone over six months old.
It will be easy to forget about influenza as the Covid-19 pandemic rages on this fall — but we mustn’t. Efforts should be made to increase availability of vaccines at pharmacies, which may be more convenient than going to the doctor; to lift restrictions that prevent vaccination of young children outside of a doctor’s office; and to ensure flu vaccination comes at no additional cost.
Doing so will help get both viruses under control and move us toward the “new normal” we all so desperately await.
This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.
Anupam B. Jena is an economist, physician and the Ruth L. Newhouse Associate Professor at Harvard Medical School.
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