CASPER — State and county health officials along with medical facilities in Wyoming are preparing for flu season as COVID-19 continues to spread. This year, they must prepare to balance typical planning and preparation for flu season with the added challenges of the coronavirus.
State and local health officials urge people to protect themselves and others as well as to help prevent strain on medical facilities and resources by receiving a flu vaccine and following COVID-19 prevention guidelines like wearing masks.
The vaccine prevents the flu or at least reduces the severity of illness, State Health Officer Dr. Alexia Harrist said.
“The influenza vaccine is always important, but this year it really is more important than ever. It can help prevent influenza from becoming a big problem while we also have COVID-19 happening.”
One focus as the Wyoming Department of Health prepares for flu season is the ability to accurately diagnose both illnesses, which can share some common symptoms, Harrist said.
Specific measures are required to fight the spread of COVID-19, such as isolation, quarantine and testing contacts of those with the illness. It’s important to be able to accurately diagnose the flu, too, because treatments and prophylactic medications are available for that illness.
“We want to make sure that we can identify flu so that we can implement those measures which are known to be quite effective and control disease that way,” Harrist said. “And so certainly, moving forward into the fall, we’re going to have both influenza and COVID. Symptoms are going to look fairly similar in many cases, and it is important that we be able to do surveillance and testing for both of those conditions.”
Some promising developments are on the way that could help.
The Centers for Disease Control and Prevention are developing a single laboratory test to detect both at once, and rapid testing technologies are being developed to diagnose flu and COVID-19. The Wyoming Public Health Laboratory and providers around the state are looking to bring on some of the technology.
“That will be very helpful both for individual patient management as well as ... implementing public health measures,” Harrist said. “So we are looking forward to that.”
The state Health Department will continue its regular influenza surveillance to determine prevalence of influenza and what flu strains are spreading. That task includes a group called sentinel surveillance providers around Wyoming who send tests from their clinics to the state laboratory.
“Continuing that surveillance is going to be critical, so we know how much flu is contributing to illness in the state as the COVID-19 pandemic continues to happen,” Harrist said.
Predictions about what flu season will look like are impossible to make now, she said.
“We certainly see variations in influenza seasons and usually by the specific type of influenza viruses that are circulating. That’s one of the reasons that we do surveillance, is that so we can understand what specific strains are circulating.”
Preparations are underway at the local level as well.
Wyoming Medical Center, for instance, has been dedicating supplies of tests and personal protective equipment for fall and winter, said Dr. Mark Dowell, Natrona County health officer and co-medical director of infection control at WMC.
Having enough tests and accurate tests is important to maintain PPE supplies because being able to identify which patients have COVID-19 changes the equipment used.
“We have two different types of tests right now that we can use, and as long as our supply chain remains intact, we’ll be in pretty good shape,” he said.
Test supplies, however, are always at the mercy of manufacturing and distribution of supplies, which can be diverted to hot spots around the country.
“And since we do not have aggressive, consistent federal help in distribution of testing, which I think is a giant mistake, we’re having to grovel along like everyone else trying to find tests,” he said. “So it’s very tricky. It’s very, very tricky right now.”
He expects a major challenge in that many viruses circulate in winter besides COVID-19 and the flu that can present in a similar fashion.
“How much testing do you have available, and how do you use it so that you don’t run out?” he said.
Tests must be free for those who come into the emergency room for respiratory issues.
Widespread testing in the community is important in preventing spread, but they must be accurate tests.
“There’s a lot to this,” Dowell said. “... And a lot of the way this goes is up to the public. It’s up to the citizens in Natrona County, because if they don’t mask and they don’t socially distance and we have it in the community like we do now, then people go inside, it can have the potential to go up very rapidly. And we know how effective masking is, so they’re making the decisions right now that will affect the fall. And the lack of masking in some places now absolutely will affect what goes on in the fall and with schools and everything else. It’s all interconnected.”
The flu vaccine protects people who receive the shots and prevents spread to others who may not be able to be vaccinated or are more likely to become severely ill, Harrist explained.
“I just can’t emphasize that enough, that it’s always important, but this year it’s really, especially important to get that influenza vaccine.”
It’s important to receive the flu shot annually because the strains change every year.
How much it protects somewhat depends on how close a match the vaccine is to current strains, Harrist noted. But the vaccine still provides some protection against catching the illness and reduces its severity, and vaccinated people are less likely become severely ill or require hospitalization.
Based on the influenza surveillance data, the state Health Department would characterize the last flu season as severe with a peak of reported flu activity around the last week of January, spokeswoman Kim Deti said.
A review of death certificate data for state residents shows 12 influenza-related deaths for the last season, 23 for the 2018-2019 season and 27 for the 2017-2018 season, according to Deti.
