Even as coronavirus destroyed populations around the world, killing 3.7 million people globally, doctors and public health officials noticed that something else was missing: there was almost no flu.
A child died of the flu this year in the United States. In 2019-2020, there were 199 influenza-related deaths in children and 144 the season before that. Influenza cases, usually numbered in the tens of thousands of millions, accounted for only a few thousand this year in the United States.
“Influenza has not been anywhere but a reasonable activity in West Africa,” said Richard Webby, an influenza specialist at St. Jude Children’s Research Hospital in Memphis.
“No one has seen it. It includes countries that have done lockdown. It includes countries that have not done any lockdown. It includes countries that have done a good job of controlling the pandemic. It includes countries that have not done a good job, ”Webby told CNN.
It is not entirely clear why. Many experts believe that measures taken to help control coronavirus also prevented the spread of influenza. It is also possible that the coronavirus somehow outperformed or interfered with the flu.
Regardless, Webby and other experts believe that the lull in flu activity is only temporary. They are afraid that when the flu returns, probably in the fall, it will be with revenge.
“The worst flu season we’ve ever had might come,” Webby said.
“When it comes back, it̵
One of the reasons why the coming flu season is likely to be bad can be explained by human behavior. People who are tired of lockdowns, of wearing masks, of staying away from other people, would like to celebrate the freedom offered by vaccines that protect them from coronavirus and pandemic attenuation.
They can exaggerate it.
The journey is already increasing, restaurants are filling up again, and schools are planning to reopen with personal classes.
However, while people flock to resorts, bars and family gatherings may be much safer against coronavirus, they are not safer against influenza or other respiratory viruses that spread in the same way coronavirus is: in the air, in droplets and on surfaces.
“I think with a larger number of people not wearing masks and not having that much social distance, there will certainly be an increase in the common respiratory infections that we see seasonally,” Allison Aiello, who studies the spread of Infectious diseases at the University of North Carolina’s School of Public Health, CNN reported.
Aiello says North Carolina is already seeing an increase in respiratory diseases.
“We can expect there to be some increases, especially in the fall when children go back to school,” she said.
Spread of viruses in school
“It’s not just the flu. It’s all the other respiratory viruses,” Webby said. These include not only the flu but respiratory syncytial virus or RSV, adenovirus, coronavirus strains that cause colds, rhinovirus and others.
“I certainly believe that when the mitigation measures that we have introduced for Covid fall down and the children go back to school in person and we all start traveling again, especially internationally, we know that all kinds of respiratory viruses will have much more opportunities to spread, ”Lynette Brammer, head of the U.S. Centers for Disease Control and Prevention, told CNN.
“And we certainly expect the flu and all the other respiratory viruses that have been low over the last year to come back,” she added.
“In some ways, we’re back to normal. You start putting children together and you get viruses.”
However, Brammer is careful to make predictions.
“Influenza is always unpredictable, and I feel like it’s more true right now than ever,” Brammer said.
There is another reason to believe that the 2021-2022 flu season may be bad. There is a theory, not well documented, that the human body’s immune response is naturally strengthened by repeated, annual exposures to viruses such as influenza. These exposures may not be enough to make people sick, but they are enough to remind the immune system to continue its defenses.
“The longer you go without exposure, the more likely you are to be symptomatic and more likely to get sicker,” Gordon said.
“We know the farther you go without being exposed to the flu, the more symptomatic you are. Sick people lead to more serious cases. We absolutely know that.”
The same goes for RSV, non-Covid-19 coronavirus and other infections. “I would generally be concerned about all of them. Anyone can cause serious illness. Anyone can cause pneumonia,” Gordon added.
In particular, RSV charges a toll on babies and very young children. It kills an estimated 100 to 500 children each year and 14,000 adults, mostly over 65 years of age.
Many of the approximately 4 million infants born during the pandemic get their first exposure to RSV and other viruses when they go to day care for the first time ever. “We do not know what effects it will have on all of these young children delaying their initial exposure to RSV,” Gordon said.
“There are likely to be very large RSV epidemics.”
Aiello is less sure of the possible effect of avoiding bacteria for a year or so. “This is a short period,” she said. Several years of avoiding exposure can be expected to have an effect, but in the 15 months or so, most people have been socially distanced, worked from home, or stayed outside the classrooms may not have been long enough to affect the immune system.
Two years value of viruses packed in one
But the fall respiratory flu may feel worse, even if it actually is not, Aiello said. If nothing else, many children will pack two years of exposure to a variety of viruses in a single season.
“When an individual has not been ill for a while, it may seem like you are experiencing more robust symptoms,” she said.
Influenza will be the only virus measured. Doctors do not test humans for most other respiratory viruses – mainly because there is no specific treatment for them – but the CDC tracks the flu.
Influenza kills between 12,000 and 61,000 people a year, depending on the season, the CDC says.
It says the 2019-2020 season was moderate, with 38 million people in the United States becoming ill with the flu, 18 million seeing a healthcare provider for treatment, 400,000 being sick enough to be hospitalized and an estimated 22,000 dying.
About 8% of the U.S. population falls ill with the flu each season with a range of between 3% and 11%, depending on the season, the CDC says.
Much depends on how many Americans are vaccinated. Every year, just under half of the population gets a flu vaccine, although the CDC recommends an annual flu shot for almost anyone over 6 months.
One thing the CDC knows for sure: Influenza activity is impossible to predict.
“I do not know what to expect. I do not know,” Brammer said. “We’ll just have to wait and see.”
Brammer has seen every flu season for decades, and each one is unique.
“Every time you think you know what’s going to happen, it’s going to do something completely different,” she said.
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