As temperatures continue to fall, local health officials are bracing for the possibility of a fall and winter surge of illness beyond COVID-19, which also continues to spread rampantly in the area.
The area already experienced an unseasonably early wave of respiratory syncytial virus, or RSV, which spread through multiple area schools in September. Flu vaccination rates are well below past years, and the efficacy of this year’s flu vaccine largely is unknown yet as few cases have been reported. And many people have dropped the mitigation strategies that helped limit the spread of COVID-19 and severely curtailed the spread of other illnesses last winter season.
“Worst-case scenario is we have a new variant of COVID with other features that could be more transmissible than delta; an influenza strain that is not very well covered by the current vaccine or that changes to make it more transmissible; and/or we have a spike in the third type of viruses (including RSV),”said infectious disease specialist and Medical Associates Clinics Chief Medical Officer Dr. Hendrik Schultz.
And waves of all these viruses coming through at once could overtax an already fragile health care system.
“We still have one of the worst shortages in health care that the United States ever saw,” Schultz said. “We still have the problem that we have these patients coming in. And we might have the ventilators, we might have the beds now, (and) we might have the PPE and all the other stuff, but we might not have enough people to cover it. That’s the other variable outside the virology that we have to think about.”
Fall is always a bit of a minefield when it comes to respiratory diseases — many of which are mild for most people but can be fatal for the very young, very old and those with pre-existing conditions.
“There are millions of viruses we deal with every day,” said UnityPoint Health Visiting Nurse Association Immunization Coordinator Laura Knabel. “Most turn into a cold or respiratory illness.”
Officials say the good news is helping prevent the spread of viruses that cause respiratory illness is as simple as wearing face coverings or staying home when ill, frequently washing and disinfecting hands and surfaces; and getting available vaccines.
Schultz said that of all the virus groups that folks contend with, there are three “major players” in autumn illness.
One now is COVID-19. The latest data from Dubuque County showed that, in the week that ended Wednesday, the daily average of new cases had spiked to the highest level since around last Thanksgiving.
The second is influenza. Schultz said flu is always a challenge for providers to deal with.
“Influenza is a very rapidly changing virus,” he said. “The problem with influenza in a population is that immunity to influenza wanes very quickly. This can hit us hard due to changes in the virus and waning immunity in the general population because they did not get exposed to a new (flu) virus.”
The ultimate impact of the flu also is impacted by how effective that year’s flu shots are — and how many people receive them. Many national experts are predicting a severe flu season.
The third “major player” is RSV and viruses that behave similarly, such as adenovirus, parainfluenza, rhinovirus/enterovirus and a few others.
“The difference between these viruses, and flu or COVID is that there are no vaccine against them,” he said. “So whatever it is, we have to deal with it, whether we like it or not.”
And 2021 has been an odd year so far for the third group.
“What was noticed about these viruses — not only for RSV, but for other viruses in this category — is they were off track in terms of their seasonality,” Schultz said. “(RSV) surged in August and September. If I believe the data and what our pediatricians told me, that’s coming down. What we don’t know is if we will see a second wave of RSV in the true winter season or whether we will see a weakened RSV season because so many children had it in the preseason.”
It might seem basic, but viruses need people or animals to spread them. If they do not kill their host, that host develops some immunity to them.
But the majority of people avoided these annual viruses last year by following the basic mitigation strategies engaged to slow the spread of COVID-19 — wearing a face covering in public, maintaining social distance and largely avoiding gatherings.
“This whole season of respiratory viruses was cut. It never happened, which is unheard of,” Schultz said. “That was 2020 to 2021, when everybody was still nervous and we had no vaccine. We had to see how we get people through the winter after we’d had a big surge in November that frightened everybody.”
That potentially leaves area residents more vulnerable to those viruses this year.
“Last year, if kids weren’t out and with other people — looking just at RSV — their immunity isn’t up,” Knabel said. “Now, they’re back out and more susceptible of picking things up.”
This year’s flu
Having no flu season last year gave experts a shaky foundation for developing protections this year.
“The problem with last year is that no virus showed up at all,” Schultz said. “We really don’t know what kind of influenza we’re going to get this year. There have not been many cases. We don’t have a good feel yet what kind of virus we’re dealing with or if the vaccine we got and started to give out in September will do the job.”
According to the Iowa Department of Public Health, there were next to no cases of influenza in the state in October and early November of this year, which is abnormal. In each of the years preceding 2020, there had been dozens of outbreaks statewide by early November.
Officials do not expect to make it through a full winter without that changing, however. Mitigation measures aimed to stop the spread of COVID-19 have been dropped.
“This year, there’s less masking,” Knabel said. “People are saying ‘Oh, I just have a cold. I’ll go about my day.’”
Flu shot rates
Flu shot rates also are lagging in 2021.
Flu shot rates were below normal in 2020, likely in part because people did not want to venture to get them and risk being exposed to COVID-19. And the Centers for Disease Control and Prevention reports significantly lower turnout so far this year than at the same point last year.
That has proven true in Dubuque County, according to Stacey Killian, executive director of UnityPoint Health’s Visiting Nurse Association — Dubuque County’s contracted public health staff.
