By: CHHS Extern Erika Steele
Image Source: Jovanmandic/iStockPhoto.com
The flu this year has shown a very rapid increase in the number of people hospitalized with laboratory-confirmed cases. More alarming, is the fact influenza activity has not peaked, and all states, except for Hawaii and Oregon continue to report widespread activity. Increased contagion is overwhelming hospitals, impacting schools, and workplaces, and it is having an effect on the nation’s economy. The CDC predicts that 18 million employed adults will miss four workdays due to the flu—an estimated economic cost of at least $15.4 billion in lost productivity due to the flu season.
Every year, influenza carries away perfectly healthy young adults and children, and tens of thousands of people over age 65. Our last severe flu season was in 2014-2015, 148 children died. The CDC does not report precise numbers for overall flu deaths, but estimates that from 2010 through 2016“influenza has resulted in between 9.2 million and 60.8 million illnesses, between 140,00 and 710,000 hospitalizations and between 12,000 and 56,0000 deaths annually since 2010. The overall hospitalization and rate of mortality during this season is higher than the overall rates reported in recent years. CDC reported 53 flu-related pediatric deaths for this season. In California, one of the hardest hit states, at least 97 people under age 65 have died as of early January.
It’s a Bad Season, But Not a Flu Pandemic
Despite the fact that the flu is widespread, across 49 US states, and reached epidemic levels, it is not a pandemic. What counts as an “epidemic” changes little from season to season; an epidemic occurs when a contagious disease spreads rapidly, often suddenly, and widely among the population in an area. Immunization and quarantine are the two methods used to control an epidemic. In contrast, a pandemic is the worldwide spread of a new disease. Flu “pandemic” occurs when a new influenza virus emerges around the world, and most people do not have immunity. Image Source: CDC FluView Interactive Map
Long before the 2009 swine flu pandemic (caused by a novel H1N1 influenza virus), there was the deadly 1918 Spanish flu, which spread around the world, infecting about one in five people and killing as many as 50 million.
What makes this flu season so unique is that it is hitting everyone at the same time, we often see a slower progression throughout different parts of the country, unlike this year, where the entire country has been experiencing lots of flu at the same time. But according Michael Osterholm, director of the Center for Infections Disease Research and Policy at the University of Minnesota, “[t]his is what we should expect from seasonal flu.”
Immunologists say that there are three main reasons that increase the risk of death from the flu: co-infection with another germ, aggravating of existing conditions such as heart disease or asthma; and a so called cytokine storm, marked by an overwhelming immune system response to infection (overproduction of immune cells turns the body’s immune system against itself). The CDC and experts continue to recommend influenza vaccination for all persons 6 months of age and older, health-care providers and the public, particularly people who are at high risk of serious flu complications must receive prompt treatment with antiviral medications an the best means to protect oneself from this contagious respiratory illness.
A Vaccine is Our Most Promising Antidote—Our Social Contract Requires Affirmative Action
The flu is adaptable and unpredictable. It is impossible for healthcare providers to predict when a person infected with the flu will take a turn for the worse. There is a gap in their knowledge and an opportunity to use our best technology to find biomarkers in a patient’s blood to help researchers find some genetic or immune characteristics to aid in the discovery of new treatments to the flu.
Even when a vaccine is not completely effective, as the flu vaccine is this year, because the circulating virus strains includes both B strains (Yamagata and Victoria), H1N1 and H3N2, and the vaccine is not working well to combat the predominant flu strain, H3N2. Indeed, according to Researchers in Canada, the vaccine proved only 10% effective against the virus, though it provides protection against other circulating strains, thus, making this year challenging because H3N2 strains have been known to cause more complications, hospitalizations, and deaths.
Given that we are seeing so much flu activity across the nation, people who have not been vaccinated should still get the vaccine. It is not too late to get inoculated. Even if the current vaccine is not as effective against the H3N2 strain, it is effective at preventing other strains of the virus, particularly when it is not unusual to have a second flu wave come through. On a related note, dogs are not immune to the flu; while canine flu cannot spread to humans, it can leap from dog to dog easily. Some veterinarians recommend vaccinating dogs against the flu.
In addition to encouraging people to get the flu vaccine, persons engaged in customer-facing professions, working in the food industry, and all children in public schools should be required to be vaccinated against the flu. Undeniably, prescribed vaccination has always raised Constitutional challenges; as seen in Phillips v. City of New York, 775 F.3d 538 (2015) and during the early 1900’s in Jacobson v. Commonwealth of Massachusetts, 197 U.S. 11 (1905), where the judiciary considered similar vaccination requirement questions. Whatever your individual stance on vaccination, the question becomes whether reasonable members of society should expect similarly situated citizens to inoculate themselves against preventable contagious diseases on the basis that our social contract demands that we not unreasonably expose others to preventable diseases.
Raise Your Voice: A Government Shutdown Could Impact DHHS’s Ability to Track the Flu
When the government shutdown in 2013, the CDC has to shut down its flu program, meaning it could no longer track where the disease was spreading, coordinate with local public health officials, test samples coming in, or monitor infections at airports around the world. With the impending government decision whether to fund or shutdown the government in the coming weeks, it is imperative that government officials take proactive steps to ensure that employees under the DHHS and FDA are not furloughed. Failure to ensure these employees are considered “essential” could slow down drugs approvals, affect food inspections, and preclude the tracking and study of new trials because patients hoping to enroll in clinical trials won’t be able to.
No matter what political affiliation, each citizen has a duty to become civically engaged in ensuring that those elected to public office are working to serve and protect the nation’s citizens. Thus, each of us should contact our elected representatives to ensure that in the event of a government shutdown, those tasked with keeping us protected from contagious diseases, including the flu, are classified as essential employees and not furloughed. Alternatively, I posit the radical idea that, akin to some states, our federal government should be constitutionally required to pass a budget each year. But, that may be wishful thinking on my part, or perhaps I have contracted the flu and suffering fever delusions.