Flu season arrives early in Northeast Ohio; as COVID lingers, experts urge vaccination

Flu season is back a few weeks earlier than in previous years, following a surge in Southwest Ohio, where the region has thus far accounted for the majority of cases in the state.

The prevalence of the flu is increasing in Northeast Ohio, as is respiratory syncytial virus, known as RSV, which is of concern for young children and older adults.

The latest Influenza Surveillance Report from Summit County Public Health shows positive tests for the flu more than doubled among those seeking treatment at health facilities in the county − from 46 the week beginning Oct. 23 to 99 positive results last week. Ten people had been hospitalized at that time.

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The number of hospitalizations has grown to 12 and positive flu cases were at 145 as of Nov. 15, said Summit County Health Commissioner Donna Skoda. Last year at this time, there was only one confirmed case of the flu in Summit County.

While Ohio's flu season typically runs from October through March, this year's increase in cases is about a month earlier than in normal years. Hospitalizations don't normally increase until around mid-December.

Weekly patient counts in most years rise to just under 100 by mid-January, although the 2017-18 flu season was that severe in November and eventually saw a peak of 200 hospitalizations by Christmas.

"December, January, February is when we usually get hit hard," Skoda said. "So we're expecting that it will continue to increase and we're expecting that it could be a rough year."

Dr. Carl Fichtenbaum, an infectious disease expert at UC Health and University of Cincinnati College of Medicine professor, said the following factors could be contributing to the early flu season jump:

• Low vaccination turnout so far this year, given how early the flu season has arrived.

• A decline in vaccinations due to hesitancy following COVID-19.

• Reduced immunity to the flu as social distancing measures were put in place during the pandemic.

The Cleveland Clinic and Summa Health also report an uptick in hospitalizations and positivity in flu testing.

Hospital systems recommend getting a flu shot

At the Cleveland Clinic's 13 Northeast Ohio hospitals, latest statistics put the Influenza A positivity rate at 23% in school-age children, and 11% among all those tested.

Summa cited a Centers for Disease Control and Prevention report, noting the current influenza hospitalization rate has not been so high so early in the season since the 2010-11 season.

"We strongly recommend everyone get the flu vaccine," said Cleveland Clinic system spokeswoman Rebekah Boyd. "Getting vaccinated each year is the best way to prevent the spread of influenza."

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Infectious disease experts recommend everyone 6 months and older get vaccinated for the flu every year.

Those most at risk of serious illness due to the flu include adults older than 65 and those with chronic conditions, such as heart disease, diabetes and asthma, among others.

For information on where to find flu or COVID-19 vaccine providers, see www.vaccines.gov.

COVID remains a concern in Summit County

While flu hospitalizations are starting to climb early, several dozen people in the county with COVID-19 are currently hospitalized, according to the county's latest COVID-19 weekly report. The report shows a slightly increasing rate of weekly hospitalizations, at about 9.6 per 100,000 people. That translates to around 52 patients when figuring in the county's 550,000 residents, Skoda said.

Flu generally comes on suddenly, rather than gradually as is the case with the cold. Fever and headache are rare with colds, but common with the flu.

The flu shares many symptoms with COVID-19:

• Fever or feeling feverish/having chills (though not everyone with flu will have a fever)

• Cough

• Shortness of breath or difficulty breathing

• Fatigue (tiredness)

• Sore throat

• Runny or stuffy nose

• Muscle pain or body aches

• Headache

• Vomiting

• Diarrhea (more frequent in children with flu, but can occur in any age with COVID-19)

• Change in or loss of taste or smell, although this is more frequent with COVID-19.

Generally, RSV, the common cold, flu and COVID-19 all are part of a family of viruses that cannot definitively be identified without testing.

Skoda noted that hospitalizations for flu were practically non-existent over the past two years, with COVID-19 restrictions reducing rates of flu infection. At the same time, patients with more contagious COVID-19 were filling hospital beds.

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Though influenza patients don't normally take up more than 100 beds in the county, COVID-19 cases were quadruple that figure early this year.

On Jan. 4, a record was set with 395 patients with COVID-19 hospitalized across Summit County's four hospital systems — Summa Health, Cleveland Clinic Akron General, Western Reserve Hospital in Cuyahoga Falls and Akron Children's Hospital.

The previous high mark had been the previous winter, when 318 people were hospitalized on Dec. 15, 2020.

Skoda said she hopes this winter won't see another peak.

"It's better than it was, but I gotta tell you, we're still not out of the woods," Skoda said. "I'm really worried that people will start to think that it's just like a cold and it's not deadly anymore. But you know, you can still get pretty sick if you're in one of the vulnerable groups."

She said COVID mortality has declined, largely due to increased vaccination rates, which can lessen the severity of symptoms, along with anti-viral drugs and improved therapeutic treatment. About 73% of Summit County adults have been fully vaccinated, according to health department records.

As of Nov. 5, Summit County had about 135,000 reported cases of COVID-19, with roughly 8,900 hospitalizations and 2,002 deaths since March 2020. According to the Ohio Department of Health, 97% of those who died were adults over 50.

In the 2018-19 flu season, prior to the pandemic, there were 711 hospitalizations in the county and a total of 206 deaths due to flu and pneumonia, a frequent complication of influenza.

Early appearance of RSV among older children; older adults vulnerable

In addition to an uptick in flu cases, RSV is also starting its season early and with cases that seem to be more severe, said Dr. Michael Forbes, chief academic officer at Akron Children’s Hospital. There is no vaccine for RSV, which is a virus most children have been exposed to by the time they're 2. Symptoms vary from mild cold-like symptoms to bronchiolitis (an inflammation of the small airways in the lungs) or pneumonia.

For the week ending Oct. 15, 40% of patients at Akron Children’s Hospital locations with symptoms tested positive for RSV and 35% were rhinovirus (the common cold).

“We usually don’t see it before Thanksgiving and it is January or February when we start to see it peak. It is usually gone by April,” said Forbes.

This year, Skoda said, children ages 4 to 8 are getting sick with RSV.

"They're older kids, and that's not usually the group of kids to get hospitalized," she said. "The theory is that one of the reasons you're seeing a lot more of this is because these youngsters have not been exposed for two or three years. They haven't had it from other kids."

Older adults also are susceptible. According to the CDC, there are an estimated 60,000 to 120,000 hospitalizations and from 6,000 to 10,000 deaths each year among adults 65 years and older.

That's a figure that approaches the threat older adults face from influenza. The CDC estimates 21,000 adults age 65 and older died of the flu in the United States during the 2018-19 season.

Eric Marotta can be reached at emarotta@gannett.com. Follow him on Twitter @MarottaEric.

This article originally appeared on Akron Beacon Journal: Flu arrives early in Northeast Ohio; COVID-19 lingers; RSV increasing