The National Foundation for Infectious Diseases (NFID) issued a new Call to Action report detailing the risks of co-infection with influenza (flu) and COVID-19 in adults with chronic health conditions, and the importance of flu vaccination during the 2020-2021 season.
The goals of the report, The Dangers of Influenza and COVID-19 in Adults with Chronic Health Conditions, have been supported by more than 35 leading medical organizations, including the American College of Cardiology, American College of Emergency Physicians, American Diabetes Association, and American Lung Association, who are now urging their stakeholders to prioritize flu vaccination for these high-risk populations.
In the US, six in ten adults have one or more chronic health conditions, including heart disease, lung disease, and diabetes, that put them at increased risk for flu and COVID-19.
For this population, related complications include the potential exacerbation of underlying health condition(s), as a result of flu-related inflammation that may persist long after the acute infection, as well as increased risk of long-term complications, such as heart attack and stroke, after experiencing acute flu or COVID-19 infection.
According to the Centers for Disease Control and Prevention (CDC), annual flu vaccination has been proven to mitigate serious flu-related complications, preventing an estimated 7.5 million flu illnesses, 3.7 million flu-associated medical visits, 105,000 flu hospitalizations, and 6,300 flu deaths in 2019-2020 alone.
Yet, a recent NFID survey found that nearly one in four US adults at high risk for flu-related complications said they did not intend to get vaccinated during the 2019-2020 flu season.
Amidst the COVID-19 pandemic, patients with chronic health conditions are facing not one, but two viruses that pose a serious threat to their health and independence. While we currently don't have an approved COVID-19 vaccine in the US, we know that annual flu vaccination can help protect these patients from hospitalization, progressive disability, and even death. It is imperative that healthcare professionals educate patients with chronic health conditions about their risks and implement strategies to increase flu vaccination rates during the COVID-19 pandemic."
William Schaffner, MD, Medical Director, National Foundation for Infectious Diseases
In advance of an unprecedented 2020-2021 flu season, NFID convened a multidisciplinary virtual roundtable with leading experts to explore the risks of co-circulation and co-infection with flu and SARS-CoV-2 (the virus that causes COVID-19) in adults with chronic health conditions.
The resulting NFID Call to Action, which summarizes the roundtable discussions, includes best practices for administering flu vaccines in conjunction with COVID-19 mitigation efforts.
Despite the limited data currently available on outcomes from co-infection with the two viruses, insights from the roundtable highlighted that the impact on patients and the US public health system could be catastrophic.
"It won't take a 'bad' flu season--just 'a' flu season to make things more difficult in the ER and elsewhere in the US healthcare system," said Nicholas F. Vasquez, MD, vice chair of the Diversity, Inclusion, and Health Equity Section of the American College of Emergency Physicians. "Further strain due to the co-circulation of flu and COVID-19 could disrupt routine care and have detrimental consequences for adults with chronic health conditions."
The relationship between flu and heart disease is of particular concern during the current pandemic, as severe COVID-19 outcomes have also been associated with pre-existing cardiovascular conditions and post-infection injury to heart tissue.
Over the past eight US flu seasons, nearly 47 percent of patients hospitalized for flu had heart disease, making it the most common underlying health condition associated with flu-related complications. Fortunately, flu vaccination can serve as an effective prevention strategy in these patients.
One study estimated the flu vaccine is between 15 to 45 percent effective in preventing heart attacks and strokes, making it equal to or more effective than smoking cessation, statins, and antihypertensive therapy.
"I am greatly concerned for heart disease patients this flu season. It is already well-documented that heart disease is a risk factor for severe flu-related illness, but with COVID-19, we are entering a dangerous and uncharted territory," said William B. Borden, MD, professor of medicine and health policy at George Washington University, representing the American College of Cardiology.
"The most important thing we can do to protect these patients is to ensure they are getting their annual flu vaccine. I am making it a point this season to strongly recommend a flu vaccine to every heart patient I see and urge my colleagues to do the same."
To help increase flu vaccination rates, the NFID Call to Action offers strategies and tactics for healthcare professionals, particularly specialists treating adults with chronic conditions during the 2020-2021 flu season, including communication methods for discussions with both patients and office staff, vaccine implementation strategies specific to the COVID-19 pandemic, and techniques for addressing vaccine misinformation.
"All healthcare professionals, including specialty care providers, have a duty to understand the risks our patients face and advocate for any preventive measure that can preserve health and save lives," said NFID President Patricia N. Whitley-Williams, MD, also representing the National Medical Association. "If you treat a patient with heart disease, lung disease, diabetes, or another chronic health condition, then you have a responsibility to insist upon annual flu vaccination."
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