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“It’s just the flu.” We’ve all heard this phrase many times, usually to reassure or reassure someone with a respiratory illness.
Throughout the COVID-19 pandemic, “It’s After than the simple flu” has been used to encourage vaccination against COVID-19 and mitigation measures such as wearing a mask. Well-meaning doctors tweet that COVID-19 kills more children than seasonal flu, hoping this information will inspire vaccine-hesitant people to protect themselves Reputable media sources remind people that COVID -19 “almost never poses” a serious threat to children, but also note that COVID-19 nevertheless kills many more children than the flu between 2020 and 2022. Even the popular Hulu series “Pam and Tommy” uses the flu as a metaphor to indicate that even if a particular situation is bad, it is not yet “a plague”.
Now imagine hearing over and over that the flu isn’t a big deal when you’re one of the thousands of people who each year experience the loss of a loved one to the flu. These words are not reassuring. They are infuriating. After COVID-19, influenza is the deadliest vaccine-preventable disease in the United States. Indeed, over the past decade, each flu season in the United States has resulted in between 9 and 41 million illnesses, between 140,000 and 710,000 hospitalizations, and between 12,000 and 52,000 deaths, including more than 100 children. There are also considerable economic and public health burdens associated with influenza that extend beyond hospitalization and mortality, such as lost days of work and school.
We are two of those thousands of people who have been personally affected by the flu. Our previously healthy little boys, Joseph Marotta, 5, and JJ Neiman-Brown, 2, died “just of the flu” in 2009 and 2020, respectively. As scientists and mothers, and in the interest of preventing more such deaths, we ask that we all work together to eliminate the misconceptions in common parlance that minimize the threat posed by influenza.
The flu is dangerous. COVID-19 is dangerous. Measles is dangerous. Whooping cough is dangerous. It’s not a contest. Vaccines are available for these pathogens because they have caused a significant public health burden, including loss of life. Confronting these infectious diseases like a horse race or a boxing match suggests that preventing one of these common, highly contagious and deadly diseases is better than another.
We recognize that changing the culture around these discussions might take some convincing. Our goal in this article is to summarize the evidence that underscores the inappropriateness of downplaying the severity of influenza and reinforces the idea that we can simultaneously promote public health and medical countermeasures against several serious respiratory illnesses.
Influenza-related pediatric deaths are relatively rare, but affect hundreds of families each year. For example, before the onset of the COVID-19 pandemic, 531 children in the United States lost their lives to the flu during the 2017-18 and 2019-20 seasons. A recent study of American children that compared the burdens of influenza and COVID-19 found that the prevalence of life-threatening illnesses was similar for both illnesses. So why do we keep hearing that COVID-19 isn’t “just the flu”? As mothers who have lost their children to the flu, we can attest that it doesn’t seem that rare when it happens to your child.
Since 2004, when influenza-related pediatric deaths became a reportable (reportable) condition nationwide by state health departments at the Centers for Disease Control and Prevention, more than 2,000 children have been killed by the flu. These thousands of pediatric flu deaths are also almost certainly a underestimate, reflecting the reality that some children who die of influenza complications may not be tested for influenza, that influenza viruses may not always be detected by some tests (especially after about a week from the onset of infection), and that the influenza is not always listed on the death certificates of those who died from influenza-related complications. About half of the children lost to the flu were previously healthy, a chilling surprise to many who assume the flu poses no threat to their child.
Data from 2017 to 2021 indicate that, compared to COVID-19, the rate of influenza-associated pediatric hospitalizations was similar or higher in children under 12, but lower in adolescents 12 to 17 years old . Like mortality data, these hospitalization data indicate that influenza may be a more serious illness for children, and especially young children, than COVID-19. So why do we keep hearing that COVID-19 isn’t “just the flu”?
The already grave threat posed by influenza is exacerbated in affected communities by the consequences of systemic racism, including inequalities in access to health care that lead to the stark disparities in disease burden and health outcomes that often characterize members of historically marginalized communities. For example, people from many racial and ethnic groups experience higher rates of serious flu-related outcomes than their white counterparts. A Centers for Disease Control and Prevention study showed significant race/ethnicity-based disparities in flu-associated hospitalization rates, intensive care unit admissions, and in-hospital death rates ; these disparities were even greater among children. These trends were seen among non-Hispanic Blacks, non-Hispanic/Latinx American Indians and Alaska Natives, and Hispanic/Latinx. The pervasive downplaying of the severity of influenza in our country and culture may even intensify these inequalities, particularly from the perspective that members of historically marginalized communities often have relatively limited access to high-quality health care.
We know that annual flu shots are the best protection against seasonal flu. Flu vaccines save lives in adults and children. Yet, flu vaccine coverage has been well below the 70% Healthy People 2030 goal set by the US Department of Health and Human Services as an achievable goal for personal protection and community immunity. During the 2021-22 flu season, preliminary estimates of flu vaccination rates among children, adults, and pregnant women in the United States were 55%, 45%, and 52%, respectively. These rates are even lower among historically marginalized populations. For example, the 2021-2022 vaccination levels among black children and adults, respectively, were 47% and 35%.
There are a variety of reasons why people don’t get their flu shots every year, including the growing threat posed by vaccine misinformation, much of it deliberate. Another major potential factor is the failure to recognize influenza as a health threat. And it doesn’t help to “move the needle” on flu shots when we constantly hear “it’s just the flu.” Primary care providers and specialists should strongly recommend influenza vaccination to all their patients each season and emphasize that it is safe to co-administer vaccines (eg, influenza and COVID-19). Health care providers should also recognize that no recommendation is still a recommendation: It is essential to actively and repeatedly encourage annual influenza vaccination as soon as a child is 6 months old. From this point of view, recommending vaccination during pregnancy is particularly important, because it is the best way to protect infants under 6 months. Ensuring children have timely access to flu testing and antiviral treatment soon after symptoms appear can also help prevent or mitigate serious flu-related consequences.
Nothing is gained by pitting deadly infectious diseases against each other. Children and adults will die unnecessarily if we minimize the burden of disease and the risks posed by influenza. Taking the flu threat seriously is long overdue. It is our collective responsibility as parents, caregivers, healthcare professionals, scientists and public health advocates to prioritize the actions needed to better prevent and control influenza.
Serese Marotta is Director of Advocacy and Education for Vaccinate your family. Maurine Neiman, a native of Minneapolis, is a professor in the Department of Biology and the Department of Gender, Women, and Sexuality Studies at the University of Iowa. Marotta and Neiman will present at 15th National Immunization Coalitions and Partnerships Conference is scheduled to be held in Minneapolis next week.
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