How the “Tripledemic” is Making this Flu Season One of the Most Serious We’ve Seen

A disease of pandemic proportions.

The flu has been a mainstay of the winter season since it first appeared to infect humans in the 1900s, so much so that we no longer pay much attention to it and have developed ways to prevent, diagnose and treat it without breaking a sweat. But this wasn’t always the case. When the flu virus first began to infect humans, nobody had immunity, nor were there means to mitigate its devastating effects. Nobody invented vaccines yet. Doctors didn’t have antivirals. There was barely any knowledge about how and why the virus was particularly deadly. This combination of factors allowed Influenza A to turn into one of the deadliest pandemics in human history.

The first flu pandemic that occurred in 1918 was one of the most devastating, sweeping across the globe with little to no resistance, infecting over 500 million people and then eventually killing an estimated 20 to 50 million of the world population, almost a million of whom were from the United States. The number of deaths alone shows how deadly this pandemic was, but more so to particular groups of people. Most of the deaths occurred among children younger than five, 20-40-year-olds, as well as older adults over the age of 65. Similar to how the novel coronavirus-causing Covid-19 swept through a vulnerable, unvaccinated population at the beginning of 2020, the 1918 flu caught everyone defenseless. Only non-pharmaceutical interventions such as quarantine, isolation, personal hygiene, and disinfectants were at their disposal to thwart the spread of the virus.

How many people get sick with flu every year?

A 2018 study by the CDC showed that an average of 8% of the US population gets sick with the flu each year. While it’s easy to shrug off this number as seemingly small, we have to consider that the US population in 2018 was well over 332 million, and 8% of that is an eye-popping 26.5 million. This is just the average too. Depending on the severity of the flu season, that percentage can go as low as 3% or roughly 9.9 million people, to as high as 11% or 36 million people. Clearly, these numbers show that influenza isn’t something that is so easily ignored. It is, in fact, an illness that health experts closely monitor all over the world.

While the flu seems to have developed a regular presence in our lives and is one that we encounter repeatedly, it is difficult to measure the actual number of people infected by the virus. Not everyone with the flu gets tested or seeks medical treatment. Most of the people we know, ourselves included, usually call in sick, stay home, rest, and self-medicate all the way to recovery without ever getting in touch with their doctor. This is true for mild to moderate cases, but some people don’t have this luxury and are hospitalized with a severe case of the virus. Based on these hospitalization rates, the CDC makes a statistical estimate of infections, divided by the census population, concluding with a number that best reflects the percentage of flu cases in a given year.

‘Tis the season for flu…

Flu season typically runs from October to May. That is when the weather turns cold, and temperatures fluctuate from the chilly 50s to the downright freezing single digits. During this time, the incidences of flu seem to spike. The months of December, January, and February log the greatest number of cases for the year. However, in the southern hemisphere, flu season doesn’t begin until June before dying down in September. It is the month when it is coldest in this part of the world. Simply speaking, the flu season begins wherever the weather is cold. In fact, the word influenza itself may be referring to its Italian origins, influenza di freddo, which translates to “influence of the cold.”

This has always been the case year after year since the flu virus began to circulate in humans, most evident in the fact that every year, around this time, we are constantly bombarded with public service messaging that encourages us to get our flu vaccines. Primary care physicians, big chain pharmacies and wholesale shopping centers are here to help. State and local health departments also send reminders. Heck, even our social media feeds are bombarded with reminders to get our annual flu shot. The same message is still out there, and that message is more urgent this year because health experts are seeing flu season start much earlier. In turn, September reflects more cases of the flu, which seems to be increasing weekly, straining hospitals and causing a lot of disruption at work and in schools.

Colder, drier climates are ideal for a flu outbreak.

There are many theories as to why the flu is particularly aggressive in the wintertime, but none more pervasive than the idea that the cold is responsible for causing the flu. This, however, is scientifically proven false. While the idea that the cold causes the flu seems to make sense as flu season coincides with the arrival of the cold months, it is, in fact, the presence of the flu virus that causes the illness, and not the temperature. This was proven in the 1930s, when scientists could isolate the virus from humans, tagging it as pathogenic. It is true, however, that the exceedingly low temperatures create an ideal environment for the virus to circulate.

A paper from the 1960s proved this when the study above tested the survival times of different viruses. How? At different temperatures and levels of humidity. It concluded that the influenza virus thrives at low temperatures and humidity levels. The virus studied in the experiment was able to survive for over 23 hours at 43 degrees and with relatively low humidity. In contrast, its survival time of only an hour at a temperature of 90 degrees and with high humidity. This was backed up by a third study that showed high rates of infection following an arid period. It proves once and for all that cold, dry climates are the influenza virus’ playground.

