It’s not “just the flu”
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“It’s just the flu.” We’ve all heard this phrase many times, typically as a means of calming for or from someone suffering from a respiratory illness.
During the COVID-19 pandemic “It is more than just the flu” was used to promote vaccination against COVID-19 and mitigation measures such as covering up. Well-meaning doctors are tweeting that COVID-19 is killing more children than seasonal flu in hopes this information will inspire vaccine-hesitating people to protect themselves Reputable media sources are reminding people that COVID-19 ‘hardly ever’ poses a serious threat to children, but also point out that COVID-19 still kills many more children than the flu did between 2020 and 2022. Even the popular Hulu series “Pam and Tommy” uses influenza as a metaphor to indicate that a certain situation is bad, but not yet an “epidemic”.
Now imagine hearing repeatedly that the flu is no big deal when you are one of the many thousands of people who experience the loss of a loved one to the flu each year. These words are not reassuring. They make you angry. After COVID-19, influenza is the deadliest vaccine-preventable disease in the United States. In fact, every US flu season over the past decade has had one resulted with an estimated 9 to 41 million illnesses, 140,000 to 710,000 hospitalizations and 12,000 to 52,000 deaths, including more than 100 children. There are also significant economic and public health burdens from influenza beyond hospitalizations and mortality, such as B. Loss of work and school days.
We are two of the many thousands of people who have been personally affected by the flu. Our previously healthy little boys, Joseph Marotta, 5, and JJ Neiman-Brown, 2, died “just of the flu” in 2009 and 2020, respectively. As scientists and mothers, and in the interest of preventing more deaths like this, we all ask that we all work together to dispel common misconceptions that minimize the threat of influenza.
Flu is dangerous. COVID-19 is dangerous. Measles are dangerous. Whooping cough is dangerous. It’s not a competition. Vaccines are available against these pathogens because they have caused a significant public health burden, including fatalities. Pitting these infectious diseases against each other like a horse race or a boxing match suggests that one of these common, highly contagious and deadly diseases is more worth preventing than another.
We recognize that changing the culture around these discussions might take some convincing. Our goal in this article is to summarize evidence that emphasizes the inappropriateness of minimizing influenza severity and supports the notion that we can simultaneously promote public health and medical responses to multiple serious respiratory diseases.
Childhood flu-related deaths are relatively rare but affect hundreds of families each year. For example, before the start of the COVID-19 pandemic, 531 children in the US died from the flu in the 2017-18 and 2019-20 seasons. A recent study of US children comparing exposure to influenza and COVID-19 found that the prevalence of life-threatening diseases was low similar for both diseases. So why do we keep hearing that COVID-19 isn’t “just the flu”? As mothers who have lost their children to influenza, we can attest that it doesn’t feel so rare when it happens to your child.
Since 2004, when influenza-related childhood deaths became a nationally reportable (reportable) illness by state health officials to the Centers for Disease Control and Prevention, more than 2,000 children have died from influenza. Those thousands of pediatric influenza deaths are also almost certainly one underestimate, reflects reality that some children who die from influenza complications may not be tested for influenza, that some tests may not always detect influenza virus (especially about a week after infection begins), and that influenza is not always listed on the death certificates of those who died from flu-related complications. About half of children who get the flu were previously healthy, a frightening surprise for many who assume the flu poses no threat her Child.
Data from 2017 to 2021 indicate that compared to COVID-19, the rate of pediatric influenza-related hospitalizations was similar or higher in children under 12 years of age, but was lower in adolescents 12 to 17 years of age. Like the mortality data, this hospitalization data indicates that influenza may be a more serious illness than COVID-19 for children, and especially younger children. So why do we keep hearing that COVID-19 isn’t “just the flu”?
The already serious threat posed by influenza is compounded in communities affected by the consequences of systemic racism, including inequalities in access to health care that result in the striking disparities in disease burden and health outcomes that often leave members historically marginalized characterize communities. For example, people from many racial and ethnic groups experience higher rates of severe flu-related episodes than white counterparts. A study by the Centers for Disease Control and Prevention showed significant racial/ethnic disparities in influenza-associated hospitalization rates, ICU admissions, and hospital mortality; These differences were even more pronounced in children. These trends were observed in non-Hispanic Black, non-Hispanic/Latino and Alaskan Native Americans, and Hispanic/Latino people. The pervasive minimization of the severity of influenza in our country and culture may actually compound these injustices, particularly given that members of historically marginalized communities often have relatively little access to quality health care.
We know that annual flu shots are the best protection against seasonal flu. Flu vaccines are life-saving for adults and children. Still, influenza immunization coverage is well below the 70% Healthy People 2030 target set by the US Department of Health and Human Services as a feasible goal for personal protection and community immunity. During the 2021-22 flu season, preliminary estimates of influenza vaccination rates among children, adults, and pregnant women in the United States was 55%, 45% and 52% respectively. These rates are even lower in historically marginalized populations. For example, 2021-22 immunization rates for Black children and adults were 47% and 35%, respectively.
There are various reasons people don’t get the flu shot every year, including the growing threat of vaccine misinformation, much of which is intentional. Another potential major reason is failure to recognize influenza as a health threat. And it doesn’t help to “move the needle” on the flu shot if we keep hearing “it’s just the flu.” GPs and specialists must make a strong commitment to influenza vaccination in all of their patients each season, emphasizing that co-administration of vaccines (e.g. influenza and COVID-19) is safe. Healthcare providers also need to recognize that the lack of a recommendation is still a recommendation: it is critical to actively and repeatedly promote annual influenza vaccination, beginning when a child is 6 months old. From this point of view, it is particularly important to recommend vaccination during pregnancy, as it is the best way to protect infants under 6 months. Ensuring that children have timely access to influenza testing and antiviral treatment soon after symptoms appear can also help prevent or mitigate severe flu-related consequences.
There’s no point playing deadly infectious diseases off against each other. Children and adults will die needlessly if we minimize the burden of disease and risk from influenza. It is long overdue to take the threat of the flu seriously. It is our collective responsibility as parents, caregivers, healthcare professionals, scientists and public health advocates to prioritize the actions needed for better influenza prevention and control.
Serese Marotta is Director of Advocacy and Education for Vaccinate your family. Maurine Neiman, a Minneapolis native, is a professor in the Department of Biology and the Department of Gender, Women’s, and Sexuality Studies at the University of Iowa. Marotta and Neiman present at the 15th National Conference on Vaccination Coalitions and Partnerships is scheduled to take place in Minneapolis next week.