Flu ‘eclipses COVID as biggest threat’ in Bay Area

SFGATE: As a public health official, what concerns you most among COVID, influenza and RSV at the population level? What do you expect to drive the most hospitalizations this winter?

Willis: We are currently in an interesting place where influenza is overshadowing COVID as the biggest threat. There is an equal number of people hospitalized between the flu and COVID, which is the first time we have seen this since the emergence of COVID.

Choosing between what I fear most is like choosing between lions, tigers and bears. As for mortality, it is COVID and influenza in the elderly population, and RSV in babies. When it comes to RSV, the most severe outcomes are primarily among our youngest residents, so infants aged 6 months and younger, and then elderly people infected with RSV can have severe outcomes.

SFGATE: To try the lions, tigers and bears analogy, let’s say I gave you three vials, one with COVID, one with influenza, and one with RSV, and then I said, “You have to take one of these.” Which one would you take?

Willis: I would take the RSV, but it depends on who you are. If you are a child, you should choose COVID because we know that COVID does not cause such severe illnesses in younger residents. But for youth and adults, RSV is almost universally perceived as a mild illness; many people do not even recognize that they are infected.

However, if you’re 70 or older, it’s a scary experiment. All three can make you sick.

SFGATE: For youth and adults, which bottle do you want to take between COVID and the flu?

Willis: Assuming I was vaccinated against both, I would probably choose the flu because COVID is still so unpredictable. Although it has become less severe due to vaccine immunity and prior infection, there is still a wide range of outcomes, and I am still concerned about long-term COVID. We don’t really see that with the flu.

The flu can be a really serious illness, and that’s what we’re seeing right now, so I’d still be brave as I take that bottle.

SFGATE: It’s been true for years that you’d rather have the flu than COVID, but the fact that you have to stop and think about it now is pretty significant, right?

Willis: Absolutely. We didn’t have the same kind of policies to deal with the flu that we had with COVID. In the past, even in bad flu years, we have never implemented flu-related lockdowns or isolations. This is a good opportunity for us to signal what the future of COVID looks like; now it’s more like the flu in terms of the impact on the community.

We are withdrawing the COVID restrictions because the nature of the threat has changed and these restrictions are no longer necessary.

SFGATE: In Los Angeles County, Barbara Ferrer says he will impose a mask mandate if the transmission of COVID continues to increase. In Santa Clara, Sara Cody, who has usually been associated with Ferrer in the past, says that he does not think that the mandates are justified three years because people have the necessary information to make informed decisions. Where do you stand?

Willis: I agree with Sarah. We offer a strong recommendation that people cover their faces in indoor public spaces in response to the wave of winter viruses, but not an order.

N-95 masks are effective against all three viruses in this tridemic. So if people are really worried, they can wear a high quality mask. Our community is aware of the benefits of masking, but a lot has changed since mandates were used. We have vaccines and so many of us are infected, which means our immune systems are primed and people can make their own decisions. The consequences of infection are reduced.

Another factor in weighing mandates is that the relationship between policy and behavior is not clean. When the last mandates were imposed, they didn’t do much to change behavior. We think that in principle it is better to work in an environment of choices and people who understand their own risk.

SFGATE: Do you wear a mask in any setting? If so, where?

Willis: In the last two to three weeks I have started wearing an N-95 whenever I am in a closed public environment. When I get my coffee, I cover my face; when I’m in the store, I cover my face; when I dine indoors, I cover my face until I sit down.

I’m still debating whether I should continue dining indoors since I have some older relatives coming into town for the holidays. As transmission increases, I’m thinking about forgoing some indoor dining experiences. I don’t like covering my face, and when transmission rates were lower, I didn’t cover my face and didn’t care if others were around, but now I do it universally.

SFGATE: And if other people decide, “I think my risk is low and I’m not going to see anyone who’s at risk for the holidays, so I’m not going to mask up,” do you agree with that?

Willis: That. And it is very important for people who are at high risk to know that they can protect themselves by wearing a high-quality mask. All the numbers are going in the wrong direction, so it’s important to recognize that as conditions change, some people should change their behavior and have the tools to protect themselves regardless of what others are doing.

