Right now, the number of flu and COVID cases aren't particularly high in Michigan. But emergency room visits due to COVID in Michigan are up slightly compared to many other states in the country. And cases of influenza are increasing, by a lot in some cases, in many U.S. states. So this seemed like a good time to get an update on these illnesses - and the vaccines that target them - from Michigan's Chief Medical Executive, Dr. Natasha Bagdasarian.
Q: I've been looking at the CDC flu activity report in particular myself, because I have been delaying getting my flu vaccine for one reason or another this year. And it hasn't started to take off in Michigan yet. I'm good. So when you look at where there is significant flu activity in the U.S. during this busy travel season, what do you think might happen with peak flu cases in Michigan? Is it too late for me to get my flu shot?
Dr. Bagdasarian: It is absolutely not too late. I will give you a little bit of an update on where we are with flu. And we have a variety of different metrics that we're following. So, number one, I will say that this is the time where we are expecting flu rates to go up. And there are a number of different data points that are indicating that flu is likely going up. Number one, we have data on wastewater. We test for flu virus in six wastewater treatment sites, in Mount Pleasant, Ann Arbor, Dennison, Warren, Traverse City and Jackson. And when we look at our wastewater data here in Michigan, we're seeing a trend upwards in quite a few different areas.
We can also take a look at numbers of people presenting to emergency departments with various respiratory illnesses. And we're starting to see that uptick for influenza. And those things, combined with the fact that it is travel season, we're seeing flu rates increase in a number of states. And as people travel and move around and congregate over the holidays, it is very likely that we will see a bump in those flu numbers. Now, usually when we talk about the big bump in flu numbers, that typically happens a little bit later in the season. That typically is sometime between January and March. But I think this is the beginning, perhaps, of an increase in those flu rates.
Q: Okay, great. So, not too late for my flu shot. I have to go get groceries after work today, and I can get my flu vaccine at the pharmacy there, they have walk-in. But let me ask you this, because I know every year scientists have to determine which flu variants are likely be be circulating, and then match the vaccine to those variants, and it looks like it just was not a good match this time. Based on what we're seeing from flu cases in South America, where the flu season is earlier, it looks like the vaccine is less effective than usual. It's only, you know, 35% effective at warding off serious flu. So why should I still get the vaccine? Give me the the elevator speech. Even if it's not a good match, should I get it?
Dr. Bagdasarian: "So that 35% is not really a number that is talking strictly about match. It's talking about reducing your risk for influenza-associated hospitalization. So if we are talking about reducing your risk for hospitalization by about a third, that to me is something that most people would want to do, especially if you are someone in a high risk group. So if you're over the age of 65, if you have other medical conditions, if you have underlying lung disease, diabetes, then reducing your risk for influenza-associated hospitalization is still a good thing.
And part of the reason why we recommend these vaccines is not because we want to prevent every single case of respiratory illness. That would simply be impossible. But we're trying to prevent deaths. We're trying to prevent hospitalization. We're trying to prevent hospitals from becoming overwhelmed with people coming in at the same time, because when hospitals become overwhelmed with respiratory illness, they can't take care of folks having heart attacks and people who've been involved in car accidents. And so to me, reducing my risk of severe influenza and hospitalization by about a third is no pun intended, but nothing to sneeze at.
Q: I do wonder if the public health communication message needs to get a little more assertive, because you often hear people say, "I don't get the flu vaccine anymore, because I got the vaccine once, and I still got the flu that year. So it doesn't work." And I think people have this idea that that's the only thing a vaccine is supposed to do — stop you from getting the illness itself. And it's not truly the case. Well, there are a few vaccines that actually are so effective that they essentially do do that. But many vaccines are just like, hey, right, I'm going to keep you out of the hospital.
Dr. Bagdasarian: You are right on the money. I think that our guidance and our public health communications need to become more nuanced, because it's very different when we're talking about the flu vaccine versus, for example, the measles vaccine. If you get the measles vaccine and you complete your doses, you are almost guaranteed not to get measles at all. So I can guarantee you with about 97% certainty that you won't get measles at all. And for those 3% who may develop measles after exposure, we would expect it to be much, much milder than someone who has not been vaccinated.
Now, that is very different than the messaging that we need to give people around influenza vaccine. The goal here, again, it's not to prevent all cases. It is to keep you out of the hospital and prevent you from dying, ending up on a ventilator. We know that there are some high risk groups and we really want to keep those groups safe this holiday season.
The other thing that we have to remember is that what most people think of as the flu is not actually the flu. There are more than 200 different subtypes of viruses that can cause cold and flu like symptoms. And just because you're having flu like symptoms, it does not mean that you have influenza. And so we don't have vaccines for all 200 of those subtypes that can cause illness. And we have to remember that the vaccine is targeted towards one particular type of virus, but that vaccine reduces your risk of hospitalization by about a third.
