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CDC chief sees urgency to cut COVID rate to avoid flu collision

NEW YORK — The head of the Centers for Disease Control and Prevention warned that many regions in the U.S. need to drive the rate of COVID-19 cases sharply lower to avert a dangerous convergence of the pandemic with flu season.

CDC Director Robert Redfield said in an interview Thursday that he’s optimistic they’ll do so, because newly recorded cases have declined from their recent peak in July and most areas of the U.S. are in a “downward trajectory.”

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Even so, there’s a great distance for most of the country to go to reduce the burden of COVID before flu season arrives. Redfield said states need to have less than 5% of COVID tests return positive — ideally even lower.

“We’d like to see those prevalence rates down under 3%, 2% of tests positive,” he said, noting that the U.S. never brought cases down as dramatically as Europe did.

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More than 30 states have reported over 5% test positivity in the past seven days, according to data from Johns Hopkins University. In Texas it is 23.7%, and 6.9% in California.

Seasonal influenza sends hundreds of thousands of Americans to hospitals each year. Health officials fear that a bad flu season could collide with the COVID pandemic, sickening millions with similar symptoms and straining hospitals. But the country has a window in the next few months to avoid that scenario, by driving down coronavirus cases and inoculating more Americans with flu shots.

Redfield said he believes more people will embrace universal mask wearing, social distancing, hand hygiene and the flu vaccine.

“There’s evidence that the American public are listening,” Redfield said. “That evidence is grounded in the changes we’re seeing across the nation in the number, not just of cases, but the number and the percent positive.”

If health officials fail to control COVID before flu season, the outlook could be grim. The flu on its own has filled hospitals beyond their normal limits, just as the novel coronavirus did earlier this year.

“If you had them both simultaneously, you could have very stressed health system,” Redfield said.

That’s why the stakes are so high to get the flu vaccine to as many people as possible. Almost 200 million doses should be available this year, a more than 10% increase compared with last year. The CDC itself purchased more than 9 million shots for adults, compared with 500,000 in a normal year, and additional shots for children.

The normal fall push for flu shots in clinics, drugstores and workplaces will be complicated by COVID’s disruption, and it’s likely to look different this season. Officials are considering delivering vaccines in new settings, such as drive-up sites that minimize the risk of spreading the infectious disease.

“The public may still have some reservations about going to any place where they’re indoors around people they don’t know,” said Marcus Plescia, chief medical officer with the Association of State and Territorial Health Officials.

About 63% of children and 45% of adults got the flu vaccine last year. Coverage varied widely by state, and Black, Latino, and Native Americans were least likely to be vaccinated. The CDC is working especially to make vaccines available in community clinics that serve low-income populations and expand outreach to Blacks and Latinos, as well as workers and residents in long-term care facilities.

The goal is that “anybody who wants the vaccine this year can get it safely,” said Nancy Messonnier, the director of the CDC’s National Center for Immunization and Respiratory Diseases.

In the U.S., localized flu outbreaks can begin as early as October, though the season typically peaks in January or later. The CDC encourages vaccination by October. It’s recommended for all people over 6 months of age, but especially for young children, older adults and people with underlying illnesses.

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In the best-case scenario, the same measures to prevent COVID — wearing masks, staying 6 feet (1.8 meters) apart, canceling mass gatherings — combined with widespread flu vaccination could significantly reduce flu illness. Sharp movement restrictions in response to COVID in the spring tamped down flu as well, and globally, flu activity is lower than expected so far this year.

But a lot of variables are in play, including how well the flu vaccine matches the strains that wind up circulating in the Northern Hemisphere, and whether fear of COVID keeps people from getting vaccinated.

“You never know beforehand whether it’s going to be a bad flu season or not,” said Arnold Monto, an epidemiologist at the University of Michigan School of Public Health. The illness has sickened from 9 million to 45 million Americans each season in the past decade, according to CDC data.

Deaths number in the tens of thousands annually. Severe flu seasons have triggered state emergency orders, crowded emergency rooms and occasionally forced hospitals to cancel elective surgeries.

The convergence of flu and COVID could aggravate the persistent testing challenges that have hobbled America’s COVID response, Monto said, because some tests for flu use the same reagents as COVID tests.

Testing companies say they’re anticipating high demand, and clinicians are concerned about strains on testing and treatment if flu and COVID converge.

“Right now we’re so limited we don’t really want to test everybody with the sniffles for coronavirus,” said David Battinelli, chief medical officer at Northwell Health in New York.

Hospitals in New York and elsewhere have learned how to handle spikes in Covid patients, converting other units to intensive care and putting beds in atriums and cafeterias. But those surges haven’t coincided with the swell of flu patients hospitals see each year.

“A regular busy flu season, with no COVID, we’re kind of primed for that,” Battinelli said. “It’s really whether both things happen at the same time.”

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