The CDC and NIH have been concerned for the last eight months about what is going to happen when the flu season arrives. This double whammy of COVID being deeply entrenched and spreading, plus the flu season at our doorstep, could synergistically produce a devastating environment to our well-being.
Evidence from the CDC has clearly shown that the flu vaccine can reduce severity of the flu and prevent hospitalizations. Preventing flu hospitalizations is especially important as it allows our hospitals to have more open ICU beds for coronavirus. That may theoretically lead to a decreased use of ventilators, PPEs, and patient workloads for our healthcare team. LJ Tan, PhD, the Immunization Action Coalition’s chief strategy officer, said, “To avoid what I call a twindemic, the U.S. needs not only safe, easy access but a strong unified message about the importance of getting the flu vaccine” (JAMA, September 8, 2020, Volume 324, Number 10).
The flu season runs from October to sometimes late May. Our hospital will start making the flu vaccine available to employees in October and we have begun administering the flu vaccine to our patients.
Based on the research and recommendations from the immunologists and virologists at the CDC, the trivalent vaccine for 2020-2021 has A(H1N1), A(H3N2), and B/Victoria, and the quadrivalent vaccine has A/Hawaii(H1N1), A/Hong Kong(H3N2), B/Washington, and B/Phuket. You can easily see the pattern of the flu strains chosen based on the coronavirus origins and transmission. The CDC recommendation is for almost everyone over the age of 6 months to get the flu vaccine.
The U.S. population has not been very accepting of the flu vaccine for a very long time. Skepticism and cost have been barriers for the American public in accepting the benefits of the vaccine. The cost of the vaccine has come down dramatically and there has been an increase in the availability of the vaccine throughout the country. According to the CDC, during the 2018-2019 flu season, 45% of US adults and 63% of children were vaccinated. The rate of vaccination for our highest-risk patients, people 65 and over, was 68%. Only 48% of young and middle-age adults with high-risk conditions including asthma, diabetes, heart disease, COPD, and most cancers had a flu shot last year.
Misinformation and anxiety have been increasing in social media. One of the biggest false social media claims is related to the Pentagon Study: Flu Shot Raises Risk of Coronavirus by 36% (and other supporting studies). This is a post from the Children’s Health Defense, which is an organization founded by Robert F. Kennedy. There is absolutely no study that has investigated any correlation between Covid-19 and the flu vaccine. This study investigated four seasonal coronaviruses that cause the common cold. SARS -CoV-2 is a distinct, very novel coronavirus species that is more deadly than our common cold virus. The theory that is promoted is called “viral interference,” and has been shown not to be true. Another misunderstanding is the thinking that if you wash your hands and wear a mask you will not be susceptible to the flu.
In June of this year, a very compelling, non-peered review study investigated 92,000 COVID-19 patients in Brazil. The study evaluated the outcomes of COVID patients who had or had not recently received the flu vaccine. The peak of Brazil’s flu season occurs in April and May. Most of the patients studied were in the 60-69 age group, with 37% requiring intensive care at some point of their admission and 23% requiring mechanical ventilation. About a third of this group had received a flu shot during the current flu season cycle.
The results of this study showed that in the non-immunized group versus the immunized group there was an increase in mortality of 14% in the under-10 age group and 84% in the greater-than-90-year-old group. Mortality was lower in all age groups in the immunized group. There was a 17% decrease in mortality in the 10-19 age group and a 3% decrease in the 90 years or more group. The 90-year-old group also had the most comorbidities which played a role in the smaller decrease in mortality.
This study shows that receiving the flu vaccine had a protective effect. It does not seem to be a viral co-infection antibody prevention. The most likely explanation may be a combination in the body’s innate immune response and an antigen challenge immunity. The body has immunological memory cells and stem cells that could be used to antagonize a viral load. The immune cells will defend the body against a variety of pathogens.
The U.S. Department of Health and Human Services has set a goal of vaccinating 70% of the population. The U.S. is far from this goal as measured by past flu seasons. As mentioned previously, the best we have done is getting 45% of the population vaccinated. If 60% of the U.S. can get vaccinated this year it would be 20 million more people than in 2018 (JAMA, September 8, 2020, Volume 324, Number 10).
The lack of an evidenced-based COVID-19 vaccine trial has put the U.S. and the world in a precarious predicament. The vaccine trials may not be ready for peer review until the end of the year. Only upon reaching an endpoint of positive viral immunity in at least 30,000 participants can production of a vaccine begin. The introduction of a vaccine to the public may not occur until the end of this year or early in 2021.
People are anxiously waiting for a vaccine, but some are skeptical to even consider getting a vaccine due to misinformation that pervades our social media. We are getting mixed messages and each of us needs to make up our own mind with the use of scientific data. We do have a flu vaccine that covers a variety of Influenza A/B variants. The flu vaccine is widely available and inexpensive. This vaccine may be the best choice we have while facing a season of two viruses. I urge you to get vaccinated for the flu season and possibly get a bonus of decreasing the risk of mortality from COVID-19.