Leader's Perspective: Forecasting the Flu Season

Leader's Perspective: Forecasting the Flu Season

Amid COVID-fueled uncertainty, an infectious disease expert says it’s crucial to lean on tried-and-true methods in the fight against the familiar virus.

Predicting the patterns and severity of the annual flu season can be a tricky exercise for infectious disease experts; this year it takes on added complexity amidst a pandemic and surging COVID-19 cases around the country.

Children's Hospitals Today caught up with Federico Laham, M.D., pediatric infectious disease physician, Orlando Health Arnold Palmer Hospital for Children in Florida, to discuss what to expect from the upcoming flu season and how children's hospitals can help curb its transmission.

How do you forecast COVID's impact on the 2020-21 flu season?

The year 2020 is unique in every aspect, and the upcoming flu season is no different.

We don't know how COVID will impact the flu season; there are many possible confounders:

  • People are really cognizant about washing their hands.
  • Schools and workplaces are very reluctant to allow people who have symptoms of respiratory illness.
  • Folks are wearing masks.

All these things work not only to mitigate COVID—but also the transmission of flu. 

Also, viruses usually don't like to cocirculate. There's a phenomenon called viral interference where, in some cases, a currently circulating virus can prevent other viruses from circulating. But we don't yet know if it will apply with COVID and influenza.

But keep in mind with the colder weather, people stay indoors—there's generally more humidity inside the house and other factors that make it more likely for influenza to transmit. So, it may be that we see some significant spikes as we see with the flu every year, but perhaps it's going to be limited to smaller groups and families who cohabitate.

Amid the uncertainty, what can health care professionals do to limit the spread of the flu?

At this point, we have two primary strategies against influenza. 

First, we know what we need to do. We have widely available access to the flu vaccine-it is free (or at a greatly discounted price), easy to get and is a single dose. And people now are more sensitized to the preventive efforts, which mirror those for COVID. 

Also, with influenza we have very effective antiviral medicines widely available. These antivirals can be taken early in the course of illness to further decrease transmission and to prevent symptom progression. Additionally, antivirals like Tamiflu can be used prophylactically. So, if someone did not receive the flu vaccine and is exposed to somebody with the flu, he or she can start taking the medicine and prevent the disease from gaining a foothold and developing. 

We have strategies. And this is a year where we need to be especially smart and prepared.

Since the southern hemisphere experiences the flu season before we do in the northern hemisphere, we can sometimes glean clues as to the nature and severity of the upcoming flu season. What are we hearing from that part of the world?

So far, decreased influenza activity in the southern hemisphere has been reported.

That's very encouraging. We don't know which mitigating factors are contributing to the lower numbers—could it possibly be viral interference? Perhaps, but I think most likely what is happening is more people are following safe practices. They all inevitably lead to decreased transmission and fewer case spikes. 

It may also be that because of those preventive efforts, the virus may be more stubborn and circulate at a lower level for a longer period of time—we just don't know yet. 

What is your advice for pediatricians and other health care practitioners striving to keep kids healthy as we approach this flu season?

The number one focus should be to not deviate from your primary role of preventing disease in pediatrics. Pediatricians are the pillar of health for children-not only because they restore health when kids get sick, but they also prevent them from getting sick in the first place. 

We've seen—especially at the beginning of the pandemic during all the lockdowns—so much advanced disease, things that could have been easily prevented or, if treated early, could prevent disease from getting more complicated. We know even during times of a pandemic; we must continue to do preventive medicine.

Regarding the flu vaccine and antivirals, timely administration is very important. Pediatricians play a huge role in that. 

Bottom line: do not delay care and continue to do preventative medicine the way it should be done.

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