California flu deaths plummeted during COVID mandates. Now cases are rising again
Flu activity and hospitalizations are soaring to levels not seen since before the COVID-19 pandemic, spurring public health officials and emergency room doctors to issue public pleas this week to Californians to get vaccinated.
That’s a major change from the last two years, when stay-home orders and mask mandates suppressed transmission of the flu so low in the Sacramento region that UC Davis Medical Center didn’t admit one patient with the disease in the 2020-21 influenza season.
“We’ve benefited the past two years from all the masking and distancing that we’ve had,” said Dr. Dean Blumberg, chief of pediatric infectious diseases at UC Davis Health. “There’s normally between 100 and 200 US pediatric deaths every influenza season. In 2020-21, there was one pediatric death in the U.S.”
It wasn’t just children who benefited, though, according to death certificates reviewed by the California Department of Health. The agency reported that flu deaths among seniors ages 65-plus plummeted by 73% in the 2021-22 flu season when compared with 2018-2019, the last flu season before the COVID-19 pandemic.
There were 355 flu deaths in California that year, more than three times the 96 reported last season.
The raw numbers of flu deaths for all age groups show a startling decline last season, when compared with 2018-19: Deaths dropped to 23 versus 141 for adults ages 50 to 64, to 29 from 99 among those ages 18 to 49, and to three from 17 for minors.
California Epidemiologist Erica Pan, a pediatric infectious disease physician, noted that “there was just less flu circulating, fewer flu hospitalizations, and then subsequently fewer deaths during the pandemic. It was pretty dramatic.“
While the number of flu deaths were even lower before the stay-home order ended in June 2021, the data from last season show that indoor mask mandates, new COVID-19 home tests, plus age-old, commonsense measures like hand-washing also could improve the mortality statistics.
To be sure, people were still traveling less last season and doing more outdoor gatherings, Pan said, and all that likely helped to lower the number of flu deaths as well.
“There’s basically dozens of circulating respiratory viruses in the winter,” Pan said, “and for most of them, a lot of things that we did, and many that we can continue to do really help prevent transmission of these respiratory viruses.”
Flu cases rising in Sacramento region
With flu-related hospitalizations climbing earlier in the season than usual, emergency room doctors from Sacramento-based Sutter Health called a news conference Thursday to stress their concerns and to encourage residents to take precautions at holiday gatherings this month. They urged the public to get vaccinated for both flu and for COVID-19 to help prevent a surge of the diseases.
Winter virus transmission skyrocketed following recent Thanksgiving family get-togethers, pushing many California hospitals to their limit, so in addition to advocating for vaccinations, Drs. Vincent Tamariz and Arthur Jey of Sutter Health urged Californian’s to take a couple other steps to prevent a repeat of that following December holiday festivities.
Tamariz, the pediatric medical director at Sutter’s California Pacific Medical Center Van Ness campus in San Francisco, recommended that parents exercise caution with their infants to prevent the spread of RSV, or respiratory syncytial virus. The disease has put a lot of kids in the hospital and has resulted in four laboratory-confirmed deaths of California children under age 5 in this flu season.
“I can’t tell you how many 4-month-olds I’ve seen who were visited by their cousins four days previously or five days previously for a family event, a wedding or something like that,” Tamariz said. “And now this 4-month-old has RSV, which could be a much more serious thing, versus a 1- or 2-year-old having RSV.’”
Jey, an emergency medicine physician at several Sutter hospitals in Northern California, recommended that people over age 2 continue to “mask up” as they meet up over the holidays.
Blumberg echoed that sentiment “I’m hoping that that the masking might be an important, positive legacy from the COVID pandemic. ... I’ve had one respiratory tract infection over the past three years. I’m seeing kids all the time, I’m like, in their faces, interacting with them, examining them. So I’ve been real pleased not to get sick over the past three years with all these restrictions in place.”
California doctors urge masks this winter
If you think about it, Pan said, what have physicians done for decades when they know they’re treating a patient with a respiratory disease? They don a mask, she said, because they know it can help to protect them, their medical team and their families from getting sick.
If you’re traveling through airports or on planes, Pan said, wear a mask to ensure you don’t pick up viruses and take them to loved ones. It’s all about managing your risk of exposure, she said.
If children wind up in hospitals with a respiratory illness, Jey and Tamariz said, parents should know that they may be transferred to another facility that can provide the level of care they need. Not all hospitals have the expertise to care for serious RSV cases, the doctors said, so children will likely have to go to a pediatric intensive care unit like those at Sutter Medical Center, Sacramento, or at the CPMC Van Ness campus.
In addition, Sacramento-area health systems are also communicating with one another and Sacramento County’s public health team to facilitate transfers and ensure patients get the treatment they need, Blumberg noted.
With all the mask mandates gone, Blumberg said, he and other infectious disease experts are expecting the 2022-23 flu season to be just as deadly as it was in pre-pandemic years.
“A lot of people don’t realize that influenza causes about 20,000 to 30,000 deaths every year in the U.S.,” he said, “and even people we don’t traditionally think of as at-risk for severe disease, like children, die of it.”
