CalMatters: Twindemic

Hospital employees leave Alta Bates Hospital in Berkeley on August 24, 2020. 

In the border county of Imperial, health officials are sharing a promising progress report: After being branded a hot spot, coronavirus hospitalizations are down. Sick patients are no longer being transferred out of county. Businesses are reopening. 

“It’s absolutely fantastic,” said Adolphe Edward, the CEO of El Centro Regional Medical Center, one of the two hospitals in Imperial County. 

But as fall approaches, Edward fears this taste of relief will be brief. For months, health experts have warned about a possible spike in coronavirus cases and hospitalizations for the fall and winter months, when colder weather will drive people indoors and holidays will likely bring friends and extended families together. That, on top of the impending flu season, could create what Gov. Gavin Newsom and others have referred to as a “twindemic.”

Doctors and public health officials across the state are echoing the message. A combination of COVID-19 and influenza could put serious pressure on a health care system that is only starting to stabilize after a summer of peaks in hospitalizations and admissions to intensive care units.

“Things can get very bad,” said Dr. George Rutherford, an epidemiologist at the University of California, San Francisco. “The concern is if there is a bad flu season, emergency rooms will get full and saturate capacity much more quickly.”

There is a glimmer of hope, though. Hospital and state officials say they are better prepared for a possible second wave of COVID, and can draw from the lessons learned during these past six months. Hospitals have refined their surge plans, and the state has come out with a plan to significantly increase testing capacity starting in November. Supply-chain constraints for coveted protective gear have also relaxed some.

Still, the toll of COVID plus the flu will depend largely on people’s behavior, Edward said. 

“We can all dream and hope, but nobody knows for sure what we’re going to see,” he said.

Here is a glimpse of what lies ahead:

 

Flu shots, flu shots, flu shots

A reminder: While there is no vaccine ready yet to fight off coronavirus, the flu is preventable. And people can get both at the same time. 

In a best case scenario, Californians largely heed public health recommendations, get their flu shots, and contribute to a mild flu season. Rutherford pointed to countries in the Southern Hemisphere, like Australia, where flu season usually peaks in August. In late August, Australian health officials reported that flu activity there was “lower than average” for that time of year. 

This could be because this year’s vaccine was a good match to flu strains, or perhaps people are still taking protective measures against COVID-19, such as wearing masks and socially distancing, Rutherford said. Precautions can protect against both illnesses.

In a worst case scenario, high flu activity in California coincides with another coronavirus surge. 

On Wednesday, Riverside County health officials reported that a man in his 80s who died last week is the county’s first flu death of the season.

In the 2017-18 flu season, considered “severe” by the Centers for Disease Control and Prevention, the agency recorded 810,000 influenza-related hospitalizations nationwide. Dr. Mark Ghaly, the state’s health and human services secretary, said about 100,000 Californians were hospitalized that year and 7,500 died from the flu.

“The flu is not to be taken lightly,” Ghaly said. 

Still, less than half of adults in the U.S. receive flu shots each year, according to the CDC.

Besides delivering more aggressive messaging on the importance of flu vaccines, Ghaly said in a recent press call that the state is working with health systems to increase the number of sites available for flu vaccinations. It is also working to ensure there will be enough supply, he said. 

Vaccine makers say they are confident they’ll meet the demand. Pharmaceutical giant Sanofi, one of the largest manufacturers of influenza vaccines, for example, will be distributing 80 million doses in the U.S. this year. That’s a 15 percent increase from last flu season and the largest volume ever, said Chris Whitman, head of influenza franchise at Sanofi in North America. Overall, the CDC estimates vaccine makers will supply between 194 million and 198 million doses.

Also, getting a flu shot this year may look a little different. 

Rather than waiting lines some providers are offering drive-up and walk-up appointments. And patients who are already visiting their doctor for any other reason, will be encouraged to get their shot right then and there, said Dr. Vivian Reyes, Kaiser’s regional medical director of hospital operations in Northern California. 

Reyes recommends that people get the influenza vaccine as soon as possible. “We never know when exactly flu season will hit,” Reyes said. “Starting early will allow us to vaccinate more people.” 

The CDC recommends that people be vaccinated for influenza by the end of October.

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