Covid is making this flu season worse.

Over the past two years, no other health concern was more pressing than Covid-19. We lived and breathed it. It dominated our lives and dictated our choices. It was the single most important thing to overcome. All our resources seemed to have been poured into preventing it from creating further destruction worldwide. The virus that causes Covid-19 was so transmissible that its global explosion virtually knocked all viruses, including the seasonal flu virus, into the background. It seems like people rendered them non-existent. Aggressive mitigation measures that were adopted to curb its spread prevented other viruses from circulating. Approaches such as masking, limiting the number of people allowed to gather indoors, shutting down schools and other public places, and practicing social distancing all worked to get us to a point when it no longer terrorizes the public.

But now that Covid has become more manageable. Thus, life has quickly gone back to normal in most parts of the world. Nevertheless, its existence has collided with influenza, back from a two-year hiatus and ready to wreak havoc once again. The fact that Covid has become something we learned to live with instead of something we could eradicate does not bode well for this flu season. As if it wasn’t difficult enough to prevent a Covid infection, now you have to dodge two bullets. Flu cases have reportedly soared early into the flu season. It doesn’t help that both viruses are respiratory in nature. Plus, they share the same symptoms. It won’t be unheard of, or completely surprising, if some people can dodge one, only to be infected by the other. Or worse – catch both viruses and hope they live to tell the tale.

RSV is also making things much worse this time around

Not only are families battling the cold, flu, and Covid viruses going around… RSV came back swinging this year. Respiratory syncytial virus, known as RSV — have been overwhelming hospitals. Public health officials warn that come winter there could be a “tripledemic.” In normal years, RSV sends thousands of children to the hospital over fall and winter, but for the second year in a row experts have seen an unprecedented spike in the number of cases beginning during the summer months. This is particularly concerning for younger children. RSV tends to be much more severe for those under the age of 6 months old; many times, requiring hospitalization.

By age 2, most children have likely contracted RSV. However, it can vary in severity. Daycares, schools, and other high volume areas tend to help RSV and other viruses spread like wildfire. Many educators have reported waves of sickness running through their classrooms at an all time high this year. RSV typically runs its course in 3-5 days with symptoms such as, congested or runny nose, dry cough, low-grade fever, sore throat, sneezing, and headache. More severe cases may result in fever, severe cough, wheezing, rapid breathing/difficulty breathing, and bluish color of the skin due to lack of oxygen. Hospitals becoming overwhelmed by all of these viruses is one of the leading concerns with a triple threat (tripledemic) flu season.

Risk and complications of the flu.

Most people who come down with the flu recover within one to two weeks, but others may experience a more serious bout of the disease. Complications from the flu can range from moderate to severe, like sinus and ear infections, which are considered moderate complications. In contrast, pneumonia is more serious because of the flu virus alone or co-occurring with a bacterial infection. Other severe complications include inflammation of different organs such as the heart (myocarditis), brain (encephalitis), or muscles (myositis, rhabdomyolysis). Multiple organ failure, such as respiratory or kidney failure, can also occur. Those with conditions like asthma or chronic heart disease may find that their ailments are made worse by the flu.

Yes, anyone can contract the influenza virus. However, certain groups of people are more vulnerable to these complications. For them, a regular bout with the flu can lead to hospitalization or even death. The CDC lists people 65 or older, children under 5, and pregnant women. Plus, anyone with a chronic medical condition like asthma or diabetes as most at risk of experiencing complications. People with liver disease, weakened immune systems, neurologic or neurodevelopmental conditions, blood, endocrine, metabolic, or other organ disorders should have a flu shot. The same goes for those who are considered obese. They are encouraged to get their flu shots annually as this is their best protection from the worst outcomes of a flu infection.

Diagnosis and treatment can go a long way.

Because the seasonal flu shares so many of the same symptoms as other respiratory illnesses, it is very hard to distinguish it from a field of other diseases. This is even more true as we approach a flu season whose severity health experts aren’t just bracing for but are already declaring as one of the worst in recent years. Occurring side by side with Covid-19, the common cold, pneumonia, and RSV, the flu can be difficult to diagnose, as all these diseases have symptoms that overlap. If you experience fever, cough, runny or stuffy nose, muscle aches, pains, or fatigue, chances are you may have the flu, but without seeing a doctor or getting tested, you can’t know for sure if that’s what it is or something else.

