A winter season featuring flu and COVID-19 together may create diagnostic problems for clinicians, a prediction that further underscores the need to educate patients about the benefits of getting vaccinated.
That’s according to leading physicians at a National Foundation for Infectious Diseases news conference on Thursday, who highlighted their concerns about the heightened dangers of flu this winter for older adults with chronic conditions.
“We have the potential for a lot of additional confusion since flu and COVID-19 are both contagious respiratory diseases, said Federico M. Asch, M.D., a cardiologist with MedStar Health Research Institute and Georgetown University. “And many of the same groups are at higher risk for complications for both viral infections.”
Anthony Fauci, M.D., director of National Institute of Allergy and Infectious Diseases agreed. “It really is a diagnostic challenge because there are shared signs and symptoms,” he said. “There is considerable concern that as we enter the fall and winter months and into the flu season, that we’ll have that dreaded overlap of two respiratory-borne diseases.”
But vulnerable adults do not appear to be entirely on board with getting their flu shots. An NFID survey has found that 22% U.S. adults who are at high risk for flu-related complications due to age and underlying health conditions were not planning to get vaccinated this season.
“We still have a lot of work to do to educate our community and convince people they need to be protected against flu and pneumococcal disease,” said Asch.
Antivirals while awaiting COVID results?
NFID Medical Director William Schaffner, M.D., said he wouldn’t be surprised if physicians in communities where flu is extensive are treating patients empirically with an antiviral drug while they await the results of a COVID-19 test.
October is the “golden month” for flu vaccination, he said. Highly vulnerable groups — including older adults whose immune systems are not as robust and who were vaccinated in August — may not enjoy protections extending into February and March, when flu season peaks in the United States, Schaffner said. No formal recommendations exist for revaccination during the season, he noted.
Meanwhile, cardiologist Asch explained that older adults have accounted for 50% to 70% of flu-related hospitalizations in recent years. And last year, 93% of adults hospitalized for flu-related complications had at least one reported underlying medical condition, including cardiovascular disease, diabetes or lung disease.
Asch recounted seeing some of the worst complications of flu in the cardiac intensive care unit, including myocarditis, an inflammation of the heart muscle that can cause chest pain and result in abnormal heart rhythms and heart failure.
Pneumococcal disease awareness is low
The speakers also stressed the need for educating older adults about the importance of being vaccinated against pneumococcal disease. The NFID’s survey found that 51% of those at high risk for the bacterial infection reported that they have not been advised to seek vaccination.
Pneumococcal disease, which can manifest as pneumonia, ear infections, sinus infections or bloodstream infections, causes 150,000 hospitalizations each year in the United States, with up to 7% of those hospitalized dying from the disease, Fauci said.
Flu and pneumococcal vaccine options for older adults this season:
- An adjuvanted vaccine and a high-dose vaccine, both designed to help initiate a more robust immune response for adults 65 and older.
- The regular dose influenza vaccine, which covers four influenza viruses, for children and adults 6 months and older.
- A flu vaccine using recombinant technology, for adults 18 and older.
- Pneumococcal vaccine PCF13, recommended for adults and children with certain underlying medical conditions.
- Pneumococcal vaccine PPSV23, recommended by the CDC for all adults 65 and older.
For the 2020-2021 season, vaccine manufacturers estimate that up to 198 million doses of influenza vaccine will be available, surpassing the previous record of about 174 million doses set last year.
