Study warns of delayed flu outbreaks after pandemic ends
The positive steps we are taking to prevent disease might have a negative side effect.
13 November, 2020
Credit: Christopher Furlong/Getty Images
- A new study out of Princeton suggests that measures to prevent COVID-19 are also preventing certain other diseases.
- The nature of seasonal diseases means that people who avoid them this year may just be putting it off, leading to a large wave later.
- These estimates don't mean we should be less preventive now, only that we must be sure to take care in the future.
<p> As the United States continues to struggle with the pandemic, the proven effectiveness of face masks to reduce the rate and risk of infection continues to be underutilized. Places that have implemented mask and distancing mandates are seeing generally lower rates of transmission and infection than those without these mandates, as more fully explained <a href="https://www.pnas.org/content/117/26/14857" rel="noopener noreferrer" target="_blank">here</a>, <a href="https://www.eurekalert.org/pub_releases/2020-06/tl-pss060120.php" rel="noopener noreferrer" target="_blank">here</a>, and <a href="https://www.vox.com/science-and-health/21546014/mask-mandates-coronavirus-covid-19" rel="noopener noreferrer" target="_blank">here</a>. <br> <br> However, one of the three iron laws of the cosmos is the law of unintended consequences; no matter what you do, there will be at least one.</p><p> As a study out of Princeton has just shown, this also applies to live-saving mask mandates. Given that many other diseases follow predictable cycles, a team of researchers has shown that the steps we're taking to prevent the spread of COVID-19 now may lead to larger outbreaks of seasonal diseases later. <br> <br> Before we go any further, we want to make it clear that we are not telling you stop wearing a mask, social distancing, or taking all the precautions against catching and spreading COVID. The point of this study and this article is to make people aware of a side effect of these measures so that we can better deal with them later, not to suggest that these measures not be taken. </p>
<iframe width="730" height="430" src="https://www.youtube.com/embed/UFX9oS2kpUA" frameborder="0" allow="accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe><p> A team of researchers based out of Princeton published a <a href="https://www.pnas.org/content/early/2020/11/06/2013182117" target="_blank" rel="noopener noreferrer">study</a> in the Proceedings of the National Academy of Sciences showing the predictions of a model that estimates the after effects of our current efforts to avoid COVID-19.</p><p>As it turns out, Non-pharmaceutical interventions (NPIs) such as social distancing and wearing masks help prevent more than just COVID-19. Instances of other diseases, such as respiratory syncytial virus (RSV) and the flu, are also lower than they would otherwise be due to people taking these precautions. Cases of RSV may have declined by as much as a 20 percent already. </p><p> This makes a lot of intuitive sense. Your mask doesn't care what kind of virus it keeps you from exhaling towards other people; it stops all of them. If you stay inside to avoid catching a particular disease, you still avoid all of them. This kind of thing has happened before. The precautions taken during the 1918 flu pandemic probably reduced measles cases by a third. <br> <br> However, these diseases come back seasonally and will be there waiting for us when the current pandemic ends. This might be a bit of a problem, as lead author Rachel Baker <a href="https://www.princeton.edu/news/2020/11/09/large-delayed-outbreaks-endemic-diseases-possible-following-covid-19-controls" target="_blank" rel="noopener noreferrer">explained</a>:<br> <br> "While this reduction in cases could be interpreted as a positive side effect of COVID-19 prevention, the reality is much more complex. Our results suggest that susceptibility to these other diseases, such as RSV and flu, could increase while NPIs are in place, resulting in large outbreaks when they begin circulating again."<br> <br> Think of it like this: As fewer and fewer people get these diseases due to our current mask and social distancing tendencies, fewer and fewer people have immunity to them. Immunity to RSV lasts only a few <a href="https://en.wikipedia.org/wiki/Respiratory_syncytial_virus" target="_blank" rel="noopener noreferrer">years</a>. If people who would have gotten it this year don't, they may contract and spread it next year when they aren't working so hard to avoid respiratory infections, along with all the other people who were likely to get it next year anyway for typical reasons. <br> <br> The model is less exact for the flu, given the number of variables affecting how contagious the flu is from year to year, but a similar principle applies. </p><p><br> There is a fair amount of uncertainty to these findings, as the authors admit. Outbreaks in some areas have been better studied than others. The behavior of these seasonal outbreaks is more thoroughly understood in Florida than in Minnesota, for example, and these predictions may not be as applicable there. The models are also highly dependent on what measures we take and when to fight COVID-19, and the worst-case ones rely on a lot of things happening in tandem. </p> So while we can't know exactly what that next flu season will look like, the essential finding of this study is that it is likely to be worse than it otherwise would be, everything else being equal. Various measures, such as getting more people vaccinated against the flu and keeping people home when they are sick with seemingly banal colds, will be necessary in the years to come. Hospitals should also brace for higher than average numbers of people coming in as a result of this.
