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Flu season starts in October, overlapping with the coronavirus pandemic that continues to rage across the state and the country. At the same time, thousands more Texas school children are scheduled to return to the classroom next month.
This combination, Texas health officials warn, could be a recipe for an unprecedented health disaster, but one they hope could be mitigated if people get their annual flu vaccines.
“If we have a bad flu season and fill up our emergency rooms, our ICU beds and our hospital beds with flu [patients], we’re not going to be able to defend ourselves against the onslaught of the coronavirus,” said John Carlo, a member of the Texas Medical Association COVID-19 task force and past chair of the Texas Public Health Coalition.
While COVID-19 cases and hospitalizations are trending downward in the state, experts are still waiting to see whether the recent Labor Day weekend and students returning to in-person instruction will lead to another surge in hospitalizations. Health officials worry that a bad flu season on top of the pandemic could lead to COVID-19 testing shortages, strain hospital capacity and create further complications for school campuses. What’s worse is that doctors still don’t know what a person catching both the novel coronavirus and flu at the same time might look like.
Meanwhile, some experts are keeping their fingers crossed that increased personal hygiene practices adopted during the early months of the coronavirus pandemic could help keep the worst of the flu season at bay.
Get a flu shot
In August, Gov. Greg Abbott said the upcoming flu season could be “prolific” and urged Texans to “understand the importance of getting ahead of the curve” and getting vaccinated.
“If that leads to greater hospitalizations, coupled with the hospitalizations that we’re seeing for COVID-19, you can easily see how hospitals in this region as well as across Texas will be completely overrun with an inability for the hospitals to take care of the medical needs of everybody in the entire region,” Abbott said at a press conference that followed a roundtable discussion with medical professionals in Dallas.
Carlo said the U.S. has an “unfortunately really low” flu vaccination rate. In Texas, an estimated 43.2% of adults and 61.8% of children were immunized in the 2018-19 flu season, according to the National Immunization Survey. He said this year the flu vaccine could also protect people from a severe outcome of having both the flu and COVID-19 at the same time.
Angela Clendenin, an epidemiologist and biostatistician at the Texas A&M University School of Public Health, said the flu vaccine is typically about 40% to 60% effective.
“The big misconception is when people go and get the flu shot, and then they end up getting the flu and they think that it failed and that the flu vaccination is useless,” she said. “Well, the thing that they don’t realize is if they hadn’t had the vaccine, their flu may have been much, much worse.”
There is no vaccine for the new coronavirus yet, but the U.S. has a plan to deliver 300 million doses by January. The director of the Centers for Disease Control and Prevention said a COVID-19 vaccine will not be widely available until at least the middle of next year, with the vaccines first going to the most vulnerable population, according to a report from The Washington Post.
Clendenin said public health guidelines for dealing with transmissible diseases like these are soundly evidence-based and that people need to wash their hands, physically distance and stay home if they’re feeling sick. For COVID-19 prevention, people should wear masks, and for the flu they should get vaccinated, she said.
While coronavirus case counts and hospitalizations have declined in Texas, “flu season is fast approaching, and hospitals are bracing for impact,” said Carrie Williams, a spokesperson for the Texas Hospital Association. She said hospitals don’t want two viruses competing for the same resources, such as doctors, nurses, intensive care unit beds and ventilators.
“COVID certainly stretched hospitals this year and while our hospitals are in the business of being ready for anything, a strain on resources is not ideal when you’re saving lives,” she said.
Stephen Love, head of the Dallas-Fort Worth Hospital Council, said while hospitals have surge plans to increase their capacity, the concern is having enough staff members and personal protective equipment.
Back to school
When kids go back to school every year, doctors see an uptick in flu cases, Carlo said.
“There’s always been a strong correlation between kids getting back to school and flu season,” Carlo said. “And the reason for that, it’s pretty clear that the classroom setting is the most socially dense environment in our communities.”
Children interacting in a classroom increases the likelihood that respiratory illnesses will spread. “On top of that, kids are susceptible to the flu, individual respiratory hygiene and hand hygiene may not be as good as we would like it to be in kids, and we know kids can shed flu virus pretty efficiently,” Carlo said.
But Clendenin said for the most part, schools that have opened back up — some as early as August — have done “quite well” in managing students that returned for face-to-face classes and have had well-thought-out plans for opening, disinfecting, reporting cases and physically distancing students.
In Texas, more than 1.1 million public school students have returned to classrooms for in-person instruction or are participating in activities on campus grounds, out of about 5.5 million. Of those, at least 2,352, or less than a quarter of 1%, have reported testing positive for the virus as of Sept. 13, according to a state dashboard.
“By far and large, particularly when you look at the K-12 schools, I think that a lot of the plans that they put in place to prevent COVID from spreading in their schools is also going to be helpful during flu season,” Clendenin said.
Houston Independent School District is the largest in the state and has plans to resume face-to-face instruction Oct. 19, dependent on COVID-19 conditions and recommendations from health officials. Other school districts across the state are also bringing students back next month, including Dallas ISD, which plans to resume classes Oct. 5.
“If everyone continues wearing a mask, washing their hands or using hand sanitizer, and practicing physical distancing, we will be able to keep flu and COVID-19 levels low,” a Houston ISD representative said in an email.
The district also provides free flu shots for all employees every year, and employees can get a flu vaccine through the end of October.
Demand for testing
Carlo said because the symptoms of both illnesses are so similar, it would be “next to impossible” for doctors to determine which virus someone has by looking at them, which could result in increased demand for testing.
He said other respiratory infections that typically circulate in fall and winter — like the common cold — will also spread along with COVID-19 and the flu.
Love said it’s encouraging that vaccines and the health precautions people are taking could help hospitals avoid another surge, but people cannot let their guard down.
Carlo also said those same precautions could help experts understand how to stop the spread of influenza.
“We have hundreds of years of flu experiences every year,” Carlo said. “And yet we really, up until this year, had very little in terms of work around how we actually do these physical mitigation measures.”
But this year more than ever, it’s important that people with even mild symptoms stay home, Carlo said.
“It’s not unusual in the past to show up for work, even with a cold, and to try to tough that out,” Carlo said. “That’s not going to be the right decision this year.”
He said people who are hesitant about getting the flu vaccine because they don’t believe they’re at risk for getting a severe flu infection should still get one and should consider the other people around them who have weaker immune systems.
“Particularly if you are around individuals that are at higher risk, there’s just — not for yourself, but for other people — a strong calling to do the right thing and get the flu vaccine to protect somebody in your family, protect your fellow co-workers, protect your community.”
Disclosure: Texas A&M University, Texas Hospital Association, Texas Medical Association and Texas Public Health Coalition have been financial supporters of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune's journalism. Find a complete list of them here.