The Evolving Landscape of Influenza Immunizations - Episode 5

Anticipating the Prevalence of the Coming Flu Season

Pharmacist roles are explored as the panel discusses the anticipation of the coming flu season.

Mitchel Rothholz, RPh, MBA: Randy, you made a good point. We looked at flu prevalence through the COVID-19 [pandemic]. Because we had masks and social distancing, the cases weren’t there. People are thinking that the flu isn’t that significant; “I don’t know anybody who got it during this time.” It showed the impact of masking and distancing. But now that all those are off, we’re starting to see some cases in Australia. We look at the southern hemisphere to see what’s trending and what may happen in the northern hemisphere. Jeff, how does that factor in as we look at what the potential flu season will be coming up? What’s happening in the southern hemisphere? What should we be alerted to as pharmacies start preparing for the season?

Jeff Goad, PharmD, MPH: You’re right. It’s an interesting bellwether to look at what’s happening in Australia. Their flu season is our summer, their winter is our summer. They saw a return in cases, which is interesting because Australia had a lot of lockdowns, even complete country lockdowns, although not as drastic as China, where they tried to get to 0 cases of COVID-19. But they still had influenza, which tells you that there’s a reservoir in humans sitting around. It’s looking for an opportunity.

In the United States, I hate to be the person who says it’s going to be a horrible flu season and then it isn’t, and then people come back and say, “You said it was going to be a horrible flu season.” Because we predicted the twindemic, and only part of the twin came through on the twindemic, we have to be careful about sounding the alarm. But there are a lot of things that are going on, such as masks being relaxed. Everything that both John and Randy mentioned are happening. Whether that’s going to translate into more cases, maybe more than prepandemic in the United States, we’ll have to see. Because we gave more flu vaccine shots in that first year when we predicted the twindemic than we had before. Then it dropped off the next year. Our challenge is that we’re dealing with the media and what they perceive vs what we’re actually seeing. It’s going to be a challenge. I don’t think it’s going to be a worse season than we’ve seen before, but I think it’s going to be a return to baseline influenza.

John Beckner, RPh: I read a couple of statistics the other day. We pay attention to what’s going on in the southern hemisphere. I saw that the World Health Organization and the FDA are monitoring over 80 sites to see what’s going on down there to serve as a barometer for what we may have during our flu season. It’s helpful to know what’s going on in another part of the world as we prepare for ours.

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: I agree with Jeff that you don’t want to say the sky is falling and that we’re going to have a tremendous flu season, but as a pharmacist, I have a responsibility to make sure my patients are educated. Because to me it becomes an N of 1 [single case study]; if you get it, it isn’t a nice thing. If you get it and you’re immunocompromised, it becomes a more serious thing. My job is to make sure that I get as many people vaccinated as possible so they don’t become that N of 1, that individual who has a severe adverse event because they contacted flu and I didn’t do what I was supposed to do to make sure they were educated about the importance of getting it.

Mitchel Rothholz, RPh, MBA: All of you made great points. Early during COVID-19 before the COVID-19 vaccine was available, the 1 thing individuals could do to protect themselves was get vaccinated against influenza. That’s when we saw those increased rates. But then as soon as the COVID-19 vaccine came out, attention on the flu vaccine waned. We’re trying to get back to a norm, whatever that new norm will be. A question that has come up to me a couple of times from patients is, in your practices or the practices you work with, are the pharmacists and the staff wearing masks?

Randy McDonough, PharmD, MS, BCGP, BCPS, FAPhA: Good question, Mitch. We had a mask mandate until more recently when the state [Iowa] came out. We have a pretty conservative state and a governor, so we felt like we couldn’t force it anymore, even though we’re a place of health care. But we’re starting to see mandates and high recommendations made because of the increase of COVID-19 rates. We’ll probably go back to everybody masking within the pharmacy, especially as we start preparing to do more vaccines. It gives a good impression to the public regarding how we take this seriously and that we want to keep them safe. We have a lot of patients who come in, especially those who are immunocompromised, and we want to make sure they realize we respect them and we need to make sure we help them stay safe. We got a bit lax, but we’re heading back the other way to make sure everybody is masked within the pharmacy.

Mitchel Rothholz, RPh, MBA: Thanks for the insight.

Jeff Goad, PharmD, MPH: One of the other challenges is we have other agencies too. We have OSHA [Occupational Safety and Health Administration]. And in California, we have the airborne transmissible standard, which has been driving a lot of the mask requirements within hospitals and other health care settings that the aerosol transmission standard covers. There are still some places that require masks. But I agree with Randy. In our pharmacies, chain and independent, most are still wearing masks. That’s very common. In fact, even in our university setting, although the university doesn’t have a mask mandate, we do within our pharmacy program. In any simulated health care environment, we make sure students know how to talk to patients through a mask and the importance of what kind of mask to wear and in what setting. We’re still doing it. But there’s still a lot of personal preference for when and where they do it.

John Beckner, RPh: I agree with both of my colleagues here. It has been a mixed bag. But I like Randy’s point. One of the most important things that pharmacies and pharmacists were able to do during the pandemic is make their patients and staff feel safe. Masking is important to convey that sense of safety to the public. I wish more people were doing it.

Transcript edited for clarity.