My job is to inform people with all the relevant information so that they can assess the risk for themselves.

SFGATE: So in terms of risk assessment, is it possible to compare the current rates of death from infection or infection and hospitalization between influenza and COVID? Or is it too hard to do because we don’t have the exact number of cases for either virus?

Willis: We don’t have an answer to that, and no one does, because as you said, we simply don’t have the data. But the scope of the flu has changed significantly. We’ve had two years without the flu, so we’re seeing big waves.

SFGATE: You said the flu eclipses COVID as the biggest threat. Do you expect it to last all winter?

Willis: It’s hard to know. This is an unprecedented experience with regard to the flu. This year we are seeing a much earlier increase, and the proportion of people with flu-like symptoms who test positive for the flu is higher than at any time in the past. Right now we are seeing that 1 in 3 people who report flu-like symptoms have the flu.

It’s hard to know which way this will go, but if things continue on their current trajectory, flu will be a bigger concern than COVID by the end of winter. But it is difficult to know whether the average severity of the disease has increased. It’s just possible that more people are infected than ever, so that means we’ll see more people coming to hospitals and dying. That might be what we’re seeing, as opposed to an increase in disease severity.

SFGATE: So you don’t really believe in the idea that this exists “immunity debt” or the idea that flu season is worse because we haven’t been infected in the last two years, so our immune system is unprepared?

Willis: I believe that’s true for infection, so we’re more likely to get infected now than we were before, but I’m not sure that’s true for the severity of the disease. Our immune systems are trained seasonally through exposure, but since COVID has changed the way we live, we are out of training and our bodies need to know how to respond when exposed.

Now we have an entire population, all of a sudden, that hasn’t seen the flu or RSV in two years. So viruses have to catch up.

SFGATE: So the only way out of this is to be exposed to these viruses again?

Willis: And that’s why vaccines are so important. Getting a flu or COVID shot before exposure to the virus is a much safer way to gain immunity from infection without vaccination. That’s why it’s worrying that flu vaccine uptake is currently so low.

SFGATE: The flu vaccine is like the COVID vaccine, where it doesn’t do much to prevent infection, but will reduce the severity of the disease?

Willis: That’s right. I would say that the flu vaccine does reduce the risk of infection, but most importantly, it reduces the severity and length of time you are infected. What I’ve seen in the last two weeks tells me that we should all expect to be exposed to the flu. Waste water clearly shows that it flows there.

SFGATE: How long do you expect influenza, COVID and RSV transmission to remain high? Is the answer different for each of these viruses?

Willis: Elsewhere, we see promising signs that RSV may be at its peak. If you look east, the number of RSV cases and hospitalizations has stopped. Marin County saw our highest rate of RSV levels last week, but it is accelerating more slowly, which is the first step toward a peak. One of our pediatricians just told me that there is less flu than RSV, but there is a slight decline in RSV. So the signs are that RSV will plateau first.

I would say that, normally, flu cases spike in mid-December and continue until mid-January, then taper off by March. This is a normal pattern for the flu, but we don’t know if it will peak earlier because it starts earlier. If it continues to grow at its current rate until January, that will be bad.

We’re telling people to have safe gatherings this winter, so the question is what does that look like if you have people gathering across generations? The biggest thing is that everyone who can be vaccinated is vaccinated. If you have older people there, who have flu shots and COVID boosters, that should prevent them from ending up in the hospital. Those who are at lower risk should also be vaccinated as this will reduce the chances of transmitting the virus. Hand washing is also important this year because RSV is primarily spread by contact. If there are babies around, that is extremely important and you might want to forgo the death of a child this year.

In addition, people can cover their faces for four days in public spaces before gathering, and people can also take tests for the antigen COVID before. Finally, gatherings should be well ventilated. Outdoors is best, but if you are indoors, try to ensure good air circulation. If all these things are in place, people can relax, enjoy the gathering and not worry about getting sick.