Influenza has become such a common part of the winter season. We normally don’t raise alarm bells anymore when we fall victim to this virus. In most cases, coming down with the flu is an uncomplicated affair. You can resolve it with a healthy amount of rest, plenty of fluids, and appropriate medication to ease symptoms. As with most viral illnesses, the flu will run its course within one to two weeks. Then, the patient fully recovers. But this is not always the case. If a bout of flu becomes bad enough to require medical attention, antiviral medications are available to combat the worst of the disease. These medications are most effective when taken within two days of experiencing symptoms. They help prevent serious complications while shortening your sick time by 1 to 2 days.

Vaccination is the best line of defense.

An ounce of prevention is worth a pound of cure. Or so the saying goes, at least. If there ever was a more effective way of thwarting a potentially disastrous flu season, it’s through vaccinations. The flu vaccine, in particular, has been around for nearly a century. It first appeared for widespread use in 1945. That was a few years after Thomas Francis and Jonas Salk at the University of Michigan developed it. It was initially tested for safety and efficacy within the military. But then the general public received it. The vaccine has evolved since then to keep up with the similarly growing strains of influenza. That explains why people are encouraged to get a flu shot every year instead of just one shot intended for lifetime protection.

Throughout history, as flu pandemics rose to peaks of destruction before waning into oblivion, scientists observed that apart from the two main strains of influenza, A and B, other sub-variants seemed to branch off and circulate. In turn, evading the protection of current vaccines and prompts health organizations worldwide to monitor these viruses year-round. They work with scientists to stay ahead of these strains with increasingly more sophisticated vaccines. This year, because of the added burden of a fast-evolving and highly transmissible Sars-Cov2 virus, Federal health officials are encouraging everyone to get their flu shot early before flu season comes in full swing. Otherwise, the public would constantly deal with a barrage of viruses. Health officials hope vaccinations will hold the line and help nip a wave of infections in the bud.

Swiss cheese, anyone?

The success of infection prevention cannot rely on only one method of suppression. Why? Because not one way is perfect by itself. There will always be “holes” in each approach, which is why most virologists agree that to prevent the worst outcomes of any viral illness, a layered approach is best. This is where the Swiss Cheese model of pandemic defense comes into play. This model first accepts the imperfection of every prevention approach available. However, they argue that if all these models are taken together, or “layered,” then the strengths of one will be able to cover up the “holes” of the others, creating an effective way of preventing the spread of viral illnesses such as the flu.

So, what are these layers? For a disease that is spread primarily through respiratory droplets and touching infected surfaces, doctors recommend the following. First, physical distancing. Next, avoiding contact with others if you are sick. Wear a mask, practice hand hygiene and cough etiquette. Do not touch your face. Also, avoid crowded spaces. Instead, have ventilation and air filtration. Quarantine and isolation are important. Finally, mass vaccinations. Each layer is crucial in building a fortress of protection, and the more layers in this protective mesh, the thicker and more effective the wall we make becomes. However, while some layers are easily adopted, some, which fall in the realm of personal choice, can become problematic. This happens when a significant percentage of the population refuses to cooperate, leaving many vulnerable to the “holes” that could lead to a particularly disastrous flu season.

Schools are getting hit hard by the flu.

How bad a particular flu season is can be measured by how many people fall ill. Plus, how sick they become. This is nowhere near as evident as in schools, where kids are confined indoors for hours at a time and are, therefore, likely vectors of the disease. According to health officials, this particular flu season looks like it’s already hitting schools early and hitting them hard. Several school districts in California and Virginia raising concerns over likely flu outbreaks. In San Diego, Patrick Henry High School had 1,100 absences out of 2,600 students since the beginning of October. Another school, Del Norte High, had an estimated 884 absences out of 2,517 students.

The same is happening on the opposite side of the US. One Virginia school reported half their total enrollment – about 1,000 students – missing school due to flu-like or gastrointestinal symptoms. It prompted the local health department to investigate and figure out a way to mitigate the situation before it worsens. The flu has been around long enough for schools to at least have protocols in place. The fact that some schools are reporting significant absences so early into the season is already setting off alarm bells, pushing parents, educators, and health officials to review and enforce necessary prevention measures. Those include vaccination, hygiene, and procedures for separating symptomatic individuals to prevent the virus from spreading within the community.

Returning to the office will make this flu season worse.

Most companies are finally walking back Covid work-from-home policies and slowly shifting employees back into physical offices. Health officials predict that the flu virus will also return to the workplace, which might be worse than the cold workers are used to catching in the office pre-pandemic. For all the same reasons that schools are likely incubators of the flu, the workplace is no different, with the added complication of relaxed health and safety protocols, such as the absence of masking and poor vaccination uptake, adding to the recipe for a catastrophic flu season in the making.