Why you should still wear a mask
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc3NDYzNS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMzc1ODM1Nn0.UNIHh2X2AtR6fq_fhAwejphFKIOY9J3lGFWgDf-R6oE/img.jpg?width=980" id="d681e" class="rm-shortcode" data-rm-shortcode-id="1dc1e7ee8c2f01ac128b4b48c1675510" data-rm-shortcode-name="rebelmouse-image" data-width="960" data-height="1280" />A chart from another study on the effectiveness of masks and lockdowns. The grey line in the bottom two marks when mask mandates were imposed.
Credit: Zhang, Li, Zhang, and Molina
<p><br>Again, before you decide that this means mask mandates are just delaying some kind of reckoning, we can look at the numbers. Several <a href="https://www.nationalgeographic.com/science/2020/07/coronavirus-deadlier-than-many-believed-infection-fatality-rate-cvd/" target="_blank" rel="noopener noreferrer">sources</a> agree <a href="https://www.cdc.gov/flu/symptoms/flu-vs-covid19.htm" target="_blank" rel="noopener noreferrer">that</a> the <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/coronavirus-disease-2019-vs-the-flu" target="_blank" rel="noopener noreferrer">coronavirus</a> is <a href="https://www.livescience.com/covid-19-vs-flu-deaths-hospitalized-patients.html" target="_blank" rel="noopener noreferrer">deadlier</a> than <a href="https://www.snopes.com/fact-check/flu-kills-more-people-covid-19/" target="_blank" rel="noopener noreferrer">the </a><a href="https://www.snopes.com/fact-check/flu-kills-more-people-covid-19/" target="_blank" rel="noopener noreferrer">flu</a><a href="https://www.snopes.com/fact-check/flu-kills-more-people-covid-19/" target="_blank" rel="noopener noreferrer">.</a> We also don't have a vaccine for it yet, unlike for the flu, and keeping yourself and others from getting sick now remains extremely important for keeping people alive. </p><p> A friend of mine remarked at the beginning of the pandemic that certain events in society leave marks on the people in it, much like growth rings on a tree showing years of drought decades after it occurred. If the findings of this study are accurate, then COVID-19 will leave rings visible in seasonal outbreaks over the next few years alongside the slew of others it will create. <br></p><p>Given what this study shows us and the hard-learned lessons we have about what happens when you don't listen to scientists, maybe we'll do a better job at controlling those potential epidemics.</p>
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Number of American parents not vaccinating infants has quadrupled
A measles comeback is not the sort of return our children deserve.
19 October, 2018
MIAMI, FL - OCTOBER 04: An influenza vaccination is prepared for a patient at the CVS Pharmacy store's MinuteClinic on October 4, 2018 in Miami, Florida. CVS stores will provide flu vaccinations at their MinuteClinic as well as the pharmacy and according to the Centers for Disease Control and Prevention and the American Academy of Pediatrics between now and the end of October is the best time to get vaccinated as the flu season begins. (Photo by Joe Raedle/Getty Images)
- The percentage of children under 2 years old who haven't received any vaccinations has quadrupled in the last 17 years.
- In 2016 in Europe there were 5,273 cases of measles. One year later that jumped to 21,315 cases.
- Discredited doctor Andrew Wakefield's false study linking vaccines and autism still influences parents, two decades later.
<p>Health care should be a public right today, especially in wealthy nations such as America, though for most of history such support systems were impossible. Social health initiatives are relatively new. Bureaucratic European states instituted such programs, but it was not until Germany introduced the "medical police" in the late 17th century that widespread programs started to take root. Johan Peter Frank helped construct the ideological underpinnings of this movement in a nine-volume series of books that took 48 years to write. </p><p>Frank was a champion of inoculation, the burgeoning practice of introducing small amounts of a disease — in this case, smallpox — into a person, which allowed their immune system build up defenses against a full-fledged ravaging virus. Inoculation itself dates back at least to ancient China; Frank was merely giving bureaucratic form to the formula. </p><p>By the middle of the 18th century, such inoculations were widespread, though an ignorance of proper dosage still lead to many deaths. While royalty and the wealthy were first in line, a physician named Edward Jenner brought it mainstream by injecting cowpox into a young boy who became immune to this ailment. Jenner called it a "vaccination," after the Latin word for "cow." </p><p>Decades later, the British Public Health Movement enforced compulsory vaccination. This led to an intense scrutiny of the major causes of disease, such as poverty, child labor, water supply, and prostitution. A linkage between our social environment and disease was forged. Public health reforms in Britain and America were instituted, with the World Health Organization being formed in 1948 to study and fight disease on a global scale. </p>
