COVID-19: Prepare for the next flu season!

Influenza or flu, as it is commonly referred to, has been known to result in death from other causes, such as chronic obstructive pulmonary disease, congestive heart failure or pneumonia. However, for many years, cases of influenza have been underreported in medical records as cause of death. Several reasons have been adduced for this underreporting, including that, states are not required to report individual influenza cases or deaths of people older than 18 years of age to the Centre for Disease Control (CDC), patients are not always tested for influenza virus infections, particularly older adults who are at greatest risk of seasonal influenza complications and death.

Many influenza-related deaths usually occur within two weeks after a person’s initial infection, either because the person may develop a secondary bacterial co-infection or because influenza can exacerbate an existing chronic condition. Even if a patient is tested for influenza, the virus infection may not be identified because the influenza virus is only detectable for a limited number of days after infection and many people don’t seek medical care during this interval until later in their illness when influenza can no longer be detected from samples obtained for testing. Added to this is that most deaths, particularly among those 65 years and older, have been typically associated with secondary complications of influenza. In Nigeria, most sick patients have been traditionally investigated and treated for Malaria or Typhoid, even though such cases may have exhibited some symptoms of influenza infection. For these and other reasons, the modeling strategies that have been commonly used to estimate flu-associated deaths, are being fed with faulty data, resulting in a gross underestimation of the true impact of influenza. With influenza, the high transmission rates significantly outweigh the usually reported low case mortality rates, leading to widespread infections and the resultant huge absolute deaths.

Going by a recent report published in a weekly peer-reviewed general medical journal, The Lancet, it is estimated that up to 646,000 people worldwide die from seasonal influenza-related respiratory illnesses each year. Out of this number, people aged 75 years and older, and as usual, people living in sub-Saharan African countries account for the highest proportion of flu-associated respiratory deaths. These colossal numbers, although still regarded as grossly underestimated for the reasons adduced above, suggest that the world has been unwittingly carrying a significant disease burden for many years. 

The foregoing revelation underscores the need for accurate reporting of influenza infections and influenza-associated mortality as critical data of importance, for national and international decision making, on public health priorities. Accurate reporting will act as a pointer that will help convince the international community as to how serious influenzas can be and stimulate action for an urgent and robust global influenza prevention strategy. 

While the advent of the COVID-19 pandemic seems to have added to the complexity of influenza reporting and management, this event appears to be the milestone that signals a change in the view of the entire world on influenza, elevating the hitherto poor attention paid to recognizing, tackling and resolving the substantial disease burden imposed by the virus family. However, with the current developments, there is still no evidence of a globally coordinated effort or guidance on a systematic approach to dealing with this emergency. Testing and data acquisition is still way below average with the frenzy over the reporting of the pandemic still indicating that statistical models are being built around faulty data, while the entire world seems to be engaged in finger pointing. 

To ensure that countries adopt the right strategies to tackle this menace, what is necessary now is unprecedented support for the World Health Organization (WHO) by ensuring that adequate resources are made available for them to contend with the challenges posed by testing and data gathering. Testing must be ramped up to cover entire national boundaries and should include, not only testing for current infections, but also testing for signatures of the virus in people who were either asymptomatic or have had their infections somehow resolved. WHO must be properly empowered to start recording actual causes of mortality relating to all influenza related deaths, including those associated with COVID-19, by enforcing the reporting of all related infections. Only such an aggressive approach will help to accurately investigate and establish the true contribution of coronavirus-associated mortality to global disease-related mortality. 

In my simple desktop research and analyses on the current COVID-19, I arrived at a conclusion that when the numbers on infections and mortality are finally tallied, it would be revealed that the Case Mortality Rate will be no greater than 1%, the transmission rate is exceptionally high leading to high absolute mortality figures, any acquired immunity will only last for about 12 months and any simple vaccine will only provide temporary protection as in older influenza vaccine types. 

Now that coronavirus awareness is high and given the state of science today, it is expedient for more concerted efforts to be made by governments to support scientists in addressing the absence of drugs that are effective for dealing with coronavirus and indeed all viral related infections. It is quite worrisome that in this age of technology, no true cures have been found that are effective for treating viral infections. This short coming must be accorded unfettered attention and addressed in the interest of humanity. Although lockdowns and current efforts by countries, as advised by health experts, will help to limit viral transmissions in the interim, the only true way to keep COVID-19 and other influenza causing viruses at bay is to accelerate the development of broad spectrum drugs that are highly effective for eliminating the virus group in addition to instituting a global program in which such drugs will be made widely available to every individual within a specified timeframe. Without addressing these important issues and implementing real solutions in the short term, the world would once again be caught napping and left unprepared for the next flu season.

Capt. Ilegbodu is a pilot and CEO of a Nigerian airline.