The 2022-2023 influenza-like illnesses (ILIs) season in the Northern Hemisphere started earlier than previous years, and seasonal influenza and respiratory syncytial virus (RSV) activity will likely continue to rise as COVID-19 stabilizes in the coming months. Although these illnesses are highly contagious and can cause potentially serious disease, many employers do not recognize them as a significant threat and suffer staffing shortages and operational delays as a result. Many of the same mitigation measures used to prevent the spread of COVID-19 can be used to reduce seasonal influenza and RSV transmission.
Like all respiratory diseases, individuals can reduce their risk of infection by taking strict respiratory hygiene precautions: washing hands regularly with soapy water and avoiding large crowds or obviously ill individuals. However, because these diseases can spread before symptoms are apparent, many preventative measures are only partially effective. All individuals, unless medically contraindicated, should be vaccinated against seasonal influenza and COVID-19. Seasonal influenza vaccines protect against influenza within 2-3 weeks of immunization, and COVID-19 vaccines within 7-10 days. There is currently no vaccine to prevent RSV.
Current Trend in the Northern Hemisphere
Seasonal influenza is not the only ILI circulating the Northern Hemisphere during the current flu season, which is also seeing respiratory syncytial virus (RSV), and COVID-19. The risks for contracting any of these illnesses are age, vaccination status, and strength of immune system. Infants and young children are most at risk, though people over 60 years of age and immunocompromised individuals are also vulnerable. Anyone can contract seasonal influenza and COVID-19, especially if they are unvaccinated or, in the case of COVID-19, did not receive a timely booster.
Notifications for respiratory infections (also known as ILIs) are occurring much earlier and increasing faster than was observed in previous years. Preventative measures, like avoiding crowding spaces, washing hands, and staying at home when ill, put in place to reduce COVID-19 transmission also reduce influenza activity. However, with these measures less prevalent, it is possible for both viruses to transmit more easily. The influenza season in the Northern Hemisphere generally begins slowly in October and can last as late as May, though in 2022, influenza activity in North America began much earlier, is more easily transmitted, and remains significantly higher than the levels observed in prior years, and it continues to rise week-over-week.
RSV activity has rapidly increased during the current influenza period across countries in the Northern Hemisphere. This trend is unprecedented as the virus is known to infect children (but at an expected rate); however, reports have indicated that during the current season, adults are at risk as well. Countries across North America (excluding Mexico) and Europe report a surge in RSV cases and related hospitalizations in recent weeks. This increase in disease transmission can be attributed to social distancing and public health restrictions, imposed to prevent COVID-19 transmission for the last two years, resulting in immune systems not having enough experience to protect against influenza viruses. In addition to the rise in RSV-related hospitalizations, countries have reported a shortage of pain medication for children to manage the symptoms associated with RSV infections.
While Mexico has not yet reported any confirmed RSV cases as of Nov. 29, authorities urge people to use preventative measures to reduce the burden of disease. Neighboring Texas State has reported a decline in RSV activity since Oct. 29th.
What Can Countries Expect with the Current Trend
Countries within the Northern Hemisphere are likely to experience earlier than usual ILI transmission peaks, excluding COVID-19. This has been observed in the US, where both RSV and seasonal influenza activity started to increase above expected rates during late August, with disease activity rapidly increasing and a second peak expected to surpass the 2021-2022 threshold for both diseases. This rapid rise in case load can impact health facilities across the country, especially pediatric units, which did not anticipate the rise in RSV hospitalizations. Similar to the US, Canada is experiencing a rapid rise in both RSV and Seasonal influenza cases which has inundated the health system, particularly availability of medicine. To date, while Mexico has not reported any RSV cases, it continues to report a surge in ILIs with the first peak occurring in late-July, and the second in mid-September; an additional peak is expected in early December. Europe reported its first peak in early November with another peak expected in late December or early January 2023. Of these three ILIs, COVID-19 has demonstrated an overall decline in transmission across the Northern Hemisphere, except for overseas territories, which are experiencing a surge in activity.
