Health Matters: Flu Shots Critical to Attenuate ‘Twindemic’

Health Matters is a biweekly opinion column. The views expressed are solely the author’s.

Despite our best efforts, SARS-CoV-2 has endured long enough to welcome influenza’s 2020-2021 campaign and there is rising concern that even a mild flu season could overload hospital systems already dealing with COVID-19.

This so-called “twindemic,” while sounding alarmist yet with rational undertones, can be attenuated by the simple preventive measure of vaccination.

To put this in perspective, influenza is historically one of the top 10 leading causes of death in the United States annually. The 2019-2020 flu season was mild, yet resulted in 740,000 hospitalizations and up to 62,000 deaths nationwide, 4,500 of which were in Virginia. The most recent severe flu season was 2017-18 with 810,000 hospitalizations, and the CDC estimates that vaccination prevented 7.1 million illnesses, 3.7 million medical visits, 109,000 hospitalizations, and 8,000 deaths. Even though influenza has become normalized and even trivialized to the public, the ramifications of the virus on our healthcare system are significant and we are fortunate to have vaccines that work.

Most individuals who get the flu recover without serious complications. However, pregnant women, elderly, very young and anybody with certain chronic medical conditions are more susceptible to hospitalization and death if infected. While there are no reported cases of simultaneous influenza and COVID infection, it is reasonable to infer that the consequences would be dire.

Vaccination is proven to reduce prevalence of influenza and mitigate symptoms, leading to less outpatient visits, hospitalizations and intensive care admissions. By comparison, COVID has no vaccine and has claimed more than 183,000 lives nationwide and in Arlington has resulted in 460 hospitalizations and 140 deaths in just a few months. COVID rates have trended downward in Arlington, but anything that could spike COVID or flu cases such as not-so-socially-distant maskless gatherings, rallies, protests and crowded bars could unfavorably tip the scales and overwhelm the healthcare system.

So in addition to hand washing, facemasks and social distancing, we should add getting the flu vaccine to the list of things we can do to help during the pandemic.  Seems simple enough, but proactive flu fighting presents a few big challenges.

Only 47% of Americans got the flu vaccine last year. CDC Director Robert Redfield stated in a recent WebMD interview that his goal for the upcoming flu season is 65%, and he plans to accomplish that by expediting vaccine availability (they have been available since mid August), increasing vaccine production to nearly 200 million (up from 85 million last year), and having the CDC purchase 10 million doses (up from 500,000) to give to uninsured adults.

The Virginia Department of Health’s Unified Command has established a Vaccine Unit to coordinate preparedness efforts in collaboration with CDC, which includes earlier availability of the flu vaccine, expanded flu shot tents with heaters in parking lots and pop-up clinics in empty school buildings, increased numbers of doses and increased marketing via social media, billboards, television and radio to encouraging flu vaccination. The private sector is also stepping up, with pharmacies like Walgreens and CVS supplying more vaccines earlier, hosting off-site vaccine clinics and offering merchandise coupons after vaccination (not part of the mile-long receipt).

Strengthening the vaccination distribution infrastructure and raising awareness may be the easy part–persuading people to get the flu vaccine may be the more difficult challenge. First, there is the ongoing anti-vaccination movement consisting mostly of millennials, whose followers believe vaccines cause more harm than good, linking it to autism and other global conspiracy theories that have largely been debunked.

Second, vaccine skepticism runs rampant in communities of color.  Studies have shown a general mistrust of public health and particularly vaccines amongst African Americans. This is in part due to a long shameful history of unethical medical experimentation, such as the stories of Henrietta Lacks and the Tuskegee project.

Lastly, and perhaps most commonly, people don’t get the flu vaccine because they just don’t think it works.  Admittedly, the flu vaccine is not perfect–it must be administered annually to account for strain variants, its protection lasts a few months unlike other vaccines and it is less efficacious in the highest risk of elderly group. In spite of these limitations, the vaccines have a proven track record of helping.

Maybe a stroke of marketing genius can persuade the non-vaccinators to vaccinate, but there is at least one recent anecdote that may help change minds. Australia recently completed their flu season and flu cases dropped by 99 percent. This is likely due to high vaccination compliance, early and increased dose availability, strict foreign entry restrictions and vigilant social distancing. If Americans can rise to the occasion and get vaccinated, we can reduce the impact of a twindemic, and in the process it will be a useful trial run for the anxiously-awaited COVID-19 vaccine.

Dr. George C. Hwang, known to his patients as Dr. Chaucer, is a practicing anesthesiologist who also helps to run Mind Peace Clinics in Arlington. He has written for multiple journals, textbooks and medical news outlets, and has been living in Arlington for the past 15 years.