The COVID-19 pandemic has created a new level of awareness of the importance of infectious disease management and prevention. The eager anticipation of the development and approval of a safe and effective COVID-19 vaccine highlights the significant role vaccines have in health promotion. COVID-19 has also reinforced the importance of individuals remaining current with vaccine schedules. With the 2020 flu season approaching, and converging with COVID-19 outbreaks, now is the time to focus on promotion and implementation of flu vaccination programs.
Seasonal Influenza Impact in Numbers
Flu is a seasonal disease, impacting millions each year and putting a strain on health care resources. The World Health Organization (“WHO”) estimates that seasonal influenza may result in 290,000 to 650,000 deaths each year due to respiratory diseases alone.1 According to the Centers for Disease Control and Prevention (CDC), during the 2019-2020 flu season, estimates of its impact in the United States were:
- 39 million to 56 million illnesses;
- 410,000 to 740,000 hospitalizations and
- 24,000 to 62,000 total deaths.2
The economic impact can also be significant. The 2017-2018 flu season, indirectly cost employers about $21 billion in lost productivity, based on calculating average wages lost by missing four 8-hour shifts.3 It is estimated that U.S. employees miss up to 111 million workdays annually because of the flu.4
While not 100% effective, the flu shot is the best way to prevent the flu. Vaccinated people develop protective antibodies against the strains of virus included in the vaccine within approximately 2 weeks. Because protection wanes within 1 year, and each year’s flu vaccine is tailored to the upcoming flu season, people must be revaccinated annually.
What Will Be Different During the 2020-2021 Flu Season?
Capacity: This year, when the flu season converges with the existing COVID-19 pandemic, flu infections will put additional strain on the already stretched health care resources.
Preventing the Flu: Vaccination rates vary by country. The Organization for Economic Cooperation and Development (OECD) has data through 2019 illustrating the country comparisons.5 Higher vaccination rates save lives and alleviate pressure on the health system. Taking the U.S. as an example, during the 2018-2019 flu season, which had a vaccination rate of 49%, the CDC estimates that vaccinations prevented 4.4 million flu illnesses, 3,500 deaths and 58,000 hospitalizations.6 These metrics are especially important now, with many hospitals operating at capacity and with limited availability of respiratory illness equipment due to the COVID-19 pandemic. By increasing the flu vaccination rate, we can not only save lives but also alleviate the burden on the health system.
Two Viruses with Similar Symptoms: Symptoms of the flu and COVID-19 present in similar ways. Determining which virus an individual is infected with will require effective and quick testing at a time when many states and localities continue to be challenged with testing availability and slow turnaround times for results from COVID-19 tests. The lab resources are already operating at maximum capacity, and the demand for testing is anticipated to continue into the fall due to the projected COVID-19 infection rates and the reopening of universities, creating an even higher demand for testing.
Seeking Preventive Care:The fact that there has been a reduced number of in-person preventive visits and an increase in the number of people seeking non- urgent care virtually points to the possibility that adherence to the recommended preventive services that need to be delivered in person, such as vaccinations, may decrease. It is important that individuals do not forego essential services such as routine vaccinations during the pandemic.
Impact of COVID-19 Precautions: It is possible that mitigation efforts in place for COVID-19, including social distancing, the use of personal preventive equipment (PPE) such as masks and face shields, physical barriers in stores and worksites, and stronger cleaning measures in public places , may also help reduce the spread of flu. Some flu virology experts are cautiously optimistic that these may dampen the impact of the flu season. Positive signs have already emerged from the Southern Hemisphere, where there appears to be a lower than anticipated flu infection rate in 2020. However, it is too soon to tell, and just as these mitigation efforts do not prevent the spread of COVID-19, they cannot be fully relied upon to prevent the spread of flu.
The Role of the Employer
Employers have a substantial role to play in health promotion during flu season. This includes education, coverage access, vaccination programs, workplace hygiene and sick policies preventing those with symptoms of respiratory illness from entering the workplace.
On-site Vaccination Programs
Vaccination rates around the world remain lower than recommendations. In the US, for adults 18-49, it remains below the U.S. target of 70%. In fact, the CDC has included workplace flu vaccination sites in its recommended strategies for expanding access to vaccinations and reducing patient costs.7 With many employees now telecommuting, and additional safety precautions required to vaccinate individuals during the pandemic, new approaches need to be considered for how employers can maintain these essential programs and modify them as needed.
Some alternate approaches may include:
- Offering drive-through immunization services at fixed sites, curbside or at mobile clinics.
- Bringing immunization programs to production facilities, utilizing vendors able to adhere to stricter safety measures.
- Ensuring that on-site clinics running flu programs have provided staff with proper PPE and that the cost of additional safety measures has been taken into account.
