Yale Daily News

In the wake of recent surges in COVID-19 hospitalizations, the Yale New Haven Health System is preparing for a potential overlap between the ongoing coronavirus pandemic and this year’s  flu season.

This scenario, which has been popularly dubbed as a “twindemic,” comes at a time when many health care systems are still reeling from the COVID-19 pandemic. In preparation for the co-circulation of both viruses, the YNHHS has been bolstering the promotion of the flu vaccine, increasing the number of telehealth consults and looking into whether current COVID-19 testing sites could also test people for the flu.

“This last coronavirus surge was a never before seen reallocation of resources,” Matthew Grant, assistant professor of infectious diseases at the School of Medicine and infectious disease specialist at Yale New Haven Hospital, told the News. “If we were to have concomitant activity of both viruses, it could lead to not just increased hospital wait times to get a bed and people having to stay in the emergency room for many nights, but it could also lead us to a place where we have … limited intensive care unit doctors [and] limited space to put patients who require an intensive care unit level of care.”

Grant said that while the YNHHS did not reach full capacity in the first COVID-19 surge, it still saw a substantial increase in patients, requiring massive logistical restructuring. Hospitals within the YNHHS had to move clinical services, create new intensive care unit floors, cancel elective surgeries and shut down outpatient services. He also noted that because of the significant patient influxes in past flu seasons and the uncertainty about future COVID-19 hospitalization spikes this year, he is concerned about the potential impact of a “twindemic” on the hospital. 

Caitlin Hansen, pediatric infectious disease specialist and professor at the School of Medicine, said that because so much is unknown about COVID-19, the scientific community is still uncertain about whether there could be serious effects should people contract the flu and COVID-19 at the same time.

“There’s no vaccine as of yet for COVID, but we do have that tool against the flu, so it’s important to make use of it,” Hansen said.

In an interview with the News, Richard Martinello, medical director for infection prevention at YNHHS, explained that the similarity in symptoms of COVID-19 and influenza –– such as fever, fatigue and difficulty breathing –– can make it difficult for doctors to clinically distinguish between the two diseases. Therefore, all patients will likely have to be treated under the assumption that they could have COVID-19, according to Martinello. 

Given that the onset of the flu season will likely result in a greater demand for hospital resources, he also said that YNHHS is taking a number of precautions.

“In our ambulatory offices, we’re working on pathways to safely care for patients who may be sick,” Martinello said. “Likewise, we’re working on ensuring that we have blood draw stations … where people who may be sick with COVID may get lab tests safely.”

Adding to those efforts, the YNHHS has also set up outdoor COVID-19 testing sites in Connecticut and is currently exploring whether or not other viruses –– including influenza –– could also be tested for at those stations, Martinello explained. 

He added that the YNHHS has adapted to provide telehealth services for patients who might need an assessment but are not urgent enough to go to the emergency department. This could prevent them from risking unnecessary exposure to either the flu or COVID-19. According to him, while Yale New Haven Hospital held only 100 or so virtual consults in January, the hospital will soon reach 400,000 telehealth appointments performed since March.

Martinello also emphasized that while it is always important to get a flu shot, the context of the pandemic has made it even more necessary. 

“People usually think of the flu being a risk for those who are elderly, immunocompromised or young children, but of course the flu is a potential risk to everybody,” Martinello said. “While we see most of the complications due to the flu … in those at the extremes of age, unfortunately each year we see young patients who have very poor outcomes.”

He said the YNHHS has also had a mandate for many years that requires all hospital employees and medical staff, including those who work mostly in private practices in the community, to be vaccinated against the flu. 

In a press conference on Tuesday, Oct. 27, Yale New Haven Health Senior Vice President and Chief Policy and Communications Officer Vincent Petrini and Chief Medical Officer Thomas Balcezak mentioned that YNHHS is joining statewide efforts to promote the flu vaccination for this season.

“We’re working in partnership with the state of Connecticut to get that word out,” Petrini said. “I don’t think it has ever been more important.”

Because the flu is seasonal, becoming more prevalent in the fall and winter months, medical practitioners in the United States tend to look toward the Southern Hemisphere for a foreshadowing of what might be in store for the flu season in North America, according to Balcezak.

Because the Southern Hemisphere seems to have had a light flu season this year, Balcezak explained, the hope is that the same will occur in the United States. However, he also emphasized that due to the unpredictability of flu seasons –– which often have varying degrees of severity and virulence –– the hospital and the wider community need to do whatever they can to prevent a large volume of infections, especially during a pandemic.

The U.S. Centers for Disease Control and Prevention estimated that there were between 24,000 and 62,000 flu-related deaths nationwide during the 2019-2020 flu season.

Maria Fernanda Pacheco | maria.pacheco@yale.edu