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As cases of omicron and influenza surge across the United States this winter, Vox's Dylan Scott argues that "flurona" will become the new "post-pandemic normal" flu season.
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Flu activity remains elevated despite a slight decline
Overall, flu activity in the United States during the week ending in Jan. 8 remained significantly higher than the 2020-2021 season —a trend that is expected to continue for several weeks.
According to CDC data, a total of 617 new flu cases were reported for the week ending in Jan. 8, down from 785 for the week ending in Jan. 1. During the same time period in 2021, the United States recorded just 4 and 16 new flu cases in those weeks, respectively.
Reports of influenza-like illnesses remained stable for individuals 65 and older and declined for all other age groups, CDC data shows. For the week ending in Jan. 8, 4.3% of patient visits reported nationwide were from respiratory illness that included a fever, cough, or sore throat, down from 4.8% the week prior.
In addition, hospitalizations for influenza also declined. According to CDC data, 1,804 new hospital admissions for influenza occurred the week ending in Jan. 8, down from 2,615 the week prior.
Will we have a 'flurona' wave every year?
Influenza has always been a seasonal virus, with the dominant strain peaking sometime between December and February, Scott writes. However, Covid-19 spikes are not bound to a specific season, and in 2020 and 2021, the United States typically experienced small Covid-19 surges in the summer and larger surges in the winter.
During the 2020-21 flu season, flu case numbers were abnormally low. Experts said measures meant to stem the spread of Covid-19, including school closures, social distancing, mask-wearing, and canceled travel, likely contributed to lower flu numbers. But now, flu cases are rising again, and Covid-19 case numbers and hospitalizations are at record levels.
Before the Covid-19 pandemic began, flu activity alone would place a significant strain on U.S. hospitals. Now, with the potential for both viruses' timelines to overlap, Scott says the United States will need to develop a new public health strategy that addresses Covid-19 and influenza surges as a single, unified threat.
"We are on the lip. We are in a transitional phase, moving from pandemic to endemic," said William Schaffner, medical director of the National Foundation for Infectious Diseases and a professor at Vanderbilt University. "With two of these respiratory viruses going on at pretty much the same time, I think that will create a greater stress on the health care system."
Separately, Richard Webby, an influenza expert at St. Jude Children's Research Hospital, said, "We know during a pretty bad flu season, that can put a strain on things," however, "[n]ow we're talking about two flu seasons."
However, according to Webby, this scenario is still hypothetical. It is possible that the flu and Covid-19 won't surge at the same time, and will instead spike and fade in cycles, Scott writes. And if the viruses spike in alternating waves, it could decrease the risk of an overwhelming number of patients flooding into U.S. hospitals.
But, in a recent medical journal article, a group of advisers to President Joe Biden's transition team wrote that "Covid-19 must now be considered among the risks posed by all respiratory viral illnesses combined," and that this combination of respiratory viruses could overwhelm the U.S. health care system every winter.
According to Scott, the imperative to "flatten the curve" to limit "flurona" cases from overwhelming hospitals will be "with us for a long time." To combat these future waves, Anand Parekh, chief medical adviser at the Bipartisan Policy Center, said the United States should focus on vaccination, testing, treatment, and masking. (Scott, Vox, 1/18)
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What recurrent outbreaks will really mean for health care leaders
By Christopher Kerns, Vice President of Executive Insights
The omicron surge is genuinely, even if temporarily, straining the health care system. And if this level of intensity plagues our health care system annually… then 'something’s gotta give,' as they say. Health care workers won't be able to manage through this forever, at least not in the way they have been obliged to do so.
But here's the thing: it’s by no means clear that future Covid-19 surges will look like omicron. While hard to imagine, they could actually be worse. Or, hopefully, they could be significantly milder, a possibility that increases if prior Covid-19 infection continues to protect against future severe illness. Unpredictability is the whole point of genetic mutation, after all. The point is that we just don't know, and it could be harmful to offer prescriptive guidance based on assumptions that may or may not be true and don’t appear to be reinforced with compelling disease models. In fact, prescriptive guidance may only help in areas where political will is strong enough to enforce it, and it is evident that this will (and the associated public willingness to comply) is rapidly dwindling. And I should also note that omicron’s experience shows that even the most restrictive enforcement is little match for a respiratory virus that seems to increase in transmissibility (if not lethality) with new variants.
I think it is important to double down on what this Vox piece only tangentially references—the problem is more about staffing than it is about beds. We've discussed workforce implications when the future is uncertain, and we can confidently discuss supply/demand and how to prepare for the future when we have no idea what is coming. That feels more useful than projecting implications about future winters mimicking this current one.
Our guidance
Rather than basing guidance off uncertain future worst-case scenarios, we believe in preparations that will support the health system regardless of our future situation. Our recommendations to prepare for the future are the same as what we have been saying for two years:
- Embrace the outpatient shift to make room in hospital beds;
- Adopt top-of-license care models to efficiently deploy the most appropriate resources; and,
- Apply scalable tech solutions wherever possible to help make up for what we now have to accept are structural staff shortages.
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