From One Pandemic to the Next: What COVID Taught Us About Flu
Author: Ryan Hassan, M.D., Boost Oregon's medical director and pediatrician working at Oregon Pediatrics in Happy Valley.
Another beautiful Oregon fall is here. That means rejuvenating rains, bright autumn colors, and millions of birds heading south along the Pacific Flyway. It also means that flu season is upon us again.
Many of us see the flu as a small nuisance that probably won’t affect us, and, if it does, we assume it will cause a minor illness from which we’ll quickly recover. Indeed, many of my patients often use the word “flu” to describe any minor cold or stomach bug, not realizing that influenza is, in fact, a completely different virus that is much more dangerous than a common cold. This is probably why each year only about half of Americans choose to get the flu vaccine to protect themselves and their loved ones.
For healthcare providers like me, though, influenza season is a very challenging time of year. Our clinic schedules and hospital beds fill up with coughing patients. I see dozens of children with mild cases of flu who will lay in bed feeling tired and achy for about a week before getting back to their normal lives. I also see children who have more serious cases and have so much difficulty breathing that I have to send them to the hospital. Almost all of these children are unvaccinated.
If I’m lucky, I won’t see any of my patients or their parents die because of this preventable disease. I’m not always lucky. Every year, the flu pandemic sickens about 30 million Americans. Of those, up to half a million people will need to be hospitalized, and 25,000 to 50,000 people, including about 150 children, will die from influenza. Nearly all of those hospitalizations and deaths occur among people who did not receive a flu vaccine. This public health tragedy is also an issue of racial justice: Children of color are up to four times more likely than white children to be hospitalized or die from flu (7).
The Centers for Disease Control and Prevention (CDC) generates maps of flu cases each week for every flu season. In a typical flu season, like the 2019-2020 flu season, the peak of cases will occur in late December or early January, and the map of cases will look something like this:
This annual, predictable, preventable tragedy of needless deaths weighs heavily on the hearts and minds of medical and public health professionals who strive to minimize the lives lost to flu each year by educating the public and getting people vaccinated.
However, in 2020, the COVID-19 pandemic swept across the US and the rest of the world, quickly leading to millions of sick people overwhelming hospitals across the nation. This new pandemic had a profound impact on the 2020-2021 flu season:
For the first time since CDC began collecting data on flu, cases were too low for the CDC to even estimate the disease burden (2). Instead of the usual 30 million cases of flu in a season, the CDC recorded fewer than 1 million cases. Instead of 100 to 200 children dying of flu, there was only a single pediatric death from flu (still too many).
Why was the flu pandemic so mild in the 2020-2021 season? Because we took an enormous number of precautions to prevent the spread of the COVID pandemic. Millions of Americans wore face masks, stayed home, washed their hands frequently, traveled less, and physically distanced themselves from one another. In addition, a record 193.8 million doses of influenza vaccine were distributed in the U.S. during the 2020-2021 season because people recognized the importance of preventing serious disease during the pandemic (3).
By working together to protect ourselves and our communities from COVID, we also prevented tens of thousands of deaths from influenza. The numbers from the 2020-2021 flu season prove that we do not have to accept the status quo. We have the power to prevent influenza from sickening and killing our loved ones every year.
The numbers from last year’s flu season, though, were not as encouraging. As we approached two years of the COVID-19 pandemic, perhaps we grew accustomed to it, similar to the way we had been accustomed to flu season. As the novelty of the disease faded, so did our fear of it. Millions of Americans chose to abandon evidence-based measures to keep people healthy like masking, socially distancing, and vaccinating. Additionally, the number of Americans who chose to get the flu vaccine dropped to pre-pandemic levels (4). The result was that both COVID-19 and flu caused many more serious illnesses and deaths than necessary:
This winter, with COVID precautions having all but evaporated in most of the country, experts anticipate our flu season will be significantly worse than last year. CDC estimates there have already been as many as two thousand deaths from flu since October (6).
It is likely that thousands more unvaccinated people in the U.S. will die from flu infection this year. This doesn’t have to be our reality. The flu vaccine prevents serious disease and death. I got the flu vaccine for myself and my baby because I know that we are safer with it than without it. I believe that my friends, family, neighbors, patients, and community are worth protecting.
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