In the first half of 2020, hospital leaders, physicians and other healthcare experts urgently mobilized their resources to meet the crisis of COVID-19. An even graver threat may lie just a few months away, however, if this year’s seasonal flu coincides with another wave of the pandemic. Hospitals across the nation have been brought to the breaking point by COVID-19 but adding hundreds of thousands of ED visits and hospitalizations for the flu will exponentially rachet up the stresses already challenging our healthcare system.
As a society, we have become inured to the toll taken each year by the flu. Even with the mandatory vaccination of healthcare workers and the proliferation of flu shots given to U.S. citizens, we still see around 50 million cases of the flu each year, resulting in about 500,000 hospitalizations and 45,000 deaths. The death toll for COVID-19, of course, has been much higher: as of July 1, there have been 2.6 million cases in the U.S., with 127,762 confirmed and probable deaths.
We must recognize, however, that no doctor can clinically distinguish COVID-19 from influenza. They look the same, they act the same, and until the titers come back, every case of the flu has to be managed as if it were COVID-19. Much of this management must also be done in a healthcare environment suffering from a nationwide shortage of over 200,000 licensed nurses. As such, the critical question we all must address – without delay – is this: how can we prepare for a collision of seasonal influenza and COVID-19?
At the systems level, the lack of clinical clarity between the flu and COVID-19 leads to a number of profoundly challenging questions. How will we provide screening so that effective care can be given to appropriate patients? How will we monitor outcomes and trace contacts of positive screens? Above all, how can we ensure that organizations like universities, healthcare facilities and businesses can continue to function through this fall season, and beyond?
Consider the long-term impact that COVID-19 could have on healthcare education. Students need onsite clinical experiences to complete their training, but many hospitals aren’t willing to risk exposing their patients to students, and vice versa. Without clinical rotations, students never get hands-on experience. One of three outcomes will result: the student can’t graduate; the student can’t get a license; or the student will be less prepared than they should be to enter the workforce. Any of these outcomes places a heavy burden on our already overburdened healthcare system, stopping a new class of professionals from supporting their peers.
Unless and until we develop an effective vaccine, organizations will need to address these issues at scale by escalating their ability to screen, trace, monitor and report the incidence of infections. These capabilities should include:
- Consistent collection of temperature readings
- Declaration of travel and symptoms
- Contact tracing after possible exposure to infected individuals
- Ongoing monitoring for high-risk indicators and trends
- Secure documentation, with the ability to review and audit all collected information
Rigorous health monitoring and contact tracing are likely to remain the best solutions we have for managing the convergence of seasonal flu and COVID-19. But these processes bring considerable logistical, technical and administrative challenges. To avoid a potentially disastrous scenario this fall, organizations need to determine – now – how they will address these challenges.
Dr. Douglas Grant, AB, LLB, MD, CCFP, ICD.D, is the Registrar and CEO of the College of Physicians and Surgeons of Nova Scotia, a leading medical regulator, and part of the Infectious Disease Council (IDC), a multi-faceted coalition of North American experts who have joined together to protect and prepare both individuals and organizations from the threat of emerging infectious disease.