Mayors around the country soon will have another concern to add to the list of those connected to COVID-19: the arrival of the seasonal flu this fall and the chance that some parts of the country will experience a “double-whammy” of flu and COVID outbreaks hitting at the same time, clogging hospitals and stretching already taxed public-health systems further beyond their limits.
But unlike the cavalcade of crises that have hit one after the next these past few months, this is one city leaders can prepare for. And now is the time that experts say they should sharpen plans to make sure as many residents as possible over the age of 6 months get a flu vaccine this year.
“If you haven’t started thinking about this, you’ve got to think about it now,” said Harvard University’s Dr. Howard Koh. “If mayors can show they can do this well this fall, and it can be smoothly coordinated, that’s going to be a huge win. But if it’s another example of uncoordinated public health efforts, that’s going to be yet another difficult chapter of this whole year.”
It’s hard to say just how bad this year’s flu season will be. While seasonal influenza is not nearly as deadly as COVID-19, it’s consistently a leading cause of death in the U.S. According to the federal Centers for Disease Control and Prevention, the 2018–19 flu season, which was classified as “moderate” in severity, sent nearly 500,000 people to the hospital and killed more than 34,000.
Even in normal times, getting people vaccinated for influenza is a challenge. Only 45 percent of adults were vaccinated in 2018–19 — and rates are lower for people of color. This year, these challenges are likely to be compounded by the pandemic. With many workplaces shut down, employer-sponsored vaccine clinics are likely to be less effective than in years past. Meanwhile, pediatricians are concerned about sharp declines in children coming in for preventive vaccinations this year.
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Last month, Dr. Robert R. Redfield, the CDC director, expressed deep concerns. “The fall and the winter of 2020 and 2021,” he said, “are going to be probably one of the most difficult times we’ve experienced in American public health because of…the co-occurrence of COVID and influenza.”
However, recent news from the southern hemisphere, which experiences the flu season before we do, offers some reason for cautious optimism. As The Wall Street Journal reported, Argentina, South Africa, New Zealand, and other countries are seeing much lower numbers of seasonal flu infections than usual this year — likely because steps people are taking to avoid COVID-19, such as physical distancing, hand washing, wearing face masks and avoiding travel, are also preventing influenza.
There’s no guarantee the U.S. will follow that pattern, though. For now, city leaders should hope for the best and plan for the worst. “We don’t know how big of a problem the flu season will be,” said Dr. Joshua Sharfstein of the Johns Hopkins Bloomberg School of Public Health. “The places that are following distancing and mask wearing will probably have less of a problem than the places that aren’t.”
Sharfstein said mayors should be more involved in promoting vaccination during flu season this year than they have in the past. That won’t just help put a lid on the flu, but also begin working out the kinks in the systems for delivering a COVID-19 vaccine when there is one. “This is essentially a way to practice around a COVID vaccine,” Sharfstein said. “The kinds of activities that are going to happen with flu are going to be similar to COVID. And the more successful the flu vaccine effort is this year, the better off everyone will be.”
Here are some of the ways mayors and city leaders can make an impact.
Step up outreach. In a moment where there’s lots of misinformation swirling around vaccines, mayors and their staff need to be actively communicating with residents. The message: If ever there’s a year when you’re going to get a flu shot, this is it. “When you have a fever, you don’t want to be worrying whether it’s coronavirus or flu, and then have to go into a doctor’s office where you might be further exposed,” said Adriane Casalotti, chief of government affairs for the National Association of County & City Health Officials. “There’s a lot that might motivate people to get a flu shot this year.”
Pay special attention to high-risk populations. At-risk groups such as nursing home residents deserve special outreach, Koh said. So do communities of color, which have been suffering disproportionate impacts from COVID-19 and have been harder to reach in the past with flu vaccine drives. “There need to be efforts in multiple languages, and mobile clinic capacity where people in the community may not go to a health facility,” Koh said. He added that where mistrust of government is an issue, the mayor may not be the best messenger: Faith leaders, doctors, or other trusted community members may have better luck breaking through.
Keep innovating. Across the country, cities responded quickly to fill gaps in COVID testing capacity by standing up drive-through and walk-up testing sites. The same can-do attitude, and even some of the same infrastructure, could be repurposed to distribute the flu vaccine. “In the past, there have been things like drive-through flu-shot clinics,” Casalotti said. “There are ways to leverage the logistics and skills that were put into doing drive-through COVID testing and flip that to flu shots that can potentially be delivered in a drive-through way.”
Keep an eye on the three S’s: staffing, supplies, and space. By now, mayors are accustomed to keeping a close watch on local supplies of personal protective equipment like gowns, masks, and gloves. Stocking up for the fall is a good idea. They’ll also want to pay special attention to hospital capacity in the event a COVID surge coincides with a flu outbreak, as beds could fill up quickly.
Five months into the pandemic, coordination around staffing is a special concern. “Local public health right now is absolutely under tremendous duress,” Koh said. “Supporting those local public health professionals and giving them the resources they need is going to be hugely important so that they’re not overwhelmed.” For example, Koh said, places that have hired more contact tracers than they currently need for COVID should consider shifting them toward vaccination efforts rather than letting them go.