Written by Katie McCall

Hospitals are bracing for fall and winter as the COVID-19 pandemic presses on. Between cases of the flu, strep throat, pneumonia and other respiratory illnesses, hospitals anticipate a busy season every winter. However, with COVID-19, the combination of factors paints a problematic picture for strained hospitals with limited or reduced capacity.

Public health officials are already concerned about a second wave of COVID-19 in the winter. But what is more concerning is the threat of a “twindemic” – a confluence of two different infectious disease outbreaks occurring at the same time. Looking ahead to the fall, experts are warning against a severe flu season paired with a surge in COVID-19 patients. Even a mild flu season could put serious pressure on hospitals that are already pushed to the limit.

young women gets a temperature check with a medical device at her forehead

Millions of Americans are infected with influenza annually. Hundreds of thousands end up hospitalized with the flu or flu-like symptoms. According to the Texas Department of State Health Services, over 10,000 Texans died during the 2018-2019 flu season. The flu shot can prevent illness that lead to unnecessary medical visits, hospitalizations and further stress on our health care system.

Carrie Williams
Williams

“We have a critical advantage to fight the flu, a vaccine. It’s important that hospitals are working in their communities to increase awareness of the importance of the flu vaccination and increase the percentage of Texans who are vaccinated this year,” said Carrie Williams, vice president of communications at the Texas Hospital Association.

THA recently launched a campaign to encourage every Texan to get their flu shot. The campaign uses the tried-and-true hygiene messaging that resonates during the COVID-19 pandemic, as well as clear, urgent communications that encourage Texans to get their flu shot. THA offers resources in English and Spanish to help hospitals encourage their patients and communities to get their flu shot. The messages will change as the flu season continues.

Melanie Wick
Wick

To better support the hospital systems, physicians underscore the importance of getting a flu shot this year. “The flu shot reduces the burden of illness, the number of flu cases and boosts individuals’ immune systems,” said Melanie Wick, MD, chief of operations for pediatrics at CHRISTUS Trinity Mother Frances and board-certified pediatrician at CHRISTUS Trinity Clinic Pediatrics in Tyler.

Mitigating Risks

As society practices social distancing to combat the spread of COVID-19, families are increasingly avoiding going to the doctor. Primary care visits have dropped nearly 50% during the COVID-19 pandemic, according to a study from Harvard University. People’s behaviors and perceptions around accessing health care have changed with many worried more about contracting COVID-19 than the long-term health impacts of skipping visiting the doctor.

Texas hospitals are putting new safety measures in place to reassure patients during the pandemic, imploring them to seek treatment in a timely manner. Hospitals are also urging parents and children to stay up-to-date with exams and immunizations, especially with flu season just around the corner.

Hospitals are stressing that avoiding or deferring treatment and immunizations is not worth the risk of more dire long-term consequences. While children can quickly catch up if they have only fallen behind schedule for two or three months, medical experts say it is not worth it to intentionally delay vaccination due to COVID-19. Dr. Wick says that flu shots and scheduled childhood vaccinations are particularly essential while COVID-19 is highly contagious.

Hospitals and doctors’ offices across the state have put in new safety and infection control measures to keep patients protected from COVID-19. Personal protective equipment is required for all staff and patients. Touchless thermometers have been deployed to check for fever. Clinics are also thoroughly disinfecting offices, limiting visitors and separating well checks from sick visits.

“Hospitals and their primary care clinics across the country have really changed the way we practice medicine in response to COVID-19,” said Dr. Wick. “We’re making our clinics as safe as absolutely possible to make it easy for patients to get the care they need, while significantly decreasing patient-to-patient contact.”

Hospitals and care clinics have shifted many visits to telemedicine to decrease the risk of spreading germs. For in-person visits, many pediatric offices are limiting one parent per visit. Patients, visitors and staff are required to wear masks and are screened for symptoms or possible exposure.

Hospitals have also employed new technologies to mitigate spread. In March, THA partnered with care.ai to create thermal temperature scanners. These ensure that any staff or visitors entering the building are fever-free.

Radha Mahale
Mahale

Radha Mahale, MD, Baylor Scott & White’s assistant division director for primary care in the Austin/Round Rock region, echoes Dr. Wick. “We’ve taken this very seriously. Our pediatric location has a self-rooming process that allows patients to avoid the waiting room altogether.”

Baylor Scott & White was the first health system in Texas to offer a drive-thru COVID-19 testing site. Through their online screening process they screened more than 200,000 patients across the entire system from March through July. They swiftly put things in motion by reconfiguring their pre-existing drive-thru flu shot clinics. For patients that do not need to be seen in the office, telehealth, drive-thru and curbside touch points are here to stay during the pandemic. “This is how we will continue to deliver some of our vaccines, especially the flu shot, in the coming months,” said Dr. Mahale.

Vaccines protect adults and children against known diseases that are still active, while stimulating the immune system to protect against diseases experts are still learning about, according to the National Institutes of Health. “While we do not have a vaccine for COVID-19 yet, getting other vaccinations stimulates the immune system and distracts the immune system decreasing the response to COVID-19,” said Dr. Wick.

Timely Vaccines Offer a Lifetime of Protection

Vaccines aid in the development of herd immunity, a phenomenon that occurs when enough people in a population have antibodies, thereby reducing or eliminating spread in the community. While medical experts do not yet have enough information about herd immunity as it relates to COVID-19, science has a firm grip on other known, deadly diseases.

“Society does much better when we have complete vaccination for diseases like measles, mumps or rubella. When the patient is protected, and 85-95% of people also receive that vaccine, we don’t see an outbreak very often. This way, when someone is exposed, the herd is protected and there aren’t that many other cases,” said Dr. Wick.

hands being washed

Prior to vaccine introduction, annual measles incidence peaked at 85,862 in 1958 in Texas. Since the introduction of a vaccine, the Texas Department of State Health Services reports cases have decreased by 99.9% in Texas. Dr. Wick cautions that when populations do not keep up with vaccinations, herd immunity stops working. “In areas where the number of people vaccinated drops below 95%, below the level required to maintain herd immunity, measles can start circulating. One person with the measles can pass it to 12-18 other people and that’s where giant amusement park outbreaks have occurred,” said Dr. Wick.

Dr. Mahale stresses that if everyone was up-to-date, the effect of a pandemic would be reduced. “New diseases will come up in our lifetime, but all we can do is protect ourselves against the ones we know about,” said Dr. Mahale.

Common sense practices also go a long way during a pandemic outbreak. “What we have in our control is prevention. Immunizations are a big part of prevention, but so are best practices of cleanliness, including self-care, getting plenty of sleep, hand washing, eating well and exercising,” said Dr. Mahale.