Q&A: Flu Data Show Potency of Anti-COVID Tactics Like Masking, Hand Hygiene

Wear a mask, good hand hygiene, follow social distancing guidelines: We’ve been hearing this advice from the US Centers for Disease Control and Prevention, the World Health Organization, and other healthcare experts for months, now. We now have data that prove that the public should put its faith in these tactics, rather than hope for a COVID-19 vaccine to bring us to a new normal, says Kevin Kavanagh, MD. Kavanagh, a member of Infection Control Today®’s Editorial Advisory Board, points out that flu rates have plummeted in the Southern Hemisphere and that is telling. The strategies just mentioned might snuff out COVID-19 in the long term, says Kavanagh, if everybody follows them. “But when you look at the flu, which isn’t as infectious, you would expect it to just annihilate that type of a pandemic and organism and that’s what we’re seeing in the Southern Hemisphere,” says Kavanagh. “Now, that of course is contingent that we follow this guidance, which as you know, is anywhere but universally accepted by the American public.”

Infection Control Today®:Doctor Kavanagh, you’ve been looking at flu data from around the world, especially the data from the Southern Hemisphere of the Americas. Can you tell us what you’ve seen and how that may impact of flu season here in the United States?

Kevin Kavanagh, MD: Well, it is surprising. If you look at the Southern Hemisphere, the number of flu cases has just plummeted. You do not see massive pandemics sweeping many nations and continents. And this is somewhat surprising. But if you think about it, it’s also very predictable. If you look at our data from the US Centers for Disease Control and Prevention [CDC] at the end of March, again, our rates of the flu plummeted. It’s a very steep slope. And so one would ask, “Why did that happen?” Well, it happened because of the use of masks, hand hygiene, and social distancing. These same public health initiatives and strategies which are very effective on COVID-19 are even more effective with the flu. Well, why are they more effective? Because the flu is not nearly as infectious as COVID-19. The flu has an R-naught on average of 1.3, or every 1 person that gets infected with the flu will infect 1.3 others. With COVID-19, the R-naught is 5.7. One person infected with COVID-19 will infect 5.7 other individuals. And so, when you have strategies of wearing masks, washing your hands, and social distancing, it may slow down the COVID 19 pandemic. It may even snuff it out over the long term if it’s embraced by everyone. But when you look at the flu, which isn’t as infectious, you would expect it to just annihilate that type of a pandemic and organism and that’s what we’re seeing in the Southern Hemisphere. Now, that of course is contingent that we follow this guidance, which as you know, is anywhere but universally accepted by the American public. There is a huge debate going on right now. It’s been politicized. People don’t believe it’s necessary. And this is not good. Reliance on a vaccine for the flu is problematic. As you know, it has a long history of sometimes being very effective, sometimes not being that effective. And when they make a vaccine for the flu, they try to judge what type of antigens will give you the best immunity. And each year, it’s a new vaccine. Well, they make that judgment from specimens which are submitted from the pandemic of the flu from South America and from the Southern Hemisphere. And so, when you have very few cases and sporadic outbreaks in different countries, which may or may not be the same strain, it’s going to be problematic to get a very effective vaccine. Our primary strategy I feel should be masking, hand hygiene, and social distancing. And using the flu vaccine to supplement this strategy. Now, they may well find a flu vaccine which is highly effective. But we shouldn’t count on that because we know what is highly effective with the flu: That’s wearing a mask, social distancing, and good hand hygiene. And this is what we need to follow. Now I should also add that when you get a flu vaccine, it does build up your immunity to all strains of the flu and you get some cross reactivity. It is very good to get every year. And this is one of the reasons why, with flu outbreaks, you will find the death and disability rates in the elderly to be much less than those of the young because they have had previous exposure to the flu antigen. So, it is very good and very necessary to get the flu vaccine. But we shouldn’t be counting on this to really ward off the utter devastation which can occur from getting flu plus COVID. We need to also do social distancing, and good public health strategies. These strategies, if widely adopted, could just annihilate the outbreak of the flu in the United States. Unfortunately, they’re not widely adopted. What we will choose or what then may happen is instead of annihilating the flu, we may suffer devastation like you’ve never seen before, where flu plus COVID is infecting individuals at the same time, and that this may not be entirely prevented by a flu vaccine, which as you know, can have questionable effectiveness. And this year may even be more problematic. So, our primary strategy to prevent this from occurring should be implementing good public health strategies, wearing masks, hand hygiene, and social distancing. And using the flu vaccine to supplement those strategies.

