Arizona public health officials are preparing for the flu in a COVID world

The start of flu season isn’t generally until October, but public health officials are already preparing for a different kind of response and public outreach campaign than in previous years in advance of what the head of the Centers for Disease Control and Prevention said could be the “worst fall” in history. 

“We can already see what COVID can do to our hospitals,” Arizona Department of Health Services Director Dr. Cara Christ told Arizona Mirror. “So, our worry is, what can it do to our hospitals if we have another surge and we have the flu on top of it?”

The 2019-20 flu season in Arizona was one of the worst on record, and it started “early and fast,” Christ said. In fact, the last two flu seasons have been particularly bad compared to previous years, data shows. 

The 2017-18 flu season saw more than 35,000 cases, followed by more than 36,000 cases in 2018-19. Both of those shattered the previous high-water mark of 23,000 in the 2015-16 flu season. 

That’s one of the reasons why AZDHS is planning to push harder than it ever has to get people vaccinated, Christ said. The campaign is hoping to launch by the end of August, around the time when the new vaccine usually comes out. 

“Influenza is one of the things that scares me the most,” Christ said. “It’s so infectious and people die of influenza.” 

The CDC estimates that between at least 34,200 deaths can be attributed to the flu in 2018 and 2019. 

“Its risk mitigation, not risk elimination,” Crystal Rambaud, vaccine preventable disease program manager for Pima County said, adding that “if you get a whole population on board, it’s huge.”

That’s why Pima County will also be pushing hard to educate the public on the importance of the flu vaccine. 

Still, Christ and other public health officials remain hopeful that the COVID-19 pandemic could actually end up mitigating the upcoming flu season. 

“In public health, we have never had an opportunity like this to get people to wear face coverings during a flu season,” Will Humble, director of the Arizona Public Health Association, said. “Unless we get a wildcard strain that comes out of South America, I expect it to be very mild.” 

Humble argued that COVID-19 prevention measures will mitigate the spread of the flu, as the two viruses both spread in the same way. In fact, Australia saw a huge decrease in their flu numbers this season due largely in part to COVID-19 prevention measures. 

Christ agreed that simple measures such as wearing a mask and handwashing will help both with COVID-19 and prevent the spread of the flu, but worried about another issue: message burnout. 

“We don’t want people to be too tired of these very simple mitigation measures,” she said.

Hence why people like Christ and Humble both agree that mitigation measures are not the silver bullet and that vaccinations are essential for preventing a catastrophic flu season. 

Christ said that ADHS has already been advising local hospitals to put in larger orders for the vaccine, something that the CDC has also done. The CDC ordered 10 million doses of the vaccine, dramatically more than the usual order of 500,000, to ensure that uninsured adults are able to have the vaccine, according to The Hill. 

Pima County has obtained an additional 100,000 vaccines from ADHS, Rambaud said. Those vaccines can be used on uninsured and underinsured people. Additionally the county is doing additional measures they haven’t done in the past. 

They’re partnering with an outside group to set up community flu shot centers in targeted communities that often don’t get the shot or are unable to afford or obtain it, Rambaud said. 

“Definitely a very different scope this year,” Rambaud said. 

Maricopa County said it will be putting a major emphasis on distributing vaccines, as well, though its plans are still being finalized. 

Maricopa County Supervisor for District 5 Steve Gallardo said the county has been looking at a program to provide free flu vaccines for free using CARES Act funds. 

Arizona already has programs through ADHS to provide flu vaccines to uninsured children and adults, and the state is procuring additional vaccines for those programs, Christ said. 

The state is also looking into the idea of drive through vaccination centers as well, Christ said. 

“We’re going to have to strategize on who gets the vaccine first,” said Dr. Shad Marvasti, an associate professor at the University of Arizona and physician who has specialized in chronic diseases. 

Health care workers and medically fragile individuals will have to be careful about how they get the vaccine in a COVID-19 environment and will likely want to get the vaccine right away, Marvasti said. 

The CDC is urging everyone from the ages of 6 months and up to get a flu vaccine this year, something echoed by public health officials in the state. Pima County’s Rambaud said that the clinics dispensing vaccines there will have personal protective equipment and expects other areas will likely be implementing similar guidelines. 

“I think that a lot of places are going to try really hard to reduce those risks and make it safer to come,” Rambaud said, adding that it shouldn’t dissuade people from getting a shot. 

Additionally, places like long-term care facilities are getting additional attention from Pima County to ensure those facilities are having their residents vaccinated. 

Christ said AZDHS will be ensuring long-term care facilities in the state get the “messaging” that they need to vaccinate their residents for the flu. 

But the flu may also present other complications. 

Both the flu and COVID-19 attack the respiratory system and present with the same symptoms: fever, cough and sore throat. 

“There is a great deal of overlap with the constellation of symptoms,” Marvasiti said. “It will be problematic in terms of how to differentiate.” 

However, the flu has a rapid-response test, which can help doctors diagnose it faster than COVID-19, Marvasti added. But how COVID-19 and the flu interact if a patient were to have both at the same time is currently unknown. 

There are challenges to combating COVID-19 concurrent with the flu, but some, like Dr. Marvasti, are cautiously optimistic. 

“It’s easy for us in Arizona to get lulled into complacency since our numbers have gone down,” Marvasti said, adding that he worries about how the flu will spread and impact how we are able to fight COVID in the coming months. “We do really need to take advantage of this window of opportunity.”