“We’re just gearing up for flu season,” she said. “And this year, we’ve had a slower start than last year by almost half. We are just reminding people as best we can to please get a flu shot.”
The county’s flu shot rate last season — from October 2020 to May 2021 — was 40.3%, according to the state.
As of Nov. 5, Dubuque County’s rate for this season was 24.2%. And while there still is plenty of time to get influenza immunizations, historically two-thirds of shots for a given season in Dubuque County have been given out by the end of October. That trend is consistent for the other nine counties in the Telegraph Herald coverage area.
If that ratio holds true this year, Dubuque County’s rate only would reach about 36% — which would be the lowest rate since 2017.
Among other local Iowa counties, the flu shot rates were:
- 34.9% in 2020; 17.7% as of Nov. 5
- 43% in 2020; 23.8% on Nov. 5
- 40.3% in 2020; 19.3% on Nov. 5.
- 42.1% in 2020; 24% on Nov. 5.
Wisconsin has a less robust, up-to-date public reporting system for influenza than Iowa. The Wisconsin Department of Public Health reported that the statewide flu shot rate was much lower than last year as of Oct. 22.
Local counties rates were:
- 18% on Oct. 22, compared to 26.5% on the same date one year earlier.
14.4% this year compared to
- 21.6% on the same date last year.
- 22.3% this year compared to 32.3% on the same date last year.
- 18% this year compared to 25.9% on the same date last year.
Efforts to get similar data for Jo Daviess County, Ill., from state and local officials were not successful.
Why fewer flu shots?
Schultz estimated that the drop in influenza immunizations this year is caused largely by societal polarization and the politicization of the COVID-19 pandemic.
“The whole discussion about vaccines and infection control measures has become increasingly heated, if not toxic, over the last 18 months,” he said. “That could be a problem.”
As of Oct. 11, a national CDC survey found that 71% of adults who were vaccinated or planned to be vaccinated against COVID-19 had received or planned to receive a flu shot this year. The same survey found that just 7.5% of adults who probably or definitely would not get a COVID-19 vaccine had or intended to receive a flu vaccine this year.
VNA Administrator Killian said some other people have been slow to return to normal habits like receiving flu shots, perhaps because the habit has been disrupted or over concerns about COVID-19 exposure.
There also might be some uncertainty, she said.
“We also have questions about when you can get the flu shot if you just got the (COVID-19) vaccine or if you can get (the flu shot) if you’re about to get your (COVID-19) booster,” she said.
According to the CDC, it is safe to receive a flu shot and a COVID-19 vaccination at the same time.
While flu shot rates are lagging, local officials said they are not seeing similar drops when it comes to long-established vaccines received by children. Knabel said that other than a brief time when parents were worried to bring in their kids due to the pandemic, the VNA has kept up with its usual rate of vaccinating children against the string of diseases they need protection from to begin school.
Steps being taken
Knabel is using routine visits with parents to help educate them about the safety of vaccines and to counter misinformation.
“When I talk to parents about COVID, it’s nice to explain that all of the things you hear about COVID are no different than any other vaccines,” she said. “They’re the same main side effects — you can get a headache; you can be tired. It reiterates that this is not new and scary as far as COVID goes. They just didn’t know enough about vaccines before. I think the training and education we’ve done with parents let’s them know like ‘Oh, OK. This isn’t new. This fearmongering, there’s no truth to that.’”
Killian said she, too, hopes education is the key to staving off a double wave of flu, other viruses and COVID-19 this fall.
“I hold onto hope that these universal precautions we’ve spent years going over every year will continue and people will understand their importance,” she said. “It has nothing to do with the pandemic. It’s something we’ve encouraged year after year. I hope people remember that. This is not new.”
Some area institutions are retaining the mitigation strategies initiated earlier in the pandemic, by law. In Illinois, schools still have mask mandates.
“Last year, with all the COVID mitigation, we really didn’t see flu,” said T.J. Potts, superintendent of the East Dubuque public school district. “When people are wearing masks and social distancing, when we’re spraying everything down, you’re free from that.”
COVID-19 not being recognized
Dubuque County Health Department Director Patrice Lambert expressed concern that because the flu season is expected to return this year, people might write off COVID-19 as the flu or a cold, as many did at the pandemic’s advent.
“But the truth is, until you get tested, you don’t know,” she said. “Please get tested. Then, they will know, as will we know, if they are positive.”
The CDC also stresses that it is possible for people to catch COVID-19 and the flu at the same time.
On the COVID-19 front, Schultz had some good news relative to last fall.
“(Dubuque County’s) vaccine rate is, I think, very good, compared to national and the state of Iowa,” he said. “We have practically 95% of everybody over 65 vaccinated. Even if they don’t have the booster, they have a decent level of protection. We have decent level of vaccination in other age groups.”
Schultz also pointed to the recent government approval of COVID-19 vaccines for children 5 to 11 as good news.
“By the end of November, the beginning of December, the whole landscape of potential transmission could change toward a more favorable situation,” he said.