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“It’s just the flu.” We’ve all heard this phrase many times, typically as a means of reassurance to or from someone suffering from a respiratory illness.
During the entire COVID-19 pandemic, “it is more than just flu” has been used to encourage COVID-19 vaccination and mitigation measures such as masking. Well-intentioned doctors are tweeting about COVID-19, which is killing more children than seasonal flu, in hopes that this information will inspire people who are vaccine-hesitant to protect themselves and others Reputable media sources are reminding people that COVID-19 “hardly ever” poses a serious threat to children, but also note that COVID-19 nevertheless kills many more children than the flu between 2020 and 2022. Even the popular Hulu series “Pam and Tommy” uses the flu as a metaphor to indicate that while a certain situation is bad, it is not yet “a plague.”
Now imagine hearing repeatedly that the flu is not a big deal when you are one of the many thousands of people who lose a loved one to the flu each year. These words are not reassuring. They are annoying. After COVID-19, influenza is the deadliest vaccine-preventable disease in the United States. In fact, each US flu season over the past decade has resulted in an estimated 9 million to 41 million illnesses, 140,000 to 710,000 hospitalizations, and 12,000 to 52,000 deaths, including more than 100 children. There are also significant economic and public health burdens of influenza that go beyond hospitalization and mortality, such as lost work and school days.
We are two of the many thousands of people who have been personally affected by the flu. Our previously healthy little boys, Joseph Marotta, 5, and JJ Neiman-Brown, 2, died of “just the flu” in 2009 and 2020, respectively. As scientists and mothers, and in the interest of preventing more such deaths, we ask that, that we all work together to eliminate common language misunderstandings that minimize the threat of influenza.
Influenza is dangerous. COVID-19 is dangerous. Measles is dangerous. Whooping cough is dangerous. It’s not a competition. Vaccines are available for these pathogens because they have caused a significant public health burden, including loss of life. Pitting these infectious diseases against each other like a horse race or a boxing match suggests that it is more worthwhile to prevent one of these common, highly contagious and fatal diseases than another.
We recognize that it may take some convincing to change the culture around these discussions. Our goal in this article is to summarize evidence that underscores the inappropriateness of minimizing the severity of influenza and supports the notion that we can simultaneously promote public health and medical countermeasures against several serious respiratory diseases.
Influenza-related pediatric deaths are relatively uncommon, but they affect hundreds of families each year. For example, before the start of the COVID-19 pandemic, 531 children in the United States lost their lives to the flu in the 2017-18 and 2019-20 seasons. A recent study of American children comparing the burdens of influenza and COVID-19 found that the incidence of life-threatening illness was similar for both diseases. So why do we keep hearing that COVID-19 isn’t “just the flu”? As mothers who lost their children to the flu, we can confirm that it does not feel so rare when it happens to your child.
Since 2004, when pediatric influenza-related deaths became a nationally notifiable (reportable) condition by state health departments to the Centers for Disease Control and Prevention, more than 2,000 children have been lost to influenza. Those thousands of pediatric flu deaths are also almost certainly one underestimate, reflects that reality some children who die from flu complications may not be tested for the flu, that the flu virus may not always be detected by some tests (especially after a week or so since the infection started), and that the flu is not always listed on their death certificates. who died of flu-related complications. About half of the children who lost to the flu were previously healthy, a frightening surprise to many who assume the flu poses no threat to their child.
Data from 2017 to 2021 indicate that compared to COVID-19, the pediatric influenza-associated hospitalization rate was similar or higher among children under 12 years of age, but lower for youth 12 to 17. Like the mortality data, these hospitalization data indicate that influenza may be a more serious illness for children, and especially younger children, than COVID-19. So why do we keep hearing that COVID-19 isn’t “just the flu”?
The already serious threat posed by influenza is exacerbated in communities affected by the consequences of systemic racism, including inequities in access to health care that drive the striking disparities in disease burden and health outcomes that often characterize members of historically marginalized communities. For example, people from many racial and ethnic groups experience higher rates of serious influenza-related outcomes than white counterparts. A study by the Centers for Disease Control and Prevention showed significant race/ethnicity-based differences in influenza-associated hospitalization rates, intensive care unit admissions, and hospital death rates; these differences were even more marked among children. These trends were observed in non-Hispanic blacks, non-Hispanic/Latino Native Americans and Alaska Natives, and Hispanic/Latino people. The sweeping minimization of influenza severity in our country and culture may even exacerbate these disparities, especially from the perspective that members of historically marginalized communities often have relatively little access to high-quality health care.
We know that annual flu vaccination is the best protection against seasonal flu. Influenza vaccines are lifesaving in adults and children. Still, influenza vaccination coverage has been well below the Healthy People 2030 goal of 70%, set by the US Department of Health and Human Services as a possible goal for personal protection and community immunity. During the 2021-22 flu season, preliminary estimates for flu vaccination rates among US children, adults, and pregnant women were 55%, 45%, and 52%, respectively. These rates are even lower among historically marginalized populations. For example, vaccination levels for 2021-22 among black children and adults were 47% and 35%, respectively.
There are a variety of reasons why people don’t get a flu shot each year, including the growing threat of vaccine misinformation, much of it deliberate. Another major potential driver is the lack of recognition of influenza as a health threat. And it doesn’t help to “move the needle” on flu vaccination when we consistently hear “it’s just the flu.” Primary care providers and specialists should strongly recommend influenza vaccination for all their patients each season and emphasize that it is safe to administer vaccinations at the same time (eg, influenza and COVID-19). Health care providers must also recognize that the absence of a recommendation is still a recommendation: It is critical to actively and repeatedly encourage annual influenza vaccination beginning when a child is 6 months old. From this perspective, it is especially important to recommend vaccination during pregnancy, as it is the best way to protect infants under 6 months of age. Ensuring that children have timely access to influenza testing and antiviral treatment soon after symptom onset may also help prevent or mitigate serious influenza-related outcomes.
Nothing is gained by pitting deadly infectious diseases against each other. Children and adults will die needlessly if we minimize the burden of disease and the risk of influenza. Taking the threat of influenza seriously is long overdue. It is our collective responsibility as parents, caregivers, healthcare professionals, scientists and public health advocates to prioritize the actions needed to better prevent and control influenza.
Serese Marotta is Director of Advocacy and Education for Vaccinate your family. Maurine Neiman, a native of Minneapolis, is a professor in the Department of Biology and the Department of Gender, Women, and Sexuality Studies at the University of Iowa. Marotta and Neiman present at 15th National Conference of Immunization Coalitions and Partnerships scheduled to be held in Minneapolis next week.