Pandemic Precautions Lead to Low Incidence of Flu

Pharmacists across the country are seeing a milder flu season this year, thanks in part to the precautions put in place to prevent coronavirus disease 2019 (COVID-19), but many are also seeing increases in the number of flu vaccinations administered at their stores.

The COVID-19 pandemic has ushered in a greater focus on health and prevention efforts, which has led to fewer cases of the flu this season than in past years. “This flu season, we have seen lower incidences of flu compared to an average season, which may be due to our shift in behavior to reduce the spread of COVID-19,” said Tasha Polster, BSPharm, vice president of pharmacy quality, compliance and patient safety for Walgreens. “For example, more people are social distancing, wearing face masks, hand washing, and forgoing travel.”

According to the CDC, laboratory-confirmed cases of the flu remain “low at this time.”1 Additionally, reported deaths due to COVID-19 remain higher than for influenza, according to recent National Center for Health Statistics (NCHS) mortality surveillance data. For the data available on January 7, 2021, the NCHS reported that 14.5% of deaths occurring during the week ending January 2, 2021, were from pneumonia, influenza, and COVID-19 (PIC). However, of the 2150 PIC deaths reported in that week, 1496 had COVID-19 listed as an underlying or contributing cause of death, whereas only 2 listed influenza.

Rite Aid and CVS officials also reported decreased numbers in flu incidence this year among patients. “As a general trend, people are more aware of health and immunity than perhaps ever before, which fits into our purpose to become a neighborhood destination for whole being health, including traditional medicine like vaccinations and alternative remedies and supplements that may help boost immunity or reduce stress,” said Jocelyn Konrad, BSPharm, executive vice president and chief pharmacy officer for Rite Aid.

Moreover, the number of Americans receiving the flu vaccine is on the rise this season. The CDC led a push to encourage more individuals to get their vaccinations in order to avoid illness or hospitalizations that could tax an already overworked health care system.

“During the COVID-19 pandemic, reducing the overall burden of respiratory illnesses is important to protect vulnerable populations at risk for severe illness, the health care system, and other critical infrastructure,” the CDC said in its pandemic guidance released to the public.²

The push—and greater concerns about health among Americans—resulted in a significant increase in the number of individuals who have received vaccinations to date. According to the CDC, by December 19, 2020, an estimated 46.9 million adult flu vaccinations had been administered in pharmacies, compared with 32.9 million at the same time in 2019, representing a 43% increase. An additional 28.9 million adult flu vaccinations were administered in physician medical offices.³

Although last year 32.1 million turned to physicians’ offices to receive vaccinations—about the same number as those who went to a pharmacy setting in 2019—this year to date there has been a significant increase in those seeking immunizations at pharmacies rather than at their physicians’ offices (46.9 million vs 28.9 million, respectively).³

These trends seem to match what pharmacists are seeing in stores. “This flu season we anticipate administering nearly 20 million vaccines, which is more than double last year, so the demand to be vaccinated has certainly increased,” said Ryan Rumbarger, BSPharm, senior vice president of retail store operations for CVS Pharmacy.

Polster said Walgreens has seen “double-digit growth” in the number of flu vaccinations administered this year at its stores compared to this time last year. The company has also seen seniors 65 or older—who are particularly at risk for COVID-19—getting flu vaccinations in higher numbers and earlier in the flu season than in past years.

“Our marketing mix is consistent with previous flu seasons; however, understanding the importance of flu shots amidst the COVID-19 pandemic, we wanted to ensure we reached our customers to raise broad awareness far earlier this flu season, and ramped up our flu messaging beginning in August,” Polster said. The organization continued its Flu Fighter campaign this year, emphasizing that getting a flu vaccination “not only helps protect you, but those you love—your crew,” she said.

Konrad said Rite Aid’s messaging focused on communicating the importance of getting a vaccination “as a way to prevent a possible ‘twindemic’ that some health care experts feared could result from the collision of flu season and the COVID-19 pandemic.”

To date, it appears that concern has failed to come to fruition, but flu season is not over, and experts and the CDC said the community needs to remain vigilant in the months ahead. “We’ve continued to remind people it’s never too late to get your flu shot,” Rumbarger said. “We’ve also increased access to flu shots for communities in need.”

Brian Caswell, RPh, National Community Pharmacists Association president and owner of Wolkar Drug in Baxter Springs, Kansas, said that although he hasn’t necessarily seen an increase in the number of flu vaccinations administered at his pharmacy this season, he has seen more interest from patients who may have declined vaccinations in past years.

“I have not talked to anyone who said that they are going to forgo their flu shot because of what’s going on, but I have talked to a few people who’ve said, ‘You know, I haven’t had a flu shot ever’ or ‘I haven’t had a flu shot in the last 2 years and with everything going on, I thought I better go ahead and get it this year,’ ” he said.

Although the COVID-19 pandemic appears to have motivated many Americans to seek out flu vaccinations, it has also presented challenges to pharmacies in terms of marketing and logistics. Caswell said his pharmacy was forced to close its lobby twice during the pandemic, and had to rely more heavily on communicating with patients through word of mouth and social media outlets like Facebook. It also switched to an appointment-based approach to vaccinations to minimize the number of individuals in the store at any given time.

“Moving over to an appointment model, I thought was going to be a problem. It hasn’t been a problem,” he said. “People were willing to do it, and I think they didn’t want to be hanging around a lobby with sick people, either.”

Caswell said he had expected the pharmacy’s home delivery services to rise during the pandemic, but was surprised to find the biggest growth was in drive-through use. “I think people still wanted to get out,” he said.

Rumbarger said CVS also amplified its digital experience within its mobile app and expanded home delivery options, like DoorDash and Instacart, to reach patients during the pandemic. “Before and during the pandemic we’ve deployed a diverse marketing strategy to meet people where they are—in our pharmacies, in the community, in the home or in the palm of their hand,” he said, adding that officials will continue to revise strategies based on patient feedback.

Konrad said Rite Aid’s marketing messages have focused on how the pharmacy chain is still able to serve patients amid the pandemic and the increased safety precautions in place. “We’ve worked hard to provide essential pharmacy services—including vaccinations—despite the need to socially distance and protect customers and associates from COVID-19 transmission,” she said. “From enhanced cleaning and sanitation protocols to [personal protective equipment] and social distancing, we’ve made sure our customers can safely visit their neighborhood Rite Aid, whether to get a flu shot, get tested for COVID-19, or pick up medications and immunity-boosting supplements.”

Polster said pharmacies are expecting the COVID-19 vaccine to be more broadly available toward the end of the flu season. There will likely be high demand for COVID-19 vaccinations, but even with help on the horizon, pharmacies will need to encourage patients to remain as healthy as possible.

“It’s going to take time for a COVID-19 vaccine to be available to the general population, so we encourage everyone to get vaccinated against the flu to avoid 2 respiratory illnesses circulating at the same time and reduce the burden on our strained health care system,” Polster said.

References

1. Flu season. CDC. Updated January 11, 2021. Accessed January 11, 2021. https://www.cdc.gov/flu/season/index.html
2. Interim guidance for routine and influenza immunization services during the COVID-19 pandemic. CDC. Reviewed October 20, 2020. Accessed January 11, 2021. https://www.cdc.gov/vaccines/pandemic-guidance/index.html
3. Weekly national flu vaccination dashboard. CDC. Reviewed January 6, 2021. Accessed January 11, 2021. https://www.cdc.gov/flu/fluvaxview/dashboard/vaccination-dashboard.html.