One 'flu over
Alan Cresswell
Admin
in Purgatory
Every year in the UK between 10,000 and 30,000 people die from seasonal 'flu (more than that if there's a bad year), and we see our hospitals frequently overwhelmed during the 'flu season with ambulances queuing to get into A&E and operations cancelled.
During the 2020/21 'flu season, the number of 'flu cases were very low, as a direct consequence of the restrictions in place to attempt to control the coronavirus pandemic. Whatever your views on the lockdown, it's undeniable that these measures have had a massive impact on not only covid19 but other respiratory diseases including 'flu.
So, we seem to be placed in a position where it's reasonable to ask whether it's acceptable that we let more than 10,000 people a year die of 'flu, is it acceptable that we let this disease overwhelm our health services every year, given that it's clear that there is an alternative. We're being offered an opportunity to build back better from the pandemic, that could include building back to a society that doesn't let so many die from 'flu.
Part of such a better future would be more investment in our health services, so that there's capacity to treat 'flu patients without having to close down much of the other services. Part would be increased numbers of people taking the 'flu vaccine. But, the reduction in 'flu we've seen this year has been stopping people getting 'flu in the first place, not treatment. If we keep wearing masks in public spaces (especially indoors), if we don't go back to pubs with standing room only and retain some social distancing measures such as table service, if we work from home more etc then we're going to reduce 'flu transmission.
Why shouldn't we build back better by building back healthier? We don't need to accept that we'll return to just as it was before the pandemic. The status quo isn't sacrosanct.
During the 2020/21 'flu season, the number of 'flu cases were very low, as a direct consequence of the restrictions in place to attempt to control the coronavirus pandemic. Whatever your views on the lockdown, it's undeniable that these measures have had a massive impact on not only covid19 but other respiratory diseases including 'flu.
So, we seem to be placed in a position where it's reasonable to ask whether it's acceptable that we let more than 10,000 people a year die of 'flu, is it acceptable that we let this disease overwhelm our health services every year, given that it's clear that there is an alternative. We're being offered an opportunity to build back better from the pandemic, that could include building back to a society that doesn't let so many die from 'flu.
Part of such a better future would be more investment in our health services, so that there's capacity to treat 'flu patients without having to close down much of the other services. Part would be increased numbers of people taking the 'flu vaccine. But, the reduction in 'flu we've seen this year has been stopping people getting 'flu in the first place, not treatment. If we keep wearing masks in public spaces (especially indoors), if we don't go back to pubs with standing room only and retain some social distancing measures such as table service, if we work from home more etc then we're going to reduce 'flu transmission.
Why shouldn't we build back better by building back healthier? We don't need to accept that we'll return to just as it was before the pandemic. The status quo isn't sacrosanct.
Comments
No. It's equivalent to asking if your immune system is weakened by not drinking water contaminated with sewage.
Re vaccines for the flu. They should be available to all for free. Which took a long time to get here. It's stupid to only target certain groups.
I think making wearing a mask - when you have a respiratory infection - culturally normative, in the same way as covering your mouth when you cough or not wiping your nose on your sleeve, would be helpful. I think social distancing is not realistic in the long term. Properly resourcing the health service would be useful.
But expecting people not to die is a problem - if you don’t die of a chest infection, heart attack, stroke, cancer or dementia: how do you die of natural causes ?
No, but people are in general social animals. Large numbers of people actively like crowded pubs and nightclubs. I might well find them incomprehensible, but I can't deny that they exist. And those people very much view getting a normal 'flu as part of the occupational hazard of being human.
If you want to look at places where we could "build back better" from Covid, then I'd look first at normalizing taking time off when you're sick. Millions of people used to turn up to work coughing and spluttering - wouldn't it be better if a lot of them could work from home, and keep their germs home with them?
(and, as @Doublethink suggests, wearing a mask if you're sick but have to go out.)
On a purely selfish motivation I'd definitely trade a month of masking in supermarkets if it prevented them (it's a bit late now).
I'm not sure that would actually happen. I suspect there were multiple factors, and I'm not sure the 'safeguards' which would work are the effective ones.
I do think there is an extent where you have to do a 'years of life/quality of life' tradeoff. We could probably cut flu deaths by keeping great-grandchildren away from pensioners. I think that would be a bad plan (and depression would take away some of the gains).
But I also think there's a good chance that there's some low lying fruit, that has a lot of benefit (even for me directly and in the short term) for little inconvenience.
Encouraging working from home when mildly sick, seems a good thing (so long as it doesn't turn into working from your deathbed)
Having a health service that has emergency services running at 70% capacity in routine time seems good (and if they can use that 30% capacity for life-improving cosmetic surgery, or to do good in the third world, rather than sitting around good on them).
