Hospital leaders are facing another potentially severe flu season with memories of last year's unprecedented round still fresh in their minds.
The 2017-2018 epidemic accounted for an estimated 80,000 deaths and was the first season in which CDC classified all age groups as "high severity."
Seniors were especially at risk. More than half (58%) of flu-related hospitalizations were people 65 and over. At least 180 children died, 80% of whom weren't vaccinated.
Joseph Masci, director of the Global Health Institute at NYC Health + Hospitals in Elmhurst, New York, told Healthcare Dive last year's flu season was challenging. The system faced crowded emergency departments and larger-than-usual numbers of hospitalized patients.
"The flu put a lot of demands on us, and we felt it. But we were there for our patients throughout," Masci said.
Last #fluseason was one of the worst in recent years, with very high levels of outpatient clinic visits, and hospitalization rates for flu-related illness. https://t.co/rxqR75FHpd #FightFlu pic.twitter.com/ExzydbretC— CDC Flu (@CDCFlu) September 27, 2018
Now, hospital leaders are planning ahead and taking precautions for a new bout with the virus. Here are five questions and thoughts about the upcoming season.
How are hospitals and healthcare organizations preparing?
NYC Health + Hospitals has been urging its medical staff, employees and patients to get vaccinated. Masci said the health site is working toward a 90% or higher vaccination rate to gain the benefits of herd immunity.
"This protects our staff and employees and also protects the patients who come to us for care," he said. "In addition, flu season creates often great demand for our services, so we need our people to stay well so they can provide care to the patients who come to us for care."
CDC reports that 78.4% of healthcare personnel received the flu vaccine last season, similar to previous years.
Hospital employees also must use respiratory hygiene and take infection control precautions to prevent the spread of the illness. That takes hospital leaders spearheading those efforts.
"Successful implementation of many, if not all, of these strategies is dependent on the presence of clear administrative policies and organizational leadership that promote and facilitate adherence to these recommendations among the various people within the healthcare setting, including patients, visitors and (healthcare professionals)," CDC said.
Predicting the unpredictable
Health officials say it's still too early to predict the coming flu season.
"Each flu season is unpredictable. It's hard to say that it will be more severe," Dorothy Loy, director of immunizations at Walgreens, told Healthcare Dive.
However, one predictor is pointing to a possible difficult season.
"We are looking at the southern hemisphere, which has been experiencing another bad flu season," Masci said, adding that the northern hemisphere may be in for similar conditions.
At this point, the CDC is showing minimal flu activity in all states. Two states (Massachusetts and North Dakota) have local influenza activity. There's sporadic activity in 40 states and the District of Columbia. Only eight states are showing no influenza activity.
The flu season usually doesn't peak until December to February and it can stretch to May.
Surveying the vaccine landscape
This year's flu vaccines have been updated to match circulating viruses, such as the B/Victoria virus and the influenza AH3N2 virus, Kristin Dean, associate medical director at Doctor on Demand, told Healthcare Dive. The nasal spray flu vaccine also returns.
Dean said the nasal spray may improve vaccination numbers this year. The spray wasn't used last year because it had a low efficiency in previous flu seasons. Dean said the World Health Organization recommended bringing it back for this season.
CDC projected vaccine manufacturers have a supply of 163 million to 168 million flu vaccine doses this season. The agency is recommending anyone 6 months and older get an age-appropriate influenza vaccine. CDC said last year's shot reduced a person's overall risk of having to seek medical care for the flu by 40%.
FDA Commissioner Scott Gottlieb said the pattern of influenza circulating in the southern hemisphere shows that "the flu strains chosen for this year's U.S. seasonal flu vaccine should offer Americans good protection."
CDC noted that most regular-dose flu shots will be quadrivalent, which targets four strains of the virus rather than last year's trivalent vaccine for three strains.
"While there was some delay in FDA approval of this year's vaccine, which resulted in some locations not having the vaccine available early on, the availability now is very good," Masci added.
Rallying citizens to get the shot
Despite last flu season's sobering numbers, two recent studies found that many Americans still aren't getting vaccinated.
A Walgreens survey said about one-third of Americans haven't received the flu vaccine in the past three years. Clover Health's flu shot monitor also found that 8% of seniors who got the flu last year don't plan on getting vaccinated this season.
People resist flu shots for the same reasons they have for decades. More than one-third said they're afraid a flu shot will get them sick, believe the vaccine is ineffective or don't think they need it.
In response, hospitals and healthcare organizations are educating patients on misconceptions. One way to convince patients they need to get vaccinated is to get them to think not of themselves but their loved ones. Masci said NYC Health + Hospitals tells patients that the greatest risks are for young children and seniors.
"Everyone needs to get vaccinated to help keep our children and seniors as safe as possible," Masci said.
The health system educates patients that they can spread the flu even if they don't have symptoms. "It's possible for someone to get a whole household sick a day or two before the first symptoms appear," he said. If there's a young child or a senior in the house, that risk can be serious. That risk is greatly reduced by vaccination."
Another way to improve vaccination rates is to make them more convenient. Hospitals are offering drive-thru flu shot clinics this year.
Pharmacy chains are also helping with immunization efforts. Loy said Walgreens is working with hospitals and employers to expand immunization efforts, including offsite clinics for employers.
Since 2010, Walgreens has given flu vaccinations to more than 60 million Americans, Loy said. The stores are also open evenings and weekends, which offers people a chance to get a flu shot when doctor offices are usually closed. Walgreens estimates that one-third of its flu shots are provided to customers on evenings and weekends.
A recent Johns Hopkins Bloomberg School of Public Health report found that dispensing flu vaccines at pharmacies saves lives and lower costs.
A potential role for telehealth?
It's not just hospitals and pharmacies preparing for flu season. Virtual care has become more common and can be particularly useful in the fight against the flu.
Telehealth can improve vaccination compliance and can reduce the spread of the disease. Providers can meet virtually with patients with flu symptoms so they don't have to leave their house and potentially spread the illness to others.
Flu patients are increasingly turning to telehealth. American Well saw seven times the volume of flu-related video visits last season compared to the previous one.
For this year, American Well is expecting higher volume across all 50 states. The company looks at patterns from the previous season to match patient demand with provider supply. American Well also works with more than 130 health systems and 55 health plan clients to prepare. The telehealth provider will adjust its plan depending on the daily needs.
Hospital partners are also pointing patients to telehealth as a first line of care. This helps triage patients based on their level of sickness and limits exposure to germs in waiting rooms.