Influenza B viruses were dominant in the earlier part of the season, Deti said, and then influenza A — which is typically associated with more deaths — started to take over in the time leading up to the recognition of COVID-19 as a concern.
“Reported flu activity dropped sharply in March as COVID-19 concerns and restrictions went into effect,” she wrote in an email. “The restrictions intended to slow the spread of COVID-19 also likely lessened the impact of Influenza this spring.”
Natrona County also will vigorously emphasize the importance of flu shots, and the hospital will urge patients to receive one while there if they haven’t already, Dowell said.
Extra flu shots have been ordered to cover what he hopes will be an uptick in vaccinations this year.
Flu season typically ramps up around December and lasts through April or May, hitting hardest from about January to April, Casper-Natrona County Health Department spokeswoman Hailey Bloom said.
But every year is different, so it’s recommended people receive shots around October.
“That way, their body has enough time to build up some kind of antibodies, and some kind of defense before that illness really becomes more widespread,” Bloom said. “And I know that people think, ‘Well, there’s no guarantee that I’m not going to get the flu if I get the shot,.’ But it truly does, even if you end up getting ill, make it at least milder and definitely helps to protect you and your family. So if anyone is able, we definitely recommend anyone who can to get a flu shot not just this year. But it is extra important this year as we’re looking at a whole different dynamic for flu season.”
The same precautions for COVID-19 also prevent flu spread, like staying home when sick, washing hands frequently, and covering coughs and sneezes.
“The good advantage that we do have is that with everyone being so practiced and so used to all of the things with COVID-19, it’ll help us for sure into flu season as well,” she said.
The Wyoming Department of Health closely tracks capacity of Wyoming’s hospitals to treat COVID-19 patients. Hospitals in the state currently are not overwhelmed or facing bed or PPE shortages, Harrist said.
“But we have seen that, unfortunately, that situation happened in other states with COVID-19. Many of the measures that we’re taking are so that we don’t find ourselves in that situation.”
The department’s preparedness group has worked since the beginning of the pandemic to prepare and ensure hospitals and health care providers around the state have the PPE they need to be prepared for a surge in both influenza and COVID-19.
All hospitals around the state participate in health care coalitions, and part of that is preparing for surge capacity in multiple situations, Harrist said.
President of the Wyoming Hospital Association Eric Boley said there could be a double-whammy with COVID and the flu.
“There are a lot of unknowns, but the way things look right now we’re going to be dealing with flu and COVID at the same time.”
The organization that represents the hospitals and about two-thirds of the nursing homes in Wyoming is also focusing on flu vaccinations and following recommendations of the state health officer to wear masks, socially distance and wash hands helps prevent both illnesses, he added.
Testing is already in short supply and he hopes to continue to see an increase in supplies.
“Unless we can see an increase in the amount of testing that we’re able to do within our state, and there are a lot of factors there, it could be really difficult,” he said. “Because right now, there are times when we struggle to have enough supplies to test all of our nursing homes and to have enough tests on hand to test the public that thinks that they may have contracted COVID.”
“It’s kind of the perfect storm,” Boley added. “You’re basically just going to put further burden and stress on an already fragile system when it comes to testing.”
WMC often admits several flu patients at a time during peak flu season, some of whom require the intensive care unit, Dowell said.
“And when you throw the incredibly high likelihood of continuing to see increasing cases of COVID, some of which will end up in our intensive care unit, whether they’re grown here in Natrona County or transferred in because we’re a referral center, I can see us getting very easily squeezed in terms of ICU beds,” Dowell said. “We have 14, and I can see them becoming full, which often happens in the winter anyway. And if you throw a few COVID patients on top of it — we do have spillover unit that can accommodate some of this, but it may become a huge issue.”
WMC can ramp up to more than 30 ventilators, he noted. If the hospital ran out of ICU beds and ability to spill over into the hospital, they’d work with the state to use a makeshift hospital in another space such as the Casper Events Center.
“There are plans that could be implemented, if need be,” he said. “Hopefully we never get there. But those discussions have already occurred. We have a good safety net at the hospital to cover overflow, to a point. But it’s no different than what you’re seeing in areas where the virus has gone crazy.”
Supplies of PPE are currently in good shape, he said.
“But again, we get some of our PPE from the state, and then we have to go out on the market and try to find it. It is, again, not ideal, because if you get a huge uptick, you’re going to eat through your PPE pretty quickly and you may or may not be able to find it.”
People in their community play a major role in public health and the safety of their fellow citizens, he said.
“I cannot emphasize enough, if people would mask when they go into businesses and gatherings, right now, it’d be a great investment for the fall and winter.”