Analysis: a severe flu season coupled with another wave of Covid-19 could have a serious impact on Ireland's healthcare system
With winter fast approaching we are yet again facing into a potential "twindemic" for the third time in as many years. But what is a twindemic and why are experts and healthcare professionals concerned about one?
"When we say twindemic, I think we need to be really clear that we're not talking about a double whammy on individuals," says Professor of Immunology Christine Loscher, Associate Dean for Research at DCU. "What we're talking about, is that we might surge with Covid at the same time as our flu season is really kicking off."
This winter is particularly concerning "because we've seen the behaviour of this year's flu in Australia and it has been quite severe. So when we say twindemic, we're worried about the impact of dealing with surges in two viral infections at the same time. Particularly for older people who would traditionally do very poorly with flu, particularly if they're not vaccinated, and we're also worried about the impact on the healthcare system."
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From RTÉ One's Six One News, HSE Chief Clinical Officer Dr Colm Henry says Ireland will see a "twindemic" this winter
Our last Covid-19 surge saw close to 1,000 people hospitalised because of the sheer volume of people that were infected, she says. "If you can imagine a severe flu on top of that, I think we're really going to be stretched." The potential impact of that on the healthcare system is "going to have consequences for everything else that we do in the healthcare system; elective surgeries, capacity to take people into the hospital for tests, waiting lists etc."
Dr Fergal Hickey, president of the Irish Association of Emergency Medicine, said last month that it will be "hell on earth" in Irish hospitals if the winter projections for hospital and ICU admissions are correct. A report for a meeting of the Emergency Department Task Force, discussing the draft HSE winter plan, said that a high flu season could see 4,350 hospitalisations, with 225 patients in ICU. A worst-case scenario for Covid-19 would see 17,000 hospitalisations, with 700 patients in ICU during the six-month winter season.
With Covid numbers on the rise across Europe, we are "potentially" heading into a difficult flu and Covid season in Ireland, says Loscher. "We just don't report case numbers the way we did previously, so we're never really sure where we are with Covid cases. We really just have the PCRs to rely on and the percentage positivity rates. We know at the moment there are more cases, there's certainly more hospitalisations."
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From RTÉ Radio 1's Today with Claire Byrne, "twindemic" concerns for the Irish health service
"If we're looking at an indicator of where we are with Covid, hospital case numbers and ICU numbers are our best indication. Because if they're higher it means that we have high cases in the community, we’ve seen that correlation before."
To minimise the risk of the impact of a potential double whammy of Covid and flu, primarily the most important thing we can do is vaccination. Covid boosters for people who are due boosters and flu vaccines for everybody," Loscher says. She’s disappointed that the flu vaccine hasn’t been made free for everyone this winter, as was the case in 2020 and 2021, but only for older people and children.
"The uptake was really significant last year and we had hardly any flu season. In total, we had very few severe cases and very few hospitalisations and that was primarily down to vaccines. But it was also down to the fact that we were taking other measures like mask wearing, which reduced transmission of lots of different viral infections including flu."
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From RTÉ Radio 1's Today with Claire Byrne, Dr Danny Altmann and Gez Medinger talk about "The Long Covid Handbook"
According to the latest report from the Health Protection and Surveillance Centre there are currently 410 people in hospital with Covid-19. A recent report published by the Department of Health on its strategic approach to Covid-19 this winter includes an emergency response plan in the case of a new variant of concern. It includes the possibility to escalate testing, tracing and vaccination if needed as well as the potential for re-introducing masks in certain settings, like transport and healthcare.
"Mask wearing and vaccination are the two key things that I think are important from the winter plan. It's all about minimising risk, there’s nothing that we can tell the public to do that's going to stop them getting Covid or stop them getting the flu. But there's lots of things they can do to minimise the risk and I think that should be the focus."
"We know that mask wearing does reduce the risk when lots of people are wearing masks. It’s less effective when individuals are wearing masks in environments where others aren’t. People are making their own decisions about what's right and I think the most important thing is always about giving people a very clear understanding of what the current situation is," Loscher says.
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From RTÉ Radio 1's Today with Claire Byrne, Professor Cliona O'Farrelly and Dr Amy Morgan answer listeners questions for the winter
"That means we do have to be clear, open and transparent about where our Covid cases are at the moment, and they are rising, and we need to be very clear about the risks of having flu on top of a surge, which is about hospitalisation and it's about impact on healthcare systems."
Our understanding of Covid is also changing the more we know about the long-term consequences. "I see a move in the concern from what happens when people are infected with Covid to a concern about how people recover with Covid. The science around long Covid is becoming very clear now. There are actually biomarkers present, there is actually a scientific basis for the symptoms that people are experiencing post-Covid."
We’re being "blasé" about the consequences of getting a Covid infection now, because it isn’t very severe in most people and we have widespread vaccination and population immunity, but we do know that long Covid is a "big deal", says Loscher.
Read: What should we be doing before the next Covid surge?
People need to "associate mask-wearing not just with the risk of getting an infection but the consequence of getting an infection in terms of long Covid, recovery afterwards and the impact on their life in general. If we start to communicate the relationship between all those things and people see the bigger picture, then maybe people will be encouraged more to wear masks for those reasons rather than just about the initial infection."
Loscher stresses the importance of people continuing to antigen test and the importance that those antigen tests are from from the HSE, which they currently aren’t. "In order to encourage people to make good decisions about when to isolate, and when not, when to send a child to school, when to go into work yourself, you need to make things easy and accessible.
"I think the best thing that the HSE did at one stage, was to have free access to antigen testing. Coming into the winter with all the other things that are circulating, to be sure about whether or not this is Covid, I would like to see the HSE make those tests very freely available and accessible to everybody."
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
