(This is Part 16 of Dr. Pagtakhan's column, Medisina at Politika, on Covid-19.)
Autumn has come and the annual fall-winter influenza season – the flu – is on its way in Canada and USA. The arrival of the seasonal flu in the midst of the COVID-19 pandemic makes for a fearful duo.
Alluding to the recent surges of COVID-19 cases seen across many US states and the flu season that could “pile up on top of the pandemic,” Dr. Anthony Fauci, a leading infectious disease world expert at the US National Institute of Health, recently wondered: “Are we prepared for the challenges of the fall and the winter?”
Both the Public Health Agency of Canada and the US Centers for Disease Control and Prevention have expressed similar concern: the 2020-2021 fall-winter season may probably be one of the most difficult times in the North American public health experience.
These concerns are all about the dual threats – the co-occurrence of the two contagious respiratory illnesses in the same patient.
Canadian Headlines on Covid-19
These headlines during the preceding week capture the current COVID-19 situation in Canada:
- ‘As caseloads spike in four provinces, Trudeau warns that pandemic will be worse this fall’ ---CBC News, Sep 23;
- ‘B.C. reports 98 new COVID-19 cases, one new death’ -The Canadian Press, Sept 25;
- ‘65 new cases of COVID-19 confirmed in Manitoba, bringing active caseload to 545’– Winnipeg Free Press, Sept 26;
- ‘Ontario, Quebec stress risk of socializing amid surge in COVID-19 cases’- The Globe and Mail, Sept 27; and
- ‘Ontario's second wave of COVID-19 forecast to peak in October’- CBCNews, Sept. 28.
Human Toll for the Two Diseases
Human Toll from Covid-19: Going into the 10th month since its onset in late December 2019 in China or the 8th month since the virus and the disease was officially named, COVID-19 has sickened over 33 million people and claimed the lives of nearly a million worldwide, not to mention the severe disruption to social, financial and economic health.
The following COVID data are pulled from the John Hopkins University coronavirus dashboard (Monday, September 28):
Reflected in these numbers are the more than half-a-million patients added anew to the over 7-million total caseload and 200-thousand deaths in the USA an average of 42,000 cases daily during the preceding two weeks. The added cases in Canada during the same period are over 17,000 an average of over 1,000 cases daily to a total caseload of over 150 thousand. Thus, the human toll in North America remains huge.
Human Toll from Influenza: Worldwide, seasonal flu is estimated to cause 1 billion cases, a quarter-to-half-a-million deaths, and 3 to 5 million patients with severe illness. In Canada, it is estimated to result in 12,500 hospitalizations and 3,500 deaths.
Comparison between the Two Diseases
The differences and similarities, some of which are superficial, between the two diseases are shown in tabulated format to better understand and appreciate the gravity of each ailment should anyone have the misfortune of contracting either or both.
Dangers of FLU-COVID-19 Dual Infections
Reportedly, 2% - 20% of COVID-19 cases had been associated with another respiratory virus infection. Although no one knows for certain, co-occurrence of COVID-19 and the flu in the same patient at the same time could, intuitively, pose the following clinical dangers: additional challenge to differential clinical diagnosis; catastrophic injury to one’s immune system; vulnerability to develop more severe infection with either or both diseases; greater potential for respiratory failure and other multi-organ complications; and increased risk of longer-term effects of any of those organ systems; and greater predisposition to secondary bacterial infection. Also, a greater burden on the health care system can be anticipated. A duo could precipitate a health care crisis unlike any other.
On the brighter side of medical life, the positive behavioral changes to flatten the COVID-19 pandemic curve – the preventive personal and community public health measures already learned and adopted as a habit of daily living – could conceivably lessen the impact of the seasonal flu. These would be the same personal and community public health measures we would need to guard against the dual threats. And yes, get a flu vaccination.
Flu Vaccination: Effectiveness, Safety and Benefits
The flu vaccine is effective and safe. The protection provided by a flu vaccine varies from season to season, depends in part on the age and health status of the person getting the vaccine, and the similarity or “good match” between the viruses used in the production of the vaccine and those circulating in the community. It is not perfect, but it offers the best prevention that we have. The influenza that one may get even after vaccination would likely be less severe and recovery would be faster.
The viruses in the flu shot vaccine had been killed (“inactivated”); hence, the flu shot cannot cause a flu illness. The viruses in the nasal spray have been “weakened”; hence, only transient minor reactions may occur and are much less than one gets from the actual flu illness.
Let me summarize the other known benefits from flu vaccination: reduces the risk of flu-associated hospitalization for children, working age adults, and older adults; provides an important preventive tool for people with chronic health conditions; helps protect women during and after pregnancy; can be lifesaving in children; and may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.
My wife and I get it every season for two reasons: our immune protection from the previous year’s vaccination would have declined by now; and to get the best opportunity of a ‘good match’ between the viruses used in the production of the current vaccine and those circulating in the community. We know that by getting vaccinated and being protected against the flu, we also help others with whom we interact, indirectly.
Development of antibodies following vaccination takes about two weeks. To ensure protection, we should get it early. Since the risk of getting the flu in Canada is higher in the late fall and winter (fall starts on September 22nd and winter on December 21st), we plan to get our “flu shot” before the end of October, well before the start of the flu season. Children who need two doses of vaccine should start the vaccination process sooner, because the two doses must be given at least four weeks apart.
The good news: well over 55% of Canadians are now planning to have their flu vaccination – ‘flu shot or by nasal spray – in contrast to a lower percentage in prior years. Indeed. I encourage everyone – as recommended by public health authorities and medical experts – to get the flu vaccine. It is imperative. It is our best protection against the fearful duo.