Could the U.S. End Flu Season as We Know It?
(AP Photo/Paul Sancya)
Could the U.S. End Flu Season as We Know It?
(AP Photo/Paul Sancya)
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The 2020-2021 flu season was the most extraordinary in recent memory. As fall turned to winter, we physicians and hospitals braced for influenza cases piled atop already dire COVID-19 numbers. If it was anything like the 2019-2020 season, there could be about four hundred thousand additional hospitalizations. Given the nature of the flu, these cases would require much the same equipment and interventions as COVID-19 sufferers. The expected burden on infrastructure and providers was immense. The American healthcare system braced, and waited.

Then the extraordinary thing happened: nothing.

Instead of the expected catastrophe of an ordinary flu season compounded by a respiratory-disease pandemic, the 2020-2021 flu season simply failed to appear. The metrics of influenza’s collapse were exceptional. The previous season saw 195 pediatric flu deaths: this season saw one. Estimates of about 45 million flu-related illnesses were set aside: by the last week of January 2021, the United States had logged only 925 cases of the flu.

What happened? COVID-19 happened. Or more accurately, social changes driven by the COVID-19 pandemic happened. Americans embraced basic social practices like social distancing, masking, and temperature checks. American workplaces and workers abandoned a longstanding ethic of working while sick, in favor of a positive social imperative to stay home at the first sign of illness.

Of course the above statement is not meant to ignore obvious testing differences between last year and previous seasons, nor other small contributions to the numerical differences.  But it would be remiss to ignore the obvious: changes meant to slow the spread of COVID-19 stopped a host of other diseases dead in their tracks. COVID-19 didn’t stop, of course: but for infections with transmission rates — known in epidemiological parlance as R0 — below COVID-19’s, the effect was dramatic. What merely slowed COVID-19 mostly ended the flu. We’ve shown that we can dramatically slow, or even stop, infectious-disease transmission.

With the end of America’s COVID-19 pandemic in sight, it’s time for us to ask how to sustainably incorporate this hard-earned lesson in a post-pandemic world.

Social distancing and masking can’t endure as common practice, and were never going to overcome the compelling need for authentic human interaction. For the same reason, working from home won’t ever become a universal practice: it isn’t just that we must be present with one another, but that we want to be.

Though a stay-at-home work ethic for symptomatic Americans may persist, corporate America’s competitive drive, and the pressures of the work environment make it unlikely without help. Unfortunately, employees are often incentivized to show up for work when sick. Many Americans lose a day’s pay with every day of lost work, thereby creating a perverse incentive for infectious and sick Americans to risk transmission of disease to co-workers. Many Americans — nearly 70% of parents — faced with a sick child who for public-health reasons ought to stay home, nevertheless send their children to school because they cannot take a day off work. Policymakers should explore how to facilitate these public-health driven changes in practice in American workplaces. Until then, how do we incentivize the simple and effective public-health ethic of staying home when sick?

Here is where technology comes in. Consider temperature checks: Frictionless, non-contact temperature-check technology can monitor public areas, workplaces, or even busy households for elevated body temperature — stepping into the epidemiological gap otherwise filled by social distancing and masking. This easy and non-invasive system detects a key sign of viral infection, often before an individual notices it in themselves.

This solution maintains the visibility of illness and potential risks of spread for the employer and the employee, even as COVID-19 recedes as a motivating force in American life.

The effects would be tremendous. Consider, again, the seasonal flu. Most sufferers of influenza run a fever, with 103-104 Fahrenheit temperatures common: easily detected, long before reaching that stage, by contactless thermography. Imagine its widespread use, in conjunction with workplace stay-at-home practices, in the 2018-2019 flu season. That season in America saw an estimated 35.5 million flu infections, 490,600 hospitalizations, and 34,200 deaths. Based on the experience of the 2020-2021 flu season’s disappearance, we could expect that the overwhelming supermajority of those prior season’s illnesses and deaths would have been prevented. Think of it: most of those 35.5 million infections prevented, most of those 490,600 hospitalizations precluded, and most important, most of those 34,200 Americans still alive and with us.

Temperature check technology is another tool in the technology toolbox to add to those readily adopted during the pandemic, like videoconferencing. It’s special because it keeps the lessons of COVID from fading. It takes the pressure off of us as we attempt to find a new balance, and apply the learning and shared responsibility so much suffering has gained us. Considering what we have lost, we should be very glad for the technological solutions that can help us do that. 

The full range of febrile illnesses and their associated consequences — work-hours lost, and deaths above all — are diminished by these easy steps. Compounded across time and cause, and the American lives saved plausibly range into the millions. If, after 9/11, America responded with investment and social changes for greater security, then the response to the pandemic should be investment and social changes for greater health. Febrile illness, after all, claims more lives each year than terrorism, or even guns.

Life isn’t truly captured in actuarial numbers. It’s in aging parents who live longer, fragile children who get a fighting chance, holidays together that wouldn’t have happened, and hands held in togetherness with loved ones whom infectious disease might have swept away. We can choose all that. The pandemic wasn’t up to us: but this is.



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