The Flu Is Coming: Too bad we are ignoring the lessons learned from Covid

“We know that kids are an important source of influenza infections.  They get it at school or day care, and they bring it home to the household,” Nayak says. Many adults also aren’t wearing masks or avoiding crowded spaces, “so there’s a potential for more transmission of influenza” this year.  “Australia’s tough flu season could spell trouble for the US this winter, especially with Covid-19 in the mix,”  CNN, September 6, 2022

Many Americans have claimed that Covid is no worse than the flu.  But all one has to do is look at the number of deaths in the United States from the flu in a typical year versus Covid to realize how nonsensical the claim is.

Nevertheless, there is a good reason to compare the flu to Covid.  How so?  Strategies and tactics that were used to reduce the transmission of Covid virtually stopped the flu in its tracks in 2020-2021.  Unbelievably, only about 700 Americans died of the flu in the 2020-2021 season, when typically we lose tens of thousands.  An ethically healthy society would look at the number of lives saved and the suffering avoided during this time and say: “Wow!  It looks like anti-Covid measures can help us against the flu and other viruses in the future.  Wonderful!  We need to make it happen.”

But we are not an ethically healthy society.

Let’s take a look at the effectiveness of various measures and then return to the issue of the morality of ignoring what we have learned.

Since the novel coronavirus began its global spread, influenza cases reported to the World Health Organization from the Northern and Southern Hemispheres have dropped to minute levels. The reason, epidemiologists think, is that the public health measures taken to keep the coronavirus from spreading—notably mask wearing and social distancing—also stop the flu. . . . The U.S. saw about 700 deaths from influenza during the 2020–2021 season.  In comparison, the Centers for Disease Control and Prevention estimates there were approximately 22,000 U.S. deaths in the previous season and 34,000 deaths two seasons ago. “Flu Has Disappeared for More Than a Year,” Scientific American, April 2021.

In the last decade there have been years in which we had over 50,000 deaths from the flu.  When we look at pediatric deaths from the flu we find:

For pediatric deaths, CDC received one report of a pediatric flu death in a child during the 2020–2021 flu season.  Since flu deaths in children became nationally notifiable in 2004, reported flu deaths in children had previously ranged from a low of 37 (during 2011-2012) to a high of 199 (during 2019-2020).  CDC.

To learn more about measures that can help, let’s take a look at those that were employed with great success by Japan against Covid, and as it turns out, which also worked exceedingly well against the flu in Japan, presumably because both the flu and Covid are spread in similar ways, although Covid is more contagious.*

Japan has one of the oldest populations in the world.  Approximately 29% of its population is 65 and over.  Much older than the US, and clearly older than Florida, whose officials and boosters keep telling us that it is the age of its population that led to so many deaths in Florida.**

In Florida 21.3% of its population is 65 and over.
In Japan it is 29.18%.

Florida has had 375 deaths per 100K people.
Japan has had 34 deaths per 100K.

Pause for a moment and consider: 375 vs. 34; 11 times more deaths!

The United States as a whole has had 316 deaths per one hundred thousand, with 16.85% of its population 65 and older.  So, over 9 times the number of Japanese deaths per 100K, with a significantly younger population.

What allowed Japan to keep its death rate so low relative to the USA?  Mandatory lockdowns?  No.  Mandatory lockdowns are against Japanese law.

Under the law, the Japanese government does not have the authority to enforce citywide lockdowns. Apart from individual quarantine measures, officials cannot restrict the movement of people to contain the virus.  Consequently, compliance with government requests to restrict movements is based on “asking for public cooperation to ‘protect people’s lives’ and minimize further damage to [the economy]”  Covid-19 Pandemic in Japan, Wikipedia.

And here’s what people were told:

People should avoid the three C’s, which are closed spaces, crowded places and close-contact settings.  The Japanese government shared this advice with the public in early March, and it became omnipresent.  The message to avoid the three C’s was on the news, variety shows, social media and posters.  “Three C’s” was even declared the buzzword of the year in Japan in 2020.  “What Japan Got Right About Covid-19,” The New York Times, January 2022

Japan also had retrospective contact tracing, seeking to learn where and when a person was infected, and who else might be infected.  In addition, during a state of emergency, governors were permitted “to restrict the use or request the temporary closure of businesses and facilities, including schools, social welfare facilities, theatres, music venues, and sports stadiums.”***

As for the future:

Even though over 70 percent of Japanese citizens are fully vaccinated, vaccination alone won’t be sufficient for the world to live with Covid-19.  The Japanese people will need to embrace the three C’s whenever there’s a surge.  This is most likely how we will continue to adapt to life with the virus. “What Japan Got Right About Covid-19.”