On the other hand, while I'd rather the pubs had a more balanced loading (rather than oscillating from literally empty to difficult to move in). I'd like at least the potential for something random, I might be sat at my table for one, or not be able to make my way to the bar, but if I had to book it in advance, that would rub it in a bit.
And probably should investigate possible negative consequences to immunity. But if we know what we're not exposed to, I'd have thought we could expose ourselves in a controlled way (vaccination).
Why are our cancer outcomes the worst in Europe?
One reason so many people die of flu is because many don't bother or decide not to have the flu vaccine. In Swansea where I live around 17, 000 people, elderly and those in clinical risk groups did not receive their flu vaccination. If it is the similar throughout the UK (rubbish at maths) it is a massive number of people who choose not to get vaccinated many of whom probably die.
Everyone should have access to sick leave, without any loss of income, if they're unwell. In the UK at least, that's something that has been a consistent failure over the last 18 months with people forced between the options of going into work despite having symptoms of covid (and, avoiding the test because if they get a positive it takes away the option) and staying home without pay and probably without a job when they recover. Many of us have jobs which can be done from home (at least to an extent) and employers who provide paid sick leave. That's not true of all - many jobs can't be done from home (retail, hospitality, manufacturing etc) and that can't be changed, and a lot of contracts don't provide for any paid sick leave or security of employment for those who do call in sick - that can be changed, and should be changed (it's a matter of employment justice that all deserve a secure, properly paid job with at least adequate access to paid sick leave and annual leave - the public health benefits are a bonus on top of what should be).
On the other hand there are more babies and pre-schoolers here in hospital and at emergency clinics this year with a viral chest infection (RSV? or RVS?).
Some doctors in New Zealand seem to think so:
https://www.theguardian.com/world/2021/jul/08/new-zealand-children-falling-ill-in-high-numbers-due-to-covid-immunity-debt
I suspect our government has as much concern for the well being of the citizens, or even less, as every death is a financial saving.
Not quite as draconic, but in the latter days of my time with the Ambulance Service, people were allowed a certain number of *sick leave* days, before receiving a Very Stern Letter threatening disciplinary action if they took sick leave again within a certain period (can't recall how long).
Obvious result - ambulance staff with coughs and colds (and feeling pretty rotten, too, especially if the weather was cold and inclement) in close face-to-face contact with Very Ill People. I dread to think how many lives were inadvertently shortened, but the government of today wouldn't care - Very Ill People are nothing but a burden on the state, and should be dispensed with...
(for the avoidance of doubt, that last sentence is irony).
I haven't had a time to look at this properly yet but we were talking about it at work yesterday.
RSV is a virus that causes bronchiolitis which is a nasty lung condition in babies. It is self-limiting but can be fatal in bad cases. Treatment is supportative and effective such that in developed countries death is really rare.
We get a season of RSV every winter sometime between September and March and for a month or so, the hospital fills with babies on oxygen and there are no beds. This hasn't happened at all in the 2020/21 winter. We are seeing all the seasonal infections now.
But yes, apparently there are these reports of very severe RSV. So it's an open question; we may be seeing big epidemiological shifts because of such a big change in human behaviour.
I'll have a look...
AFZ
There's always an alternative, the question is whether it's an alternative that's better than the status quo.
My husband just got an invitation to be part of an RSV vaccine trial. Sadly, after clicking through it appears he's not eligible. But something is apparently in the works, which might turn out well.
Re. Alan's specific suggestions, I think the devil is the details. Working from home is not practicable in the medium term for a lot of people, including many people who are doing so right now. My employer is generous with sick days, but there are circumstances where my actually taking a sick day could have serious repercussions down the road beyond my (or my employer's) control.
Annual shots are offered at my work as standard practice. I don’t actually know how much it would cost me to get one otherwise. I do know it’s free for people over a certain age (65 I think but not certain).
EDIT: found the full list of people who get vaccinated for free.
children aged 6 months to less than 5 years
all Aboriginal and Torres Strait Islander people aged 6 months and over
people aged 6 months and over with certain medical conditions that increase their chance of severe influenza and its complications
pregnant women (at any stage during pregnancy)
people aged 65 years and over.
Free for everyone here. But only taken by 30 to 40%.
I didn't get quite as sick as you but was ill for about 4½ months. Would get better only to get worse.
re effectiveness. We've been told that the vaccine may not prevent you from getting the flu but it will reduce the severity.
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I have floated and threatened that if you get the flu and haven't been vaccinated I won't pay your sick leave.
What is a reasonable requirement is a moveable feast. Right now, our Govt. is saying that aged care workers must get vaccinated or lose their jobs, but disability workers don't have to. That might change though.