Many workers face challenging positions amid a flu season bound to create disruptions. The resurgence of other viruses that have lain dormant as Sars-Cov 2 went on a 2-year rampage around the world is wreaking havoc in the healthcare system. Not only do families and individuals have to combat the flu. They also have to watch out for Covid, RSV, the common cold, pneumonia, and other illnesses that share similarities with influenza, making it difficult to spot and treat accordingly. Sometimes, these illnesses seem to come one after the other without so much as a break in between. It leads to absences, drops in productivity, and problems with childcare for workers with family members who are also sick.

Working from home is no longer an option.

An early uptick in the number of flu cases has many workers feeling particularly vulnerable. Why? Because they try to keep themselves safe from contracting a viral illness amid the pressure of finally returning to the office. However, the chances of picking up a bug have skyrocketed in recent weeks. According to a Gartner survey of 240 HR leaders, 36% of have called workers back to the office at least three days a week beginning September. That figure is up 25% from the previous month. Caroline Walsh, a Gartner VP, says this continues to be the trend despite their data not showing remote work harming performance or culture.

Fears of a looming recession may also compound the pressure to return to the office. That is especially true amid high inflation and a volatile stock market. Amid such a bleak economic backdrop, workers may feel like they have no choice but to come to work sick or risk losing their jobs as companies push for greater productivity to ride out an unstable market through to the end of the year. These circumstances look to erase the gains made in the workplace since the pandemic rewrote the rules for calling in sick. While Covid 19 finally made it okay to prioritize health over productivity, returning to pre-pandemic practices doesn’t mean we have to go back to the misguided heroics of fighting through sickness to work. To prevent this flu season from being one of the worst in recent years, workers’ health should be the priority.

Working while sick shouldn’t be the norm!

For one, working while sick is actually counterproductive. If showing up to work means the job assigned to you gets done, being present at the office at a reduced capacity doesn’t guarantee that the work is up to standard. You won’t have to do it again. Substandard work equals less productivity. Furthermore, physical presence does not always mean productivity. Not only does sickness affect levels of quality, but it also lengthens recovery time, keeping workers from coming back healthy in as little time as possible. If bosses force employees to fight through their sickness, the time they could’ve used to rest and recover exacerbates their illness even more.

Not to mention that showing up to work at a time when flu cases are at an all-time high. A long list of viral illnesses is circulating in the environment is, at best irresponsible and, at worst, downright selfish, with little regard for the welfare of others. We never know what our colleagues are going through health wise. You don’t know if they or their loved ones are immunocompromised. Plus, you don’t know if they go home to families who could be particularly vulnerable to diseases. By exposing ourselves to the workplace in such a condition, we are putting more than our coworkers at risk. Plus, we are putting the lives of their loved ones on the line.

Please, let workers use their PTOs.

Leaders also have a vital role in ensuring that their workforce remains healthy and productive. Providing a meaningful amount of paid sick leave should be a top priority. That goes double as we enter an awful flu season. The potential for contracting illnesses in the workplace or bringing viruses in and spreading them around is at an all-time high. However, paid time off is considered a luxury. In fact, 1 in 5 employees don’t have access to it. That is especially true for those considered low-wage workers. For those who do have this benefit, managers should encourage their subordinates to use those PTOs. Knowing that their managers are supportive of their health allows workers to focus on recovery without fear of losing their jobs due to absences.

Another way managers can take the lead in preventing significant loss in productivity due to illness is to take time off themselves. As leaders, they set the expectations for good self-care in the workplace. They must show workers that you aren’t invincible yourself. Plus, you should know when to pull back will permit everyone else to do the same. Good managers know that productivity is all about keeping workers at peak performance. If that means allowing everyone, including themselves, to take a day or two off to recover, everyone in the office will be all the better.

Where Do We Find this Stuff? Here Are Our Sources:

https://www.everydayhealth.com/flu/flu-season-looks-to-be-off-to-an-early-and-robust-start/

https://www.cnbc.com/2022/11/10/why-flu-season-is-so-bad-this-year.html

https://www.cnbc.com/2022/10/24/cold-and-flu-season-is-here-and-people-are-showing-up-to-work-sick.html

https://sitn.hms.harvard.edu/flash/2014/the-reason-for-the-season-why-flu-strikes-in-winter/

https://www.cdc.gov/flu/about/keyfacts.htm

https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862331/#:~:text=Influenza%20pandemics%20have%20been%20reported%20for%20at%20least,see%20what%20has%20developed%20from%20his%20earlier%20assumptions.%E2%80%9D

https://www.macrotrends.net/countries/USA/united-states/population#:~:text=United%20States%20-%20Historical%20Population%20Data%20%20,%20%200.80%25%20%2069%20more%20rows%20

https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination

https://www.nytimes.com/2020/12/05/health/coronavirus-swiss-cheese-infection-mackay.html

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