The Forgotten Flu Season
And How Covid-19 Might Change Flu Vax Forever
By Dale Dauten, Syndicated Columnist
That old devil Mr. Flu was having a pretty big season, back before it got big-footed by covid-19. So let’s take a brief look at how this last flu season is wrapping up, and what it might mean for flu when we have a covid-19 vaccine.
Here’s the CDC’s graphic of the “Disease Burden” for flu, as of the end of March 2020…
Those are big ranges, especially when it comes to deaths. That high end of the range for deaths, at 63K, would surpass the awful total of 61K back in 2017-18.
We asked STChealth’s epidemiologist, Dr. Kyle Freese, for his thoughts on the most recent flu season: “We knew early on it was going to bad,” he said. “I remember taking my daughter to the pediatrician last December and there were already 13 or 14 thousand deaths. And then I started hearing anecdotally about the severity of the illness – that’s what was most distressing. We were worried that this might be a repeat of 2017-18. One of the reasons that season was so bad because one strain was circulating, then another started being reported in March, 2018. And while flu usually affects the young and the old most severely, that season impacted all ages.”
FLU VS. COVID-19 – WHICH WILL BRING MORE DEATHS?
We’re still a long way from knowing the total deaths in the U.S. attributed to covid-19, but if that number comes in on the low end of recent projections, and if the flu comes in at the higher end, the two totals could be similar. We asked Kyle if that would vindicate the “just another flu” argument for downplaying the dangers of covid-19.
“It’s ironic,” he responded, “that now flu is getting more attention, when the crude numbers are used to suggest that covid is no big deal. But covid-19 is the much bigger worry, of course. There’s the case fatality rate, with covid perhaps 10 or 20 times more deadly for many subsets of individuals, and we have no vaccine and no immunity outside the small percentage of people who’ve recovered from it. And we’re only two months in, compared to flu season having run its course. The covid data change daily.”
When there’s a covid-19 vaccine, we wondered if there’s any reason to believe that will be more effective than the hit-and-miss success of annual flu vaccines.
“Viruses are tricky little buggers,” Kyle noted. “And we’re months away from knowing how effective a covid-19 vaccine will be; but, we do know that much of the success of a vaccine comes down to coverage – that’s going to be the key. The uptake of flu vaccine is what? Around 40%. But covid is going to change the conversation. It is going to create a worldwide teachable moment. We are going to see a massive uptake in vaccinations. I can imagine that even many anti-vaxxers are going to want the new covid vaccine.”
WHAT WOULD A HIGH COVERAGE RATE FOR A COVID VAX DO TO OTHER VACCINES?
So now let’s add a second assumption — not only are we going to assume that a covid vaccine will be found, but let’s also assume that supply and distribution will be close to universal. How does that world look to an epidemiologist?
“The opportunity will be there. If you give mass vaccinations, patients will be in front of you who have had no contact with the medical community. If you have someone with no vaccines, how do you prioritize? Are people going to be willing to get five vaccines in one sitting? Probably not. But we need to take advantage of the contact, develop the relationship with the patient, and recommend the correct vaccines. There will be opportunities to improve coverage of vaccines such as flu and pneumonia, given they follow nicely within the current CDC guidelines. I think they’ll be in the same bin, both having respiratory implications.”
But that sounds like it would create supply and inventory problems, right?
“It doesn’t have to. We have a lot of tools at our disposal, including the ability to combine census, geographical and medical information. So if you’re, say, a pharmacy doing vaccinations, we can take a five-mile radius of your pharmacy, and know the current coverage rates and thus the current opportunities. You’ll be able to continuously update inventory, and, with bi-directional data from state registries, help every patient with their vaccination decisions.”
THE BIG CHOICE
So here’s the big choice that many will be making, and making now, depending on how they are preparing…
Covid-19 could end up providing a massive lift in other vaccinations. Flu shots, specifically, could reach big new records in coverage.
Or, on the other hand, a rush of covid-19 vaccinations may cause vaccinators to focus on that one goal, downplaying flu or other vax, possibly leading to a decline in coverage.
Which will it be? The goal for vaccination programs must be to have the resources to add many millions of new covid-19 vaccinations while also adding millions of additional flu and pneumonia vaccinations. It seems likely we will look back on this as a historic opportunity and ask ourselves how we responded.
So how do you get to be an epidemiologist?
A visit with Dr. Kyle Freese
It’s a good time to be an epidemiologist. Perhaps this pandemic could even generate a new big generation of epidemiology students, like Watergate did for journalists. That led us to wonder how Kyle Freese came to the profession…
“Back in 2008, I finished up my undergraduate work in Health Sciences and Physiology early, graduating in December, so I had some time before starting grad school in the fall. I ended up working at a halfway house, doing renovations and general administrative work. I spent a lot of time talking with the residents – primarily those recovering from substance abuse – and that got me thinking about the role of public health and how I might make a difference.”
In 2010, he started at the University of Pittsburgh, working on a Master’s in Public Health, with a focus in Behavioral and Community Health. And that’s where the evolution of his thinking continued: “I was out in the community doing research. I was in both the medical and the analytical worlds. I realized that epidemiology is the glue that brings specialties together. It was so translatable and so quantitative. I wanted to have the tools to add a level of truth to research. So I kept going, getting my doctorate in epidemiology so I could have the skill set to do the research to answer the most interesting and highest impact questions.”
As for Kyle’s personal life, he grew up in the Phoenix area and did his Bachelor’s degree at the University of Arizona. But it was at the University of Pittsburgh where he met his wife, Gianara, who was working on her doctorate in Physical Therapy, and who also happened to be from Scottsdale. They found their way to Arizona in 2017, brought their daughter, Maddalena, into the world last October, and Kyle came to STChealth in February.
Vax Stats of the Month
Accelerating Health Care Supply Chain Analytics
in a Pandemic
by Bill Davenhall, Geomedicine Analyst, STC Health Analytics (Bill_Davenhall@stchome.com)
Could we have known where to point a limited number of tractor trailers filled with essential healthcare supplies; or, could we have alerted hospitals in certain markets any faster of the likelihood of serious health care worker and personal protective equipment (PPE) shortages, based on data that we already had in hand?
The map below should be relevant to a broad national supply chain ecosystem (products and workers) that must “deliver” locally. Typically, we think of groceries, manufacturing, and retail businesses as the only ones that need supply chain analytics, but what about the supply chain for the health care work force, (e.g. physicians, nurses, respiratory therapists) and so many other essential workers? More importantly, will we be better prepared, analytically, for the next national health emergency using todays analytics that don’t easily provide actionable local information quickly at a national scale?
The analysis below took less than five minutes to prepare and an additional five minutes to create a map to help illustrate what the data was saying. A detailed list was then generated identifying the Top 99 Hospital Service Areas (HSA’s) that should be in the “headlights” of the supply trucks. (The complete list ranks each of the 3,408 hospital service areas across the United States on a single factor – household population density but using Hospital Service Areas to predict where specific hospitals, supplies and people would be impacted the most.) No new data required, no time remaining to get prepared, but enough information to climb into the truck and head out to the first ten hospital service areas most densely populated.
While the analysis was straightforward, the speed at which it was prepared is as important in the early hours of most emergencies, as there is little time for in-depth analysis or exhaustive searches for more relevant data. It simply must be present and ready to be shared. Your maps should “talk” to you – it’s all about clarity of the context and the usefulness of the insights the analysis provides – it can’t be complicated. It’s much clearer now that we must do better at accelerating the data flows and improving the usefulness of analytics that support decision-makers to be better prepared for pandemic conditions anywhere.