Q: So how are we doing on people taking advantage of this vaccine in Michigan right now? Are people really being a little too lackadaisical?
Dr. Bagdasarian: We have data on this. And one of the disappointing things is we have seen a decrease in the number of folks getting their influenza vaccine year upon year since 2019. So at this time in 2019, 3 million people had received their influenza vaccine. And this year we're only at 2.3 million people, which is lower than we would like it to be.
And really, that is not the full story because we see a lot of differences in how vaccine uptake is doing based on where you might live in the state. In Washtenaw County, we're seeing about 35% influenza vaccine coverage. And then we've got some other counties, [like Cass County] some smaller counties that are closer to nine and 10%.
Q: Well, 9% and 10% is not good at all. How do you account for that? Did the pandemic do something to our brains? I wonder if we are just not the same people that we were before the pandemic. We had this terrible new disease kill a lot of us. And now it seems we're just so blasé about another illness that we've had for a long, long time, that does still kill a lot of people, especially frail and elderly folks, and immunocompromised folks. How do you account for this decline in many of us, including those most at risk, in getting a flu vaccine?
Dr. Bagdasarian: I think one of the things to really remember is that influenza does not just kill people who are elderly and frail. I very clearly remember the flu season when I was in residency where we saw many, many young, healthy people dying of influenza. It can have great variation in how it manifests. Someone can have a relatively mild influenza infection and then for someone else, someone who is relatively young, relatively healthy, it can still be a life threatening infection. We see children dying from influenza every year. So it's not just something that impacts those who are old and frail and immunocompromised, although they are people who are at greater risk. We also have to remember that it is a virus that can cause terrible infection during pregnancy and can, in fact, result in in adverse outcomes for both mom and baby. And so this is a virus that has the potential to do a great deal of damage.
And there's been a lot of misinformation and disinformation that came out during the COVID 19 pandemic that has persisted. And I think everyone is trying to make the best decisions for themselves and their families. But we in public health have to make sure that they are receiving the information that allows us to make the best possible decision. And there is a lot of misinformation out there. I think it's hard for people to know what is true and what is not.
Q: Okay, so on to COVID 19! How are we doing with COVID activity in Michigan? Is it booming right now?
Dr. Bagdasarian: It is. I'll give you a few pieces of data. When we look at our wastewater data, the wastewater data actually is not showing an upward trend, the same way that I'm seeing for flu. But when I look at the emergency department data, COVID 19 is a little bit higher than for flu.
However, this is the time of year when we know that all of these viruses like to spread. Holiday season is coming up. People will be traveling. And so if we don't see an uptick in both COVID and flu and in fact, RSV, I will be surprised.
Q: I have anecdotally heard from quite a few people that they aren't going to get a COVID 19 vaccine this year. What are we looking at data wise for these vaccines, and I guess there's also a new one, which is a non-mRNA type of shot.
Dr. Bagdasarian: So we look at all the COVID vaccines together. We would like people to get vaccinated with whichever one they would like to get vaccinated with. And in terms of rates of uptake of COVID vaccine, we are doing worse with COVID than we do for flu. Only around 10% of residents in the state of Michigan are vaccinated with this season's COVID vaccine. But again, there's a lot of variation. So when we look at Washtenaw County, we're at 22%, so more than double the state average. And then there are many counties out there that are hovering around or five or six percent vaccine uptake.
Q: So are people concluding COVID 19 isn't a danger anymore, it's not going to kill me or land me in the hospital or give me long COVID?
Dr. Bgdasarian: It seems to be that is the perception. But of course, COVID hasn't gone anywhere. It is still here.
The good news is that we're not in the same position we were in in 2020, where no one had immunity to COVID. About 98% of the general population has some sort of immunity to COVID. But we know that immunity wanes, even for people who have received prior doses of the vaccine, which is why it's so important to get vaccinated with this year's vaccine, because it targets the vaccine variants that are currently circulating. And it allows for your immune system to get a little bit of a boost and to be better prepared to be exposed to COVID in the next four months or so.
Q: But it does sound like most of us do have some immunity now, either from getting COVID 19, or from getting vaccines in the past, so has this virus become less dangerous to us?
Dr. Bagdasarian: Absolutely. It has become a less dangerous disease. The vast majority of Americans, the vast majority of Michigan residents, have some sort of immunity to COVID. And so a COVID infection in 2024, 2025, this is potentially not going to be as dangerous as it was in 2020. However, there are still people being hospitalized from COVID. There are still people ending up on ventilators from COVID, and there are still people dying from COVID.
