The Flu Season That Wasn’t
By Liv Osby
Thousands of South Carolinians get the flu each year, with many winding up in hospital beds and others succumbing to the virus.
But the 2020-2021 flu season stands out as almost non-existent by comparison.
“It’s been remarkable,” said Dr. Christine Carr, senior clinical advisor to the South Carolina Hospital Association and professor of emergency medicine and public health at the Medical University of South Carolina.
“The flu and RSV (respiratory syncytial virus) - the other winter virus we see – are almost nowhere to be found,” she told Greenville Business Magazine. “They are a fraction of what they were.”
The five-season average for flu in South Carolina is 3,564 cases – including 6,715 cases in the 2019-2020 season alone, according to the state Department of Health and Environmental Control.
That compares with 116 cases of flu in the 2020-2021 season by the end of April.
And there were 154 hospitalizations and 18 deaths from flu during that time frame, compared with a 5-season average of 2,680 hospitalizations and 122 deaths, DHEC reports.
Dr. Jonathan Knoche, a public health physician for DHEC and a medical consultant in its Division of Immunization and Acute Disease Epidemiology, confirmed that South Carolina has seen a much lower number of flu cases this year.
“Up to this point, we’ve had 113 confirmed cases,” he said in mid-April. “Last year, we had over 6,700.”
There also have been far fewer hospitalizations this season compared to the same point in the previous season, he said.
On the other hand, South Carolina logged 482,907 confirmed cases of coronavirus as of April 30, including 8,379 confirmed deaths.
Carr and other experts attribute the low flu numbers to the precautions taken in the battle against the coronavirus, like wearing masks and social distancing. Keeping children home when they have a fever, and staying home from work, has also helped, she said.
“My husband is a pediatrician and he gets sick at least three or four times a year, and he has not … for a year, which is incredible,” she said. “He wears a mask religiously.”
Indeed, a Mayo Clinic study found that wearing a mask – both the disposable medical kind and two-layer cloth masks widely available on the market – is the most important measure in reducing the risk of exposure to the coronavirus.
It concluded that if two people are 1 foot apart, the exposure risk is 100 percent if neither is wearing a mask, but just 0.5 percent if both are masked.
Dr. Surabhi Gaur, chief medical officer for Bon Secours St. Francis Health System, said South Carolina’s numbers are in line with national data and that anecdotally, all respiratory illnesses seem to be down, especially in children.
Nationally, the number of flu cases in the 2020-21 season is far below any season since 2009, and one-tenth the rate of the 2011-12 season, according to the U.S. Centers for Disease Control and Prevention.
Covid precautions have made the difference, Gaur said.
“We have drastically changed the way we work and interact with other human beings, even though things have been open at some level for months now,” she said. “And what we did to prevent coronavirus has helped in preventing widespread flu.”
Gaur also points to good hand hygiene, adding, “I’ve never seen people more conscientious of washing their hands.”
A Gallup poll found in March that nearly half of all Americans, 47 percent, were “completely” or “mostly” isolating themselves from people outside their household.
“People are keeping their distance, wearing a face mask, and washing their hands,” Knoche said. “And if you’re protecting from one infection, you’re protecting from others as well.”
Masking helps keep everyone’s germs to themselves, Gaur said, adding that the message has even seeped into some of the more resistant personalities.
“We’ve gotten pretty good at this,” she said. “I laugh that my kids in elementary school, I have to remind them to take their masks off when they get home because they’re so used to having a mask on.”
Gaur said she suspects that for certain populations and sectors, such as health care and service industries, mask wearing may become the norm even once the virus is under control because it makes practical sense when people are in close quarters and handling food.
“I wonder if going forward, if coronavirus becomes a thing of the past in the next year or two, that during cold and flu season, are we always going to wear masks? And why didn’t we always?” she said. “It’s not that weird to us anymore.”
Carr says she’s a big believer in masks and will be wearing them for some time to come.
“I’m pretty sensitive to upper respiratory infections in general. And I hate getting sick,” she said. “So I’ve worn masks for years when I’ve gone into a patient’s room … until I sort the situation out. We’ve known for a long time that masks help curb the spread of respiratory droplets spread by viruses, like mumps.”
Knoche said that the more people who wear masks, the more protection there is for the community. But while some people may continue to wear masks, others won’t, he said.
“Some people decided it was a good preventive health measure,” he said. “But I don’t suspect it will be the majority of the population.”
Meanwhile, although the CDC has updated its mask guidance to allow vaccinated people to go without them in many settings, Carr says they are still indicated in other settings, including for high-risk people like health care workers and those who are around unvaccinated elderly or immunocompromised people, to reduce transmission to those vulnerable people.
“We are almost to the finish line with regard to the original Covid, but we have variants and will have more and more of them. And how they come about is when the virus replicates when it goes from person to person and it changes,” she said.
“The sooner we all get vaccinated the fewer people the virus can spread to and therefore opportunities for the virus to mutate are reduced.”