Editor’s Note: Kent Sepkowitz is a physician and infection control expert at Memorial Sloan Kettering Cancer Center in New York. The views expressed in this commentary are his own. View more opinion on CNN.
Just before South African scientists identified the Omicron coronavirus variant, many experts were beginning to focus on a completely different potential problem: the collision of Covid-19 and influenza, which is now in the first weeks of its annual surge.
If the issue seems familiar, it is because it is: there was a big fear last year over the possibility of the same unholy alliance. It was so concerning it was even dubbed the “twindemic,” to denote the anticipated one-two punch of both viruses circulating at once.
Thankfully, last year’s influenza season was extremely mild, perhaps owing to social distancing, masks and other preventative measures.
This year, however, the new influenza season may be a “doozy,” as many people across the country have returned to in-person activities.
The double whammy of flu and Covid could be both individual and societal: first, a person infected with both viruses is likely to have a very rough time of it since each one attacks the lungs. They also both cause more severe illness in people with underlying medical conditions. Then there is the impact on public health as a high demand for care could potentially put a strain on emergency resources and hospital beds.
Since so much has been and will be written about Covid-19 and vaccination options and mandates, I want to draw attention to the dangers of the flu, which I think may cause more harm this winter than we are prepared for.
Influenza season began in earnest about four weeks ago: the rate of positive diagnostic tests in persons with symptoms has risen from less than 0.1% to about 1.5% now and rising. In the teeth of a bad flu season, the positive rate often exceeds 10%. An estimated 495 patients were hospitalized across the country the week ending November 27 for management of influenza.
There also has already been a well-publicized “large and sudden” influenza outbreak among students at the University of Michigan (most of whom did not get the flu shot), while the rest of the state was experiencing a substantial rise in Covid-19 cases.
Though the flu outbreak was modest in scale, the Michigan story is unsettling: over 500 flu cases had been diagnosed in about five weeks, including 313 in a single week. Given that many of the cases thus far have been seen in college-aged young adults, the potential culprits could include: dorm living, low flu vaccination rates among young adults and lack of social distancing.
But the occurrence of this influenza outbreak raises concerns beyond the same-old, same-old. The almost two-year grind of dealing with the Covid-19 pandemic has worn down almost everyone and frayed relationships between public health departments, infectious disease experts and the general population.
This chronic pandemic fatigue appears to be affecting influenza vaccine rates in the US. So far, influenza vaccination rates are down this year compared to previous years in many target populations. The US Centers for Disease Control and Prevention speculates that this may be due to vaccine fatigue related to the Covid-19 vaccination program or a possible assumption by some that the Covid-19 vaccine will also protect from influenza infection (it will not).
An additional factor, not listed by the CDC, is a distinctly political one. There is a widening gap between Democrats and Republicans when it comes to the influenza vaccine, echoing a similar split on Covid-19 vaccines.
This disparity means many Americans may be susceptible to both viruses. And the US population – and their lungs – are worse off now in the 2021-2022 season than before. Nearly 15% of the US population are known to have been infected by SARS-CoV-2. Many others were likely infected but never diagnosed.
For many of these people, Covid-19 infection resulted in significant lung damage. A study published in the Lancet in August reported the long-term health of 1,276 patients who had been hospitalized with Covid-19. Of this well-characterized group, 30% reported lingering shortness of breath a year after leaving the hospital.
It’s possible that Americans who were infected with Covid-19 sometime in the last two years and who get the flu this season could develop more severe disease. Taken cumulatively, this could lead to more hospitalizations and deaths, which could place a squeeze on medical professionals as well as available hospital beds and respirators and lead us back in the direction of the nightmare of the first months of Covid-19.
So here we are with the Omicron variant already in America, the Delta variant still surging and influenza season starting to intensify with dwindling enthusiasm for flu vaccines and a fractured political landscape.
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As a result, we will end 2021 facing the same unpredictable and treacherous mess that we faced at the end of 2020: gnawing concern over not one but two circulating viruses – this time, with an ever more fatigued and irritated population.
The viruses don’t care that we have had enough. And though the death of more than 788,000 people in the US from Covid-19 has done little to pull people together, perhaps the bumpy ride ahead will finally force more people to think rationally about the current crisis and respond not with selfish rants about mandates but rather with selfless communitarian resolve.