Let’s recall that in the United States there was one recorded death of a child due to flu in 2020-2021 in the US versus a low of 37 and a high of 199 since 2004.  Now think about this cumulatively and ask: How many children’s lives will be lost over a ten year or twenty year period if we ignore the lessons learned in 2020-2021?

And of course the flu has potential consequences for those it doesn’t kill:

They include viral or bacterial pneumonia, dehydration, and ear infections and sinus infections, especially in children. The flu can worsen long-term medical conditions, like congestive heart failure, asthma, or diabetes.

You might also have muscle inflammation (myositis), problems with your central nervous system, and heart problems such as heart attacks, inflammation of the organ (myocarditis), and inflammation of the sac around it (pericarditis). “What Are Flu Complications?” (WebMD).

When we see death and consequences on this scale, it would be unethical to turn our backs on what we have learned.  There is too much solid evidence not to act, and the costs of action are minimal in relationship to the potential benefits.  But instead of a willingness to act, we see a drive to return to “normal” and pay as little attention as possible to what we have learned.  It’s quite sad, really: ignoring what we have learned because we want to pretend the pandemic didn’t happen (or that it’s over).

No one is suggesting that we go back to all of the measures used during the first year of the pandemic.  We don’t have to, not for seasonal flu, but we can employ much of what we have learned.  People should of course get flu shots.  And during the height of a flu season they should Do the Right Thing: cut back on crowded social gatherings, social distance when necessary, wear masks in enclosed public spaces, make sure that schools have properly filtered air, extend the Christmas school break if we are in the middle of a surge in flu cases, etc.

If we could avoid half, or 1/4, 1/5, or even only 1/10 of the illness and death that we see in a typical flu season it would be the right thing to do.  Since this coming flu season has the potential to be an especially bad one, we have all the more reason to utilize what we know.  Yet it’s highly unlikely we will.  Medical professionals may be especially worried about a bad flu season this year, but have you heard any public health announcements beyond the standard “get vaccinated,” which of course makes a public health issue into a matter of personal responsibility?  And this course of action alone is misguided, because it leaves us depending too much on vaccines.  Vaccines can’t promise 100% protection.  Flu shots typically don’t come close.  When the vaccines are a good match for a particular strain, “flu vaccination reduces the risk of flu illness by between 40% and 60% among the overall population.”****  Flu remains a public health issue, which involves more measures than vaccination, as do other highly contagious viruses.

Americans talk a good line about the value of individual lives.  Don’t believe it.  It’s nice in the abstract, this talk of the sacredness of the individual.  But ask people to be inconvenienced or lose a little money to help others, and it’s Not My Problem!  Or as the recent mask campaign in NYC put it, “You do you.”  It’s not about the sacredness of individuals in general.  It’s about my individuality, my desires, my health.  Morality, however, is not primarily focused on how I treat myself.  It is about how I treat and respect others.

It would be tragic if we ignored what we have learned.  In our rush to return to “normal,” we will end up condemning thousands to needless illness, suffering, and death.  Must this be The American Way?

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* Regarding influenza cases in Japan:

Influenza cases in Japan are at a record low level for a second consecutive season.

Every year, the Ministry of Health, Labor, and Welfare publishes weekly figures of flu cases from September until May of the following year.  In a typical year, there is a steady uptick in cases from November, but as with last season, the number of reported cases in 2021–22 remains extremely low. Measures taken against COVID-19, including the use of masks and regular washing and disinfecting of hands, seem to also be effective in flu prevention.  “Flu Cases in Japan Remain Extremely Low Again in 2021–22,” Nipon.com, January, 2022.

** Figures on Covid deaths are from The New York Times, as of September 13, 2022.  Per cent of seniors in the US and Japan in 2020, Wikipedia, source The World Fact Book.  Florida’s per cent of seniors in 2020, PRB.

*** Here a longer summary regarding what the Japanese government could do:

The amendment allows the Prime Minister to declare a “state of emergency” in specific areas where COVID-19 poses a grave threat to the lives and economic livelihood of residents. During such a period, governors of affected areas will receive the following powers: (1) to instruct residents to avoid unnecessary outings unless they are workers in such essential services like health care and public transportation; (2) to restrict the use or request the temporary closure of businesses and facilities, including schools, social welfare facilities, theatres, music venues, and sports stadiums; (3) to expropriate private land and buildings to erect new hospitals; and (4) to requisition medical supplies and food from companies that refuse to sell them, punish those that hoard or do not comply, and force firms to help transport emergency goods.  From Covid-19 Pandemic in Japan, Wikipedia.

**** From the CDC:

CDC conducts studies each year to determine how well influenza (flu) vaccines protect against flu.  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 those used to make flu vaccines. https://www.cdc.gov/flu/vaccines-work/vaccineeffect.htm