I don't think you could argue that "not infecting others at the workplace" was a reasonable requirement at the moment. If attitudes change across the country though, such an argument might get up in front of an unfair dismissal tribunal.
Probably helped that we were next door to a chemist, but at a former workplace of 35 people, the MD basically decided to pay for everyone to have the flu vaccination there (at £50 a head or whatever it was) as a legitimate business expense, with dark hints about levels of sympathy to be expected if calling in sick with flu in the future not having had it.
Oddly enough, take up every year even from those straight out of university was high...
This year I would have been tempted to try again as it has been a while, so my system will have, hopefully, desensitised, but, in consultation with the asthma specialist at my GP, we prioritised the Covid19 vaccine, because if I'd reacted badly to a flu jab it was likely I would have disqualified myself from the Covid jab.
What happens to those of us who don't react well to the flu jab if you make this compulsory?
I'd hope, as with masks, that there would be exemptions - which you'd clearly fall under.
Not that I'm arguing for compulsory flu vaccinations.
I started getting flu shots when my father was diagnosed with cancer - they cost £15, and that included a voucher for a free hot drink in the adjoining café (possibly a win-win for the café as I always bought a cake to accompany my free hot drink). Had I been my father's carer, rather than a regular visitor, I think I would have been eligible for a free flu shot.
To @Alan Cresswell Australia also had a very low flu case-load in winter 2020. It is probably difficult to know if some of the less onerous of the Covid-19 restrictions/procedures i.e. increased hand hygiene, minimal overcrowding standards (eg 1 person per sq metre) and encouragement of masks in any relatively crowded indoor situation, would assist in lowering the flu caseload, perhaps to about halfway between the old normal and the 2020 caseload.
There is no paid sick leave here, only unpaid. There's also no short or long term disability required of employers. Thus, can easily decide to pay or not pay someone who's off sick. Noting that we've bought insurance for illness beyond 30 days for staff, and have always paid full salary for that first month. Even if I mutter about it: long story about person who didn't properly manage preventable health crises and we basically supported after insurance cut them off. (I'm full of angry impulses sometimes, don't express nor act on them.)
I think our shipmate is drawing a distinction between making comments in front of the employee and/or their colleagues, and complaining in "private" about it. Rather in the manner that someone might work well with a colleague at work, and then come home and blow of steam about what that fool did today to a spouse.
Israeli data apparently shows >90% effectiveness against asymptomatic transmission for the Pfizer vaccine against the original variants (it's probably worse vs Delta, but I haven't seen good numbers).
90% is good enough to control the spread with just vaccination, if you get good uptake.
Some other studies have been suggesting numbers nearer 50% (different vaccines, different variants, ...) which isn't enough by itself to control the spread even if everyone gets the jab.
'Flu vaccines seem to have real-world efficacy of about 50% in the best year, and much worse in a bad year (depending on how accurate the "guess what strains are coming our way" game has been). Staying home when you're sick is a more effective weapon against 'flu spread than vaccination. Vaccination is somewhat effective against dying.
Covid rates across the US are climbing again. Data from Contra Costa County, CA found at https://www.coronavirus.cchealth.org/overview shows that the rise is entirely in the unvaccinated population. You have to be a little careful with that, because without a surveillance screening program, you'll miss asymptomatic cases in vaccinated people. I'd like to see everyone's data separated out by vaccination status: it's a very clear indication that vaccines are worthwhile.
Note also that unvaccinated people are mostly not randomly scattered throughout the population. People with medical reasons to not vaccinate are probably random, but they're a small number of people. Most unvaccinated are either people who don't trust vaccines (for whatever reason) or are poor and have difficulty accessing vaccination. These are basically social groups - poor people spend time with other poor people, "Faith not fear" nutjobs have similarly nutty friends, and so on.
We are used to having the ordinary flu injection from the GP. That costs us an ordinary consultation and did so this year. The covid was also at the GP's, and was free. We're both over 70, so I don't know if the age is 65 or 70.
Yes this is correct. One of my main principles of living is to try not to boss people, reactionary I suppose to my upbringing. Which has meant as a boss I get a bit swindled sometimes. Preferring non-hierarchical consensus based decision making.
As a parent it means I've been following children's instructions for a very long time. We didn't do "discipline". I don't do it as an employer either. It's all coaching
When I retired, I had almost a year of unused sick leave. That unused sick leave counted toward years of service for calculating my retirement benefit (defined benefit plan), meaning a higher annual payment, so I definitely did well from not being sick more than I was and not using the sick leave.
We also had a system where if one employee didn’t have enough sick leave to deal with an illness, other employees could donate some of their sick leave. That happened with some regularity.
As for flu shots, here the cost is generally completely covered by health insurance. Of course, that raises the ongoing problem of people who don’t have/can’t get/can’t afford health insurance.