Possible Good News About Influenza 2020-2021
First published Sept. 1, 2020
Anyone interested in some good news? It is only a forecast, but if it pans out, we could be in for a mild influenza (flu) season. This prediction should not decrease the plan for residents and staff of Fountainview Gonda to get the flu vaccine. For seniors, the vaccine is made at four times the dose of the standard vaccine to try to overcome our lowered immune response. We know that this adjustment does produce a better antibody response in those over 65 years and one hopes that it translates into better protection or a milder illness, should one get the flu. Vaccine manufacturer receive from regulatory agencies the flu strains that hit the Southern Hemisphere in their fall and winter (our spring and summer). A decision about the most important strains of virus to use for the vaccines is made by February. This selection process of virus strains is elaborate and complex. In their judgment, those are the strains heading our way later in our fall and winter. Vaccine manufacturers use those flu viruses to design and prepare the vaccines for us so as to be available by late summer. Making an effective vaccine for flu is a challenge because the virus mutates every year and sometimes several times within a year. This year manufacturers are preparing to make tens of millions more doses than usual to meet an anticipated increase over the low fraction of the population that usually gets the vaccine. This anticipated increased demand is a result of people’s fear of flu and covid-19 * occurring simultaneously. But, let’s get back to the central message in this report. This flu season, the frequency of flu in the southern hemisphere has decreased, dramatically. (see Table ).
Table. No. of Cases of Flu in 4 Southern Hemisphere Countries from April to mid- August by Year of Study
Country 2018 2019 2020
Argentina 1517 4623 53
Chile 2439 5007 12
Australia 925 9933 33
South Africa 711 1094 6
Data from Science Magazine, August 14, 2020.
This reduction in case frequency is the most dramatic found in 36 years of surveillance by the South African National Institute for Communicable Diseases. Several reasons for this profound decrease in incidence have been proposed. Most important may be the policies instituted to avoid SARS-CoV-2 * : closed schools, decreased travel, social distancing, wearing masks, frequent hand washing, and sheltering in place. If we continue those practices, which we will need to do, we can decrease both flu and SARS-Cov-2 infections and subsequent hospitalizations and deaths. The concern that flu or other respiratory viruses and covid-19 will coexist and, perhaps, co-infect individuals is real. Co-infection of respiratory viruses is well documented and, generally, causes more severe disease. That is why, regardless of the possibility of a less severe flu season, the vaccine is critically important for young and old. Indeed, it is an obligation of citizenship and shared values that younger adults get vaccinated for flu. The willingness to get the flu vaccine, and the covid-19 vaccine, when available, if it cannot be made mandatory (unclear but being examined), should be a high priority factor in hiring decisions by the JHA. Approximately, 45 percent of adults (< 18 years) in the U.S. and 60% of children (>18 years) get the flu vaccine. A small increase of, for example, 10% of the percentage of vaccinated would make a significant difference in infection rate, hospitalization and death. In addition, therapy for flu and covid-19 is very different, so a specific diagnosis is very important. The Center for Disease Control and Prevention has given emergency use status to a test that can identify either or both infections in one sample. One hopes that differential diagnostic ability will be available locally. With the exception of loss of sense of smell and, perhaps, more dramatic shortness of breath with covid- 19, the most common early symptoms are similar with flu or covid-19. Specific testing will be crucial. Unlike covid-19, the flu is most infectious after symptoms appear. Let us hope this forecast for less flu is accurate. A decrease in the frequency of influenza in the late fall, winter and spring of 2020-2021 will decrease the rate of hospitalization and loss of life for all our citizens, but especially seniors. But do get vaccinated. A mild flu season is a hope not a reality, yet, and if one does not get vaccinated and the forecast is wrong or less dramatic, we will all be at risk.
*SARS-CoV-2 is the viral cause of the disease covid-19
Written September 2020