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‘It’s just the flu’

It’s just the flu”. We’ve all heard this phrase many times, typically as a means of reassurance for or from someone in the throes of a respiratory illness. Throughout the COVID-19 pandemic, “It’s more than just the flu”, has been used to encourage COVID-19 vaccination and mitigation measures such as masking.  In other words, downplaying the flu to emphasize the seriousness of Covid-19 has been deployed as a strategy throughout the pandemic.


But imagine hearing repeatedly that the flu isn’t a big deal when you are one of the many thousands of people who, each year, experience the loss of a loved one to influenza. These words are not reassuring. They are infuriating. 


We are two of those many thousands of people who have been personally impacted by flu: our previously healthy little boys, Joseph Marotta (5 years old) and J.J. Neiman-Brown (2 years old), died of “just the flu” in 2009 and 2020, respectively. As scientists and mothers, and in the interest of preventing more such deaths, we ask that we all work together towards eliminating common language misconceptions that minimize the threat posed by influenza. 


After COVID-19, influenza is the deadliest vaccine-preventable disease in the U.S. Over the last decade, each U.S. influenza season has resulted in an estimated 9,000,000-41,000,000 illnesses, 140,000-710,000 hospitalizations, and 12,000-52,000 deaths, including over 100 children. There are also substantial economic and public health burdens of influenza that extend beyond hospitalization and mortality, such as lost work and school days. 


Influenza is dangerous. COVID-19 is dangerous. Measles is dangerous. Whooping cough is dangerous. It’s not a contest. Vaccines are available for these pathogens because they have caused a significant public health burden, including loss of life. Pitting these infectious diseases against one another suggests that it is more worthwhile to prevent one than another.


Flu-related pediatric deaths affect hundreds of families each year. Prior to the start of the COVID-19 pandemic, 531 children in the U.S. lost their lives to flu across the 2017-18, 2018-19, and 2019-20 seasons.


A recent study of U.S. children that compared the burdens of influenza and COVID-19 found that the prevalence of life-threatening illness was similar for both diseases.


These numbers don’t even represent the whole story. Influenza deaths are almost certainly underreported because children who die of influenza complications may not be tested for influenza, influenza viruses are not always detected by some tests, and influenza is not always listed on the death certificates of those who died from flu-related complications. 


The threat influenza poses is heightened in communities impacted by the consequences of systemic racism, including inequities in access to health care that drive the striking disparities in disease burden and health outcomes that often characterize historically marginalized communities. People from many racial and ethnic minority groups experience higher rates of severe flu-related outcomes, including hospitalization and death. A CDC study showed significant racial and ethnic disparities in influenza-associated hospitalization rates, intensive care unit admissions, and in-hospital death rates; disparities that were even more marked among children. The pervasive minimization of flu severity in our country and culture might even exacerbate these inequities.


We know that annual flu vaccination is the best protection against seasonal influenza. Flu vaccines are lifesaving in adults and children. Even so, influenza vaccination coverage has been well below the Healthy People 2030 target of 70% established by the U.S. Department of Health and Human Services as a feasible goal for personal protection and community immunity.


Nothing is gained by pitting deadly infectious diseases against one another. Children and adults will die needlessly if we minimize the disease burden and risk posed by influenza. Taking the threat of influenza seriously is long overdue. It is our collective responsibility as parents, caregivers, health-care professionals, scientists, and public health advocates to prioritize the actions needed to better prevent and control influenza. 


Serese Marotta is director of advocacy and education for Vaccinate Your Family


Maurine Neiman is a professor in the Department of Biology and Department of Gender, Women’s, and Sexuality Studies at the University of Iowa. Marotta and Neiman presented their findings at the 15th National Conference for Immunization Coalitions and Partnerships.


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