ICT®: Are you suggesting a huge public health campaign?

Kavanagh: Well, it needs to have consistent messaging from the top. Infection preventionists can help with that messaging. But if we don’t do this, we can be easily overrun with these two pathogens at the same time. And that can be a disaster, or it will be a disaster. And so, we need to do this. I don’t know what we can do to get people to take this seriously. I still hear comparisons, “Well, COVID-19 is just the flu.” Well, it’s not just the flu. COVID-19 outcompetes the flu in the Southern Hemisphere, and COVID-19 involves every organ system of the body as the flu is primary respiratory. So COVID-19 is extremely more deadly, and has lasting disability, which can occur fairly commonly in individuals. We need to take this seriously. And if you add flu plus COVID-19, you’re just going to compound the problems. Make a bad situation even worse.

ICT®: Are our public health officials sounding the trumpet loud enough and long enough? Isn’t what you’re saying the same as what the CDC has been saying?

Kavanagh: Well, certainly, but it’s not what a lot of our leaders are saying. And there is a lot of messaging trying to discredit science. And that’s one of the things that is going on now, which is inhibiting our response to this pandemic. And getting active on social media. Getting this message out is something which we need to do. Infection preventionists can be very, very much instrumental in getting out the correct message and counteracting the false messaging, which we are hearing on both social media and also, unfortunately, from our elected officials. Schools are opening in many areas of this nation and to me this is a dangerous experiment. One college, I believe it was in North Carolina, opened and then had to close because of outbreaks. And so consistent messaging on the front end, can prevent us from having to learn from experience. We should be learning from the experience of others.

ICT®: I know you’ve written on our website and other places about herd immunity, and how some will argue that we have to create herd immunity by having enough people walking around who have had COVID-19 and who have recovered. That might be something someone might say in response to what you’re saying.

Kavanagh: Well, herd immunity is a false narrative. This virus is far too infectious. You would have to have greater than 70% to 80% of the populace to become immune before herd immunity would kick in. And long-lasting immunity with this virus is in question. If you look at the recent data from San Quentin, two-thirds of the inmates have come down with COVID-19. And they are still getting infections. There doesn’t appear to be a big latent immunity in that population that is preventing infections. And herd immunity has not kicked in yet. If you look at population studies, the most recent is out of England. If you look at Sweden, if you look at Spain, if you look at the United States data from New York City or from Los Angeles, the amount of neutralizing antibodies that they’re recording in the general population is surprisingly low. So, herd immunity is a false narrative. It’s a very simplistic way of looking at things and there is nothing that I’m seeing in current research and data that is encouraging that this will take place.

ICT®: Any final words for infection preventionists or anybody else that might be watching?

Kavanagh: Well, I think it is to get out there and to spread the word. Do correct messaging. Get on social media. Do not get intimidated by the internet trolls. There are many of them. Most of them have fake accounts that are completely blank. And personally, I agree with the study from Carnegie Mellon that a lot of these are being orchestrated by outside influences that are trying to undermine the United States. I think we really do need to get messaging out there to counteract this false narrative which is spreading around our populace. Because I do not think we can depend upon the flu vaccine to ward off this disaster which may well happen: getting flu and COVID-19 at the same time. What we need to do is adoption of basic public health strategies of wearing masks, washing your hands, and social distancing.

This interview has been edited for clarity and length.

To view charts and graphics related to this presentation go here.

To listen to an audio version of this interview go here.

To read Doctor Kevin Kavanagh’s article in Infection Control Today® go here.