- Adjusting the flu vaccination site setup and operations to ensure physical distancing by:
- Providing specific appointment times to manage patient flow and avoid crowding;
- Setting up a one-way flow through the site and ensuring physical distancing between patients;
- Arranging a separate vaccination area or separate hours for persons at increased risk for severe illness from COVID-19; and
- Where possible, consider setting up temporary vaccine clinics outdoors.
Not all companies and company locations can provide access to on-site vaccination programs. However, employers can still promote the importance of flu shots to employees and their families. Communicate early and often about the benefits of flu vaccines, especially during the COVID-19 pandemic.
Consider taking the following steps:
- Explain coverage to ease any concerns related to out- of- pocket costs.
- Connect employees to health care providers and clinics that can provide the vaccine.
- Leverage local programs. Governments of many countries are urging as many people as possible to obtain a flu vaccine this year. Australia and New Zealand have begun flu vaccinations early.
- Consider the needs of employees in geographies with limited access to the flu vaccine this year. For example, South Africa has indicated that it will prioritize its available flu vaccines for health care workers, as they have a limited supply.
- Use reliable resources to make the case for the benefit of flu vaccines. Such resources may include:
- The World Health Organization: https://www.who.int/influenza/en/
- Centers for Disease Control and Prevention: https://www.cdc.gov/flu/, and https://www.cdc.gov/flu/season/faq-flu-season-2020-2021.htm; and
- State specific resources such as: https://www.health.ny.gov/diseases/communicable/influenza/seasonal/
According to the Centers for Disease Control and Prevention, vaccination should be deferred (postponed) for people with suspected or confirmed COVID-19, regardless of whether they have symptoms, until they have met the criteria to discontinue their isolation. While mild illness is not a contraindication to flu vaccination, vaccination visits for these people should be postponed to avoid exposing health care personnel and other patients to the virus that causes COVID-19. When scheduling or confirming appointments for vaccination, patients should be instructed to notify the provider’s office or clinic in advance if they currently have or develop any symptoms of COVID-19.
Handwashing and Hand Sanitizer: Employees should be encouraged to wash their hands often with soap and warm water. If handwashing is not available, employees should have access to alcohol-based hand sanitizer.
Sick Employees Should Stay Home: When employees are beginning to experience early symptoms of any illness, especially respiratory illnesses like the flu, they should stay home for as long as they are symptomatic. If the illness was confirmed to be the flu through a positive test result, employees should also remain home for at least 24 hours after their fever has subsided without the use of fever-reducing medications or after symptoms have improved (at least 4-5 days after flu symptoms started).8 Individuals should also seek advice from health professionals about whether their symptoms are consistent with COVID-19 and if a COVID-19 test is needed.
This year, getting a flu vaccine is more important than ever. While it’s not possible to predict how challenging the upcoming flu season may be and what impact the changes in behavior and attitudes toward infectious disease protection will have on the rate of spread, we can be almost certain that flu viruses and the virus that causes COVID-19 will both be spreading this fall. Therefore, the CDC recommends that all people 6 months and older get a yearly flu vaccine.
Employers have a significant role to play in ensuring that vaccinations take place. The time to prepare for the flu season is now.
- 1 | World Health Organization. Burden of disease. https://www.who.int/influenza/surveillance_monitoring/bod/en/. Accessed August 4, 2020.
- 2 | Centers for Disease Control and Prevention. 2019-2020 Flu Season: Preliminary Burden Estimates. April 17, 2020. https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm. Accessed August 4, 2020.
- 3 | Becker’s Healthcare. Flu cost employers $21B last season. October 22. 2018. https://www.beckershospitalreview.com/quality/flu-cost-employers-21b-last-season.html. Accessed August 4, 2020.
- 4 | MedExpress. Financial impact of the flu: how it pays to be proactive. September 10, 2018. https://www.medexpress.com/blog/workplace-wellness/financial-impact-of-the-flu.html. Accessed August 4, 2020.
- 5 | Organization for Economic Co-operation and Development. Influenza vaccination rates. https://data.oecd.org/healthcare/influenza-vaccination-rates.htm. Accessed August 4, 2020.
- 6 | Centers for Disease Control and Prevention. 2018–19 Influenza Illnesses, Medical Visits, Hospitalizations, and Deaths Averted by Vaccination. January 16, 2020. https://www.cdc.gov/flu/about/burden-averted/2018-2019.htm. Accessed August 4, 2020.
- 7 | Centers for Disease Control and Prevention. Flu Vaccination Coverage, United States, 2016-17 Influenza Season. September 28, 2017. https://www.cdc.gov/flu/fluvaxview/coverage-1617estimates.htm. Accessed August 4, 2020.
- 8 | Centers for Disease Control and Prevention. Stay Home When You Are Sick. April 9, 2019. https://www.cdc.gov/flu/business/stay-home-when-sick.htm. Accessed August 4, 2020.