Cause for optimism? COVID-19 could curb spread of seasonal flu

“We really cannot tell how this will play out: The best policy would be to hope for the best and prepare for the worst.”

Ichilov Medical team at the coronavirus unit, in the Ichilov hospital, Tel Aviv, Israel, July 28, 2020. (photo credit: YOSSI ALONI/FLASH90)
Ichilov Medical team at the coronavirus unit, in the Ichilov hospital, Tel Aviv, Israel, July 28, 2020.
(photo credit: YOSSI ALONI/FLASH90)
Social distancing, mask wearing and increased personal hygiene, along with higher rates of flu vaccination, could reduce the number of cases of the respiratory virus in Israel and worldwide this year, according to public health professionals.
“There are some hints from the Southern Hemisphere that the public health measures to prevent COVID-19 also reduce influenza,” chairman of the Israeli Public Health Physicians Association Prof. Hagai Levine told The Jerusalem Post. “There will now be a very unique situation that may teach us how to better prepare for the flu season even after COVID-19 is over.”
According to the Centers for Disease Control and Prevention, both COVID-19 and the flu are spread in a similar manner, via person-to-person contact or between people who are within about two meters of each other. Both are spread mainly by droplets made when people with the illnesses cough, sneeze or talk. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into their lungs.
Furthermore, both can be spread via touching a surface or object that has the virus on it, as well as from infected people with very mild symptoms, before they begin showing symptoms, or who are asymptomatic.
Eyal Leshem, director of the Center for Travel Medicine and Tropical Diseases at Sheba Medical Center, cautioned that while flu incidents may actually be lower this year, the burden on the healthcare system may actually be increased because the threshold for seeing a doctor and for being admitted for hospitalization may be reduced.  
Because flu and COVID-19 share similar symptoms – fever, cough, shortness of breath, fatigue, sore throat, body aches and headaches – people experiencing these symptoms will likely be more inclined to visit their doctor or even seek care in the emergency department, whereas in the past they may have stayed home and rested.
“More people will want to be tested,” he said. “We really cannot tell how this will play out – and the best policy would be to hope for the best and prepare for the worst.”
THERE IS precedent for believing that the measures in place to stop the spread of the novel coronavirus will positively impact the country’s experience with seasonal flu. Already in May, these measures were found to have shortened the flu season in the Northern Hemisphere by about six weeks, according to the World Health Organization. 
“Public-health measures such as movement restrictions, social distancing and increased personal hygiene likely had an effect on decreasing influenza and other respiratory virus transmission,” WHO told Nature magazine in May.
Since an estimated 290,000 to 650,000 people typically die worldwide from seasonal flu, that means the shorter season could have spared tens of thousands of lives.
Furthermore, several infectious diseases are on the decline worldwide and in Israel. 
The Nature article quoted a Hong Kong infectious disease specialist who said that in his country, compared to previous years, the number of chickenpox cases dropped by about half to three-quarters. He also said that in April, global cases of measles and rubella were at their lowest since at least 2016. 
Measles cases have been on the rise for the past several years, spiking by more than 300% in the first three months of 2019 compared to 2018. However, according to the WHO, in 2019 there were 216,662 cases worldwide between March and May 2019, while in 2020 there were only 23,973 during those months – an 89% decrease.
Ever since the introduction of measles vaccination in Israel in 1967, there has been a steady decrease in the number of patients. However, outbreaks still sometimes occur in children who are not vaccinated, mostly a consequence of the disease being imported from abroad, the Health Ministry explains on its website. 
“Measles has been largely eliminated in Israel,” Leshem told the Post. “It only happens when people come from abroad and enter Israel unvaccinated. This has happened several times in the Orthodox community.”
He said the last large outbreak was brought to Israel from London, when a haredi (ultra-Orthodox) young man attended a wedding in the country and infected several people, who then spread the disease. In 2019, Israel had more than 800 cases. 
With the borders closed since March, Leshem said, Israel is not seeing any measles.
FLU SEASON is at its peak this month in the Southern Hemisphere, Leshem added. He said there does not seem to be anything unique about the flu strain there – it does not seem to have a propensity for higher or lower incidents than last season. 
An important aspect this winter will be whether the local population is vaccinated against the flu. On Sunday, Health Minister Yuli Edelstein said that Israel has three million doses of the vaccine and is working to obtain more, though he said they were not yet readily accessible. 
“There could be much hysteria, with people lining up to be vaccinated – and we can really only get one-third of the population vaccinated, meaning we will have two-thirds that do not have any flu coverage," Leshem noted.
In this instance, he said, ideally Israel would successfully prioritize vaccinating older people, those with chronic illnesses, infants and pregnant women; otherwise, the country could face a second crisis. 
Prof. Levine, who is also a Hebrew University-Hadassah epidemiologist, said that in Israel every year, flu season crushes the health system and sick Israelis are hospitalized in the corridors.   
“If we can, by proportional measures, prevent the outbreak of flu, maybe we should do it every winter – wear masks, take better care that sick people do not go to school and work,” he said. “These simple measures could actually prevent many deaths.”
“In every crisis is opportunity," he said. "If we do have an opportunity here to promote public health by improving our preparedness for the winter every year, we should take it.”