And if I could just mention waning immunity. So when we look at vaccination from last year, what we saw was that vaccine efficacy really waned at about 120 days after vaccination. So vaccine efficacy that protected people against hospitalization went from around 50%, to around 14% by 120 days after vaccination. So if people are relying on last year's vaccine, if they're relying on those first rounds of vaccine back in in 2020, 2021, those are not going to be as effective at keeping people out of the hospital. We are not looking necessarily to prevent every single case of COVID. But what we want to do is prevent deaths, hospitalization, admission to the ICU, people being put on ventilators.
Q: Which is why it makes all the sense in the world to just get your your COVID 19 vaccine updated every single year because there's 365 days in a year.
Dr. Bagdasarian: It really makes sense to get your COVID booster and your annual flu shot around October, potentially November— even now, it's not too late —because what it does is give you a boost to your immunity so that your immune system is more aware of what's out there for the next 3 to 4 months.
Now, when we look at who is receiving COVID vaccines by age, the data is a little bit more promising. When we look at folks who are over the age of 75, our vaccine uptake for this year's COVID vaccine is around 40% and it's much lower in younger age groups. So we are at least making sure that that our older age groups are vaccinated and protected against COVID 19. But again, we know that COVID can be a threat to people who are younger as well.
Q: What do we know about the role of vaccination at preventing long COVID?
Dr. Bagdasarian: There does clearly seem to be a risk between long COVID and folks who did not get a COVID 19 vaccine. There are other risk factors as well. And I think as time goes on and as we have more time to study long COVID, again, this is a virus that is relatively new, we will gain more clarity. But it does appear that people who don't get a COVID vaccine are at higher risk.
Q: I imagine it's something that's hard to study, since even getting diagnosed with long COVID can be a long process, getting the diagnosis recognized and hammered down.
You did mention one more thing of in terms of vaccines, which is the RSV vaccine. I think it's now recommended for folks over age 65? [RSV is a common respiratory virus that usually causes mild, cold-like symptom, but can cause very severe illness in some people.]
Dr. Bagdasarian: The RSV vaccine is available to those over the age of 65 or over the age of 60 with underlying medical conditions. It's also available to pregnant women. Again, it is something that we really do recommend because RSV can be a very mild infection in some, but it also has the potential to be quite severe. We had a very severe RSV season a few years ago and lots of kids, lots of older adults, ended up in the hospital. So again, these are viruses that can have a range of manifestations. They can be mild, they can be severe. And we are trying to prevent those severe outcomes.
We also have an RSV monoclonal antibody for babies born during the RSV season. This is very exciting. So we've got tools that we've never had before. And this is typically a one time vaccination, although again, we may find out more information as time goes on. But it actually looks like it is about 80% effective against lower respiratory tract illness.
Q: Is there anything else I have not asked you about these two topics that I should have or that you want to add?
Dr. Bagdasarian: I just want to give you a couple of plugs. Number one, in terms of staying healthy this cold and flu season, I mentioned that there are over 200 virus subtypes that can cause cold and flu like symptoms. We often don't know which virus is causing those symptoms. The best way to prevent getting any of these viruses is to make sure that you're getting enough sleep. You're eating a healthy diet, you're getting enough exercise, and you're boosting your immune system with those vaccines. Again, it's not too late to get those vaccines.
And then the other thing I just want to quickly say is that for folks who do become ill, a couple of things here. Number one, we have tests that you can now purchase over the counter, not only for COVID 19, but for influenza as well. So having some tests on hand is not a bad idea.
Then, if you do test positive for COVID or flu, the good news is there are some antiviral therapies. So talk to your health care provider about an antiviral. I will also just remind your listeners that antibiotics don't work against viruses. So asking your doctor for a Z PAC is not necessarily helpful if you have a viral infection.
But another really important thing is, regardless of test results, if you are feeling unwell, the best thing you can do over the holidays is to stay home and avoid spreading it to either travel companions or people at your destination who you love and care about. If you are feeling unwell, if you have fevers and chills and body aches, the best thing to do is stay at home and stay away from others. If you must be around others, wearing a mask can reduce the risk of those virus particles getting out into the air.
Q: I know quite a few people who are so angry when friends or relations show up at planned holiday events and say, "Hey, we just tested positive for COVID! We love you."
Dr. Bagdasarian: I think people people are scared to cancel their holiday plans. They don't want to let their family members down. But nobody wants to have a sick person showing up to their family gathering. So put yourself in the other person's shoes. Nobody wants to be exposed to COVID or flu or any other viruses this season.
Q: Yeah, the best way to show your your love for someone is, if you're sick, actually, don't "show" them. Don't show up.
