Where’s the Flu?

Suzie Glassman

Why fears over a “twindemic” remain unfounded at this point


Scrolling my social media feed, a video came up from our pediatrician. In it, he said something that stopped me in my tracks. He has seen zero (yes, zero) flu cases in his office so far this season.

According to the CDC, in the U.S., flu activity peaks between December and February, although activity can last as late as May. Here it is mid-January, and my kids’ pediatrician isn’t the only one noticing a lack of sick patients in his waiting room. Many physicians are breathing a sigh of relief after fearing the worst this Fall.

Dr. Anthony Fauci of the U.S. National Institutes of Health in September warned about considerable concern as we enter the fall and winter months and into the flu season that we’ll have that dreaded overlap (meaning COVID and flu). We began hearing the world “twindemic.”

Luckily those fears aren’t playing out. While COVID continues to set terrifying record-breaking numbers day after day, flu cases are also setting records — record lows. Sciencemag.org reports,

The World Health Organization (WHO), based on global surveillance data collected through late last month, says flu activity in the Northern Hemisphere is at “interseasonal levels,” meaning it’s as low as in an ordinary summer.
In the United States, the percentage of outpatient visits for influenzalike illness is at 1.6%, well below the 2.6% baseline used to define a seasonal epidemic. U.S. clinical labs have collected 925 positive samples since the end of September 2020, versus 63,975 at this point in the 2019–20 flu season.

The flu didn’t magically disappear. Where did it go? And can we take a lesson from the past year's events to limit the severity of flu seasons from now on? Here’s what the experts are saying as to why we aren’t seeing the flu this season.

1. Record Number of Flu Vaccinations

Perhaps worry over experiencing COVID and the flu in combination sent thousands more individuals to their local pharmacy. I’ll admit I was far more concerned about having my family vaccinated this year than in the past.

Dr. Kevin Ban, Chief Medical Officer at Walgreens, said,

The unprecedented demand we’ve seen for flu shots this season, along with safety precautions everyone is taking to limit the spread of COVID-19, such as social distancing, wearing facemasks and frequently washing their hands, may be contributing to lower flu activity this season.

Manufacturers of the flu vaccine distributed 19 million more doses this year than last year. The CDC also reported that as of Nov. 21, 44.5 million flu vaccines had been administered in adults in pharmacies so far, compared to 30.4 million at the same time in 2019.

Countries outside the U.S. ordered more flu vaccines than in prior years, as well. The CDC reports, while vaccine effectiveness (VE) can vary, recent studies show that flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population during seasons when most circulating flu viruses are well-matched to the flu vaccine.

2. Masks and Social Distancing are Working

John McCauley, a virologist who directs the Worldwide Influenza Centre at the Francis Crick Institute in London, told Science Magazine he doesn’t believe the low numbers are necessarily due to more flu vaccinations.

McCauley believes measures like social distancing and wearing masks are helping prevent the spread of COVID and contagious viruses like the flu. Not to mention frequent handwashing, covering your mouth and nose when sneezing, and staying home when you don’t feel well.

The flu spreads through droplets in the air and can impact someone up to six feet away. Sound familiar? In addition, the flu is often spread through schools and the workplace, two places highly impacted by efforts to reduce social contact.

What remains to be seen is how our knowledge of mask-wearing and social distancing will impact our behavior in years to come. Can we limit the spread of the flu in the future through these now common measures?

3. Travel Restrictions

While flu season peaks in the Northern Hemisphere in Fall and Winter, the Southern Hemisphere is on the opposite schedule.

Greg Poland, an influenza expert at the Mayo Clinic, told Scientific American,

In the Southern Hemisphere, flu season would have been just taking off, but cases were virtually nonexistent. Never in my 40-year career have we ever seen rates … so low.

Besides the reasons listed above, experts agree that restrictions on incoming air travel during the Northern Hemisphere’s flu season also helped prevent travelers from bringing the flu to the Southern Hemisphere. Of course, the same thing happened in reverse this Fall. Fewer people traveling globally means viruses don’t have the chance to spread across borders.

Bottom Line

Fewer cases of the flu globally are a welcome relief to an overburdened healthcare system. CDC estimated the 2019–2020 flu burden was moderate with 38 million people sick with flu, 18 million visits to a health care provider for flu, 400,000 hospitalizations for flu, and 22,000 flu deaths.

Still, a repeat of last year’s moderate levels was precisely what people like Dr. Fauci feared the most. While flu season isn’t over, and experts warn it come pop up anywhere and at any time, it remains likely this year’s flu season will remain at record low numbers.

McCauley explains,

To see nothing so far, it’s difficult to see how it’s going to come up in large numbers in January.

While travel restrictions are sure to lift once the COVID vaccine reaches widespread vaccination rates, we can continue to increase the number of people who are vaccinated from the flu in future years. We can also stay home when we’re sick, wear masks, and practice better hygiene. We no longer have any excuses.

Photo credit: By Polina Tankilevitch from Pexels

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I'm a reporter covering the Douglas County School District in Colorado.

Denver, CO

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