By Karen Dandurant
PORTSMOUTH – Influenza and COVID-19 resemble each other in symptoms, and it is possible for people to contract both illnesses at the same time, so the medical community is urging everyone to get a flu vaccine to help minimize what could be a terrible season.
While there is no preventive measure yet for COVID-19, doctors say getting a flu shot has taken on an even stronger importance this year.
“We know the season will be bad,” said Dr. Travis Harker, chief medical officer at Appledore Medical Group in Portsmouth, and a family practice physician. “One thing we know for sure is that COVID-19 is most deadly when the system is overwhelmed. If we do not do all we can, our hospitals are going to be filled with cases of both illnesses.”
Dr. Kasra Djalayer, an internist with Greater Seacoast Community Health, which includes Families First and Goodwin Health, said the overlap of coronavirus and flu is concerning to many epidemiologists.
“Both can cause severe epidemic and can cause death,” said Djalayer. “That causes a double burden on the health care system. The risk of co-infections gets higher when two viruses are circulating in the same region. Anybody can get co-infected at the exact same time. Whatever happens, there is one important step people can take that may change the trajectory of either epidemic: Get the flu vaccine.”
“Even before the COVID-19 pandemic, receiving a flu vaccine each flu season has been highly recommended,” said Dr. Irene P. Rupp Hodge, an infectious disease doctor, and the medical director of Frisbie Memorial Hospital’s Center for Wound Care and Hyperbaric Medicine. “This certainly will remain the case for the upcoming flu season. By wearing masks, avoiding contact with people when sick, and utilizing the flu vaccine as recommended, this should reduce the spread of influenza this season, which will be a benefit to the public’s health in general and will free up resources to continue to combat the COVID-19 pandemic.”
Djalayer said influenza occurs in epidemics nearly every year. According to the Centers for Disease Control and Prevention, during the 2017-2018 flu season, 61,000 Americans died.
“Influenza virus is capable of changing its structure and genetic composition in a process called mutation,” said Djalayer. “Due to the high rate of mutation, it compromises our immune system to fight against the new virus. For this reason, new vaccines are produced every year in order to stimulate our immune system to fight against the influenza virus with new genetic composition. We need to vaccinate people every year because the immunity slowly vanishes during the year.”
Harker said the precautions being taken against COVID-19, masking, good hand hygiene and social distancing should help, even in preventing some flu cases, but he said he hopes people take the extra step and get the flu vaccination.
“One thing we know for sure is that the vaccination can help minimize the impact of influenza,” said Harker. “That might also help minimize the COVID impact.”
Martha Wassell, MPH, director of infection prevention at Wentworth-Douglass Hospital, said that even those people who might not have gotten the flu shot in past years should do so now.
“For whatever reason you didn’t in the past, now is the time to change your behavior,” said Wassell. “It’s the right thing to do for you and for those around you, especially if we do encounter the perfect storm of both illnesses striking at once.”
Wassell said to her knowledge a person with both viruses has not yet been seen, but she imagines it will be, and it will be bad.
“I would dread that day,” said Wassell. “I would assume this would overwhelm the person who is host to both illnesses.”
While the two illnesses can look very similar, Harker said testing can determine which illness a person is experiencing.
“We have set up protocols to manage both illnesses and do the testing for diagnosis,” said Harker. “Schools are going to pose a unique challenge this season and will have a low threshold for sending people home during this uncertain time.”
“They will need to use good judgment. It’s challenging, especially with young elementary school-aged children, who may not really understand the need for the precautions that are necessary. I have been impressed in my practice, seeing children as young as two, wearing a mask because they do not want to bring the illness home to grandma.”
Harker said Black and Latino populations are seeing five times the amount of COVID-19 cases as other populations.
“Black people represent four times the death rate, and Latinos, two times the death rate,” said Harker. “I think part of the answer is systemic racism, housing, and education opportunities, but that’s not the only reason. These populations are having a higher risk of comorbidities like diabetes and high blood pressure. COVID-19 is spread through the respiratory system, but it also attacks the blood vessels, so these comorbidities put them at a higher risk.”
Harker said it’s not too early to get the flu shot, and he said the shot is safe. It is too early to gauge the effectiveness of this year’s shot or how bad the season will be, according to Harker.
The CDC’s Advisory Committee on Immunization Practices recommends influenza vaccination for all individuals 6 months of age and older, for all healthy non-pregnant adults less than 65 years of age as well as for individuals over or at the age of 65. Patients with a history of Guillain-Barre Syndrome, who are pregnant or are immunocompromised, or have a history of egg allergy should consult their primary care doctor before getting the flu shot.
Harker said the population who cannot get a flu shot is small, but that if everyone else gets one, herd immunity may protect those people.
Djalayer noted flu shots are offered in many doctors’ offices, pharmacies, clinics, health departments as well as by many employers, and even in some schools.
“We need to be as ready as we can,” said Harker. “If things go south, we may need to lock down again. If we take the right steps up front, we may be able to avoid that and we can get through this upcoming very challenging season. If most people do the right thing, we should be OK.”
One more very important point, raised by Wassell, is people getting the flu shot and doing what they can to protect themselves and others could have an added bonus.
“It could help protect valuable resources we may need to deal with both illnesses,” said Wassell. “It can preserve space, beds, resources and staff we may need soon. If we can directly reduce the percentage of people getting the flu, we will be better able to handle whatever does come down the road.”