This is not a normal flu season (if you hadn’t heard). Normally, summer sees a return of flu cases to a low baseline, but not this year—this year we saw a bump in cases around April, with a consistent trickle of cases throughout the summer, and significant outbreaks at summer camps and military bases. And now, from that “higher low point” we are seeing an early, rapid rise in flu cases. Some of this is likely attributable to an increase in reporting—people are worried and going to the doctor for illnesses that they would normally ignore. But that isn’t likely to be the bulk of reported cases.
Flu visits, from the CDC
An “influenza-like illness” (ILI) is usually defined as a fever of 37.8 or above (100 degrees Farenheit), plus either sore throat or cough, without another explanation, such as strep throat. Many ILIs are not influenza, but during the flu season, the sets of ILI and actual flu increasingly overlap; that is, more ILIs are due to actual flu when there is a lot of flu in the community, making this a useful marker of flu activity. We can’t test everyone, so we have to make an educated guess, and the fact that ILI rates are soaring above anything we normally see, combined with samples from surveillance sites, confirms that we are seeing flu rates far above what would normally be expected.
In addition to high rates of flu, the population affected by this flu is significantly shifted to the left, that is, it is affecting (and killing) a younger group of people than the usual flu. While it might not be more virulent than usual flu (with some possible exceptions such as pregnant women), it is infecting an immunologically naive young population who are dying at the rate one sees with flu. This rate is not high, but if enough people are infected, the absolute numbers become rather sobering.
Pediatric flu deaths, from the CDC
Normally, influenza knocks off the old and infirm, largely sparing the young and healthy. This year, because so many additional people are becoming ill, more are dying. Influenza has a certain mortality rate associated with it, so if flu infections go up, mortality goes up, and if more young people are infected, more young people die.
I’m repeating myself a bit here because it’s easy to get this wrong, as many newspapers and alternative medicine websites often do. This flu is a big deal, not because you’re going to die when you catch it, but because you’re very likely to catch it, and some who catch it die.
This is a public health fact—if enough become seriously ill, we will have to ration care, making decisions about who is allowed to use up ICU and ventilator resources, and who is not. Another public health fact is that this is a preventable illness. We will never vaccinate enough people to achieve herd immunity, but we can vaccinate enough to blunt the infection rate and the mortality rate. Vaccine supply and distribution is a problem, but if you keep an eye on your local public health department, you will likely find a vaccination clinic and time near you. Vaccinations are being given using a triage system to get the highest risk individuals and health care workers first.
I’ve heard a bit of moaning about health care workers being at the head of the line, but there’s a good reason for this. First, we don’t want health care workers getting the flu and spreading it around. Second, we need healthy doctors and nurses to stay at work and take care of the huge increase in sick people. We must be able to staff all of our beds, and still be able to send people home when they have the flu.
This pandemic is serious business. It’s easy to think of it as being over-hyped—that makes all of us feel more comfortable about it. And the hype can be overblown. That’s why it’s important to understand the facts. Let me personalize it for you: I have a young, asthmatic daughter. She is the single most important fact in my life. When I read the anti-vaccination propaganda about “saving your child”, I feel it—I feel the tug of balancing risks. After all, she’s not sick now so why risk anything that might hurt her?
But I read the facts and I educate myself. I know that the risk of becoming ill or dying from the flu is many times higher than any problem from the vaccine (some might say the risk is nearly infinitely different), and I know that the vaccine is her best chance to avoid the flu.
And I remember laying in a hospital bed with her while she struggled to breathe, holding a little oxygen mask over her face because she was too young to leave it on herself. I remember how frightening a lower respiratory tract infection can be in a vulnerable person. I see how busy the ERs, clinics, and wards are and wonder, if this gets bad, will there be room? Will there be an oxygen line for my daughter, my heart?
That’s why my family takes this seriously and is going to get vaccinated.