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="97c72e57b6ecb83f0f6d333586765bf6"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/7VG_s2PCH_c?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>Such efforts made a huge impact. Malaria was cut down in many countries. Perhaps the biggest victory was smallpox, whose last known case occurred in 1977. In May, 1980 the agency announced its extinction. Other chronic diseases have been greatly restricted: polio, measles, and tetanus are confined, while influenza, HPV, and chicken pox have been verified as ailments that vaccines minimize.</p><p>Then, in 1998, a now-discredited British doctor, Andrew Wakefield, was <a href="https://sciencebasedmedicine.org/antivaccine-hero-andrew-wakefield-scientific-fraud/" target="_blank">paid to falsify evidence</a> linking the MMR vaccine and autism. The paper was eventually retracted. Yet it was published during a time when conspiracy theories were growing thanks to a new communications device called the internet. Rightfully-confused and upset parents were seeking a cause to the growing number of autistic children. Wakefield offered an answer, of sorts. </p><p>Problem is, that answer didn't address the question of making us healthier. Not only do vaccines not cause autism, the anti-vax movement that has grown from his deceptive paper is making us sicker. Last year in Minnesota the <a href="https://www.washingtonpost.com/national/health-science/imams-in-us-take-on-the-anti-vaccine-movement-during-ramadan/2017/05/26/8660edc6-41ad-11e7-8c25-44d09ff5a4a8_story.html?utm_term=.75815407e075" target="_blank">worst measles outbreak</a> in generations occurred in a Somali population that received false information from an anti-vaxxer group. It's not only America: in 2016 in Europe there were 5,273 cases of measles. Due to <a href="https://www.popsci.com/measles-vaccination-rates-outbreak" target="_blank">anti-vaxxer fever</a>, just one year later 21,315 people fell ill to a disease that has been successfully fought since 1960. </p><p>And now, this disturbing news was <a href="https://www.washingtonpost.com/national/health-science/percentage-of-young-us-children-who-dont-receive-any-vaccines-has-quadrupled-since-2001/2018/10/11/4a9cca98-cd0d-11e8-920f-dd52e1ae4570_story.html?utm_term=.ae5f4db17854" target="_blank">recently published</a> regarding American children:</p><p style="margin-left: 20px;">The percentage of children under 2 years old who haven't received any vaccinations has quadrupled in the last 17 years, according to federal health data released Thursday.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8xODc0NDQ5MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0ODQ2MTYxN30.85iMPThYVIp6xooWkWPKZk_HiIA-JKooxGo0K98dKZ4/img.jpg?width=980" id="828fc" class="rm-shortcode" data-rm-shortcode-id="6c75b1a5a3730fd4b08dcbc0944d74b2" data-rm-shortcode-name="rebelmouse-image" />INDONESIA-HEALTH-CHILDREN
A medical worker injects a baby with a measles-rubella (MR) vaccine at a health station in Banda Aceh in Aceh province on September 19, 2018. Photo by CHAIDEER MAHYUDDIN / AFP
<p>The CDC <a href="https://www.cdc.gov/mmwr/volumes/67/wr/mm6740a4.htm?s_cid=mm6740a4_e" target="_blank">notes</a> that coverage was lowest among the uninsured and children covered under Medicaid. A free, federally-funded <a href="https://www.cdc.gov/vaccines/programs/vfc/index.html" target="_blank">Vaccines For Children</a> program exists, causing <em>The </em><em>Washington Post</em> to speculate that at least part of this issue might be education. </p><p>Yet really, this entire debacle is indicative of a lack of education. Vaccine researcher Peter Hotez, whose daughter suffers from autism, has published a book detailing the issue, in which which he <a href="https://www.vox.com/science-and-health/2018/10/16/17964992/vaccine-autism-book-peter-hotez" target="_blank">explains</a>: </p><blockquote>From my experience, a majority of vaccine-hesitant parents are not deeply dug in. They've gotten misinformation from anti-vaccine websites and social media, or they've heard something unsavory about vaccines from friends and relatives… Then there's another group, maybe 10 to 20 percent who are deeply dug in and believe all of the fake conspiracy theories. Those individuals are really difficult to reach.</blockquote><p>For most of history, disease was ambiguous, random, metaphysical even — there is no dearth in literature relating sickness with gods and demons. It was long thought karma was the reason you fell ill or died. We know better today, yet too many people refuse to recognize this basic fact, placing their faith in biological mysticism. This is child abuse, yet sadly this is akin to smartphone addiction: we're simply not ready to label it as such on a societal scale. </p><p>Vaccine science is not perfect. Each year, the efficacy of the influenza vaccine is an educated guess. However, just because researchers haven't nailed every facet of disease does not mean we should write off the science. Millions of lives have been saved due to vaccines. Now, if current trends continues, millions more will be put at risk.</p><p>The majority of American children are vaccinated. I've heard complaints by a number of friends whose children are put on a rigorous schedule from birth; their skepticism of the validity of this approach is warranted. We should debate courses. We should not, however, debate basic science, such as vaccinating children for measles or polio. Parents putting their children at risk due to their own lack of common sense is not only unfair, it's dangerous.</p><p>--</p><p><span></span><em>Stay in touch with Derek on <a href="http://www.twitter.com/derekberes" target="_blank">Twitter</a> and <a href="https://www.facebook.com/DerekBeresdotcom" target="_blank">Facebook</a>.</em></p>
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