Flu season a 'no-show' thanks to COVID-19 precautions

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Kevin McClintock, The Joplin Globe, Mo.
·5 min read
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Feb. 21—The 2020-21 flu season has been pretty much a no-show this year, according to doctors from Joplin's two regional hospitals.

This is remarkable, they say, considering that the 2019-20 season — which ran from Oct. 1, 2019, to April 4, 2020 — resulted in 38 million sick with influenza, 18 million medical visits, 405,000 hospitalizations and 22,000 deaths nationwide, according to the Centers for Disease Control and Prevention. During the 2017-18 flu season, 61,000 people died.

"Not only flu itself but all the other respiratory viruses have just remarkably decreased or have been almost absent," said Dr. Rob McNab, director of Freeman Health System's COVID-19 unit. "I wouldn't say there's been no flu, but at the very beginning of the flu season ... I maybe had two cases of the flu, and I haven't seen a case since then."

Dr. Nicole Sleiman, infectious disease doctor for Mercy Hospital Joplin, agreed that "remarkable" describes the current flu season.

"Every person, at least the patients who are getting admitted to the hospital with any fever or flulike illness, whether it's COVID-19 or not, they are getting checked for the flu, and we have seen a very low number of flu (cases)," she said.

How low can we go?

Just how historically low have this season's numbers been?

"We only had three flu admissions this year, the entire winter," including one patient suffering from both the flu and COVID-19, Sleiman said.

"I don't have any patients in the hospital for a viral respiratory infection or chronic obstructive pulmonary disease (at the moment)," McNab said, "with the exception of a few COVID patients."

During a normal year, a drop in flu and pneumonia cases would have made worldwide headlines, had it not been for the discovery of the novel coronavirus in late 2019, resulting in 28.3 million cases and more than 500,000 deaths in the U.S. alone.

Still, the CDC reports that flu levels in every state and territory have been "minimal" and "lower than usual" this flu season.

In Missouri, between Oct. 1 and Dec. 26, 2020, there were 681 people who tested positive for influenza and only a single confirmed influenza-related death, according to Missouri's Department of Health and Senior Services. This was the lowest total during that time period dating back six years. During the 2019-20 season, Missouri recorded 46 deaths directly related to the flu; the previous year, it was 78 flu deaths.

Overall, flu case numbers at the end of December in Missouri typically average just under 13,000.

During a normal flu season, McNab said, "we would be taking care of 15 to 20 patients a day; I would have two to four patients on any given day and four or five emphysema patients who have had a bad flare-up."

The reason there has been such a dramatic drop in flulike cases in Missouri, and why it's not circulating the way it normally does, has to do with pandemic precautions adopted by Americans over the past 11 months — most notably, wearing face masks or shields covering the mouth and nose.

"The only thing that's really changed (between this winter and previous winters) is all the things that we now do to deal with COVID-19 — the masking, social distancing and the washing of hands," McNab said. "I definitely think that you can strongly say these things are correlated."

"I think another part of it is that a lot of people usually don't get the flu vaccine, but they did get (one) this year," Sleiman said. "Comparing to previous years, that has really helped."

Is masking here to stay?

The fact that masking and other precautions, initially adopted to slow the spread of COVID-19, have worked well against the winter flu should neither be forgotten nor ignored, McNab said. During future flu seasons, it wouldn't be a bad idea for people to don masks when out in public, he said.

"I think the answer to (the masking question) is that we probably should," he said. "The flu is terrible. ... So if something as simple as (wearing a mask) can keep something like (the flu) at bay, then why wouldn't you want to do it?"

One of the early misconceptions about the coronavirus was that it would be a one-and-done experience. In other words, Americans would hunker down, the pandemic would wash over communities like a giant wave, and after a few months it would disappear and everything would return to normal.

That didn't happen. As McNab put it, "COVID-19 is here to stay."

The best way to combat COVID-19 is for people to get their current vaccinations now, as well as their annual shots in future years.

"I don't see any way around that. There's no way at this point to remove COVID-19 from the environment," McNab said. "And like the flu, (COVID-19) seems to mutate enough that last year's vaccine may not be as effective as we need it to be this year — which is the reason why we need to get a flu shot every year, because it's a different flu."

The body's immune system and its antibodies are built to physically interact with the shape of an invading virus and its spiked proteins, like a key fitting neatly into a lock. They have to fit together perfectly for them to be effective, McNab said, and if there are little changes to those proteins — caused by a mutation — then the antibodies may not be as effective as they normally would be.

Masking, hand washing and social distancing "help slow the rate of spreading the infection, and that's fantastic and a very reasonable thing to do," he said, "but the real thing that puts us back in the game with normalizing our daily lives is our immunity; the more immune we are to this, the less sick people are going to be, or maybe won't have any symptoms at all."