Vaccination against COVID-19, Seasonal Influenza, and RSV
Historical trends suggest that flu vaccine coverage was similar across age groups in countries of the Northern Hemisphere between 2020-2022. However, for the 2022-2023 season, coverage fell slightly. In the US, as of Nov. 12, seasonal influenza doses are more than 30 million fewer compared to a similar period in 2020. This drop in uptake of seasonal influenza vaccine uptake can be attributed to individuals already being ill with an ILI, meaning they are unable to be vaccinated, resulting in easier transmission of ILI viruses to a now larger pool of unvaccinated individuals. Canada has not yet released vaccine coverage data; however, historically between 2020-2022, seasonal influenza coverage has been similar across all ages for each season. The increase in ILI diseases can be attributed to the restrictions that were imposed over the last two years to prevent COVID-19 transmission: the body’s immune system is “out of practice” to prevent ILI infection.
There is no vaccine to prevent RSV; treatment consists of supportive therapies to reduce symptom severity, which may include mechanical ventilation for children with severe cases and pain management. Canadian health authorities are reviewing an RSV vaccine to protect the elderly, individuals aged 60 years and older.
As of Nov. 29, nearly 65-percent of EU citizens are fully vaccinated, however, only 31 percent have had a single booster. Similarly, in the US, 68.8 percent and 62.8 percent in Mexico are fully vaccinated.
Economic Burden of Influenza-like Illnesses
The burden imposed by ILIs annually across the Northern Hemisphere not only impacts individual health, but also healthcare services, associated healthcare costs and productivity losses.
Vaccination is one of the most cost-effective ways to prevent disease transmission and plays a significant role in the overall public health of a country. The economic cost of becoming ill from an ILI impacts individuals, as well as the workforce as a whole and, by extension, national economic growth. If a population is unprotected against ILIs like seasonal influenza or COVID-19, it will lead to lower productivity due to higher illness-related employee absenteeism. In countries where businesses do not offer flexible benefit packages, employees can experience further stressors in the form of high unexpected medical bills and lost wages.
Even though there is no RSV vaccine, it continues to have an economic burden. Parents of infants, young children, and caregivers of the elderly are primarily impacted. The incubation of RSV can range from 2-8 days, and caregivers and parents therefore need to remain at home to take care of their dependents. The current RSV burden in the Northern Hemisphere is overcrowding hospitals’ pediatric units, and caregivers will therefore need to remain home for longer, increasing employee absenteeism rates.
The economic burden of ILIs on business will depend on the size and business model of the company, as well as the labor laws of the country. Smaller companies that have limited laws on worker compensation and benefits will most struggle to absorb direct expenses and productivity losses due to ILIs compared to medium and larger companies are better prepared to mitigate this burden.
Prevention Strategies for the Workplace
1. Raise Awareness about COVID-19, Seasonal Influenza, and RSV
Employees who believe they are at risk of becoming infected with ILIs - and who understand the consequences associated with influenza infection - are more likely to alter their behaviors to reduce the risk of infection. Therefore, it is important that employers educate workers about how ILIs spread, their symptoms, and the potential complications related to ILI infection. This information should be communicated to employees through emails, talks by accredited healthcare professionals, and by placing flyers or posters in high-traffic areas, to maximize visibility.
ILIs are very contagious viral diseases that spread through respiratory droplets created when an infected person coughs, sneezes, or speaks. There are several types of seasonal influenza viruses - including H1N1, H3N2, and influenza B. Influenza vaccines are available and must be obtained every year to be protective. Antibiotics can neither prevent nor treat the flu, as antibiotics target bacteria and are ineffective against viruses. There many variants of COVID-19, with Omicron the main variant of concern circulating the globe. There are currently 11 different types of COVID-19 vaccines which can offer protection against the virus.
Symptoms of influenza:
- Coughing, sore throat, runny or stuffy nose, muscle or body aches, headaches, fatigue, sometimes fever or feeling feverish/chills. People usually recover from the flu in a few days, and most infections resolve within two weeks. However, some people, especially young children, and people with weakened immune systems, may experience more severe complications that require additional medical care or even hospitalization.
Symptoms of COVID-19:
- Symptoms occur 1-14 days following exposure (average of 3-7 days). These symptoms typically include fever, fatigue, and dry cough; less common symptoms include headache, diarrhea, loss of taste or smell, reddening of the eyes, skin rash, or discoloration of the fingers or toes.
Symptoms of RSV:
- Congestion, dry cough, fever (low grade), sore throat, sneezing, and headache. Healthy children and adults recover from RSV within 8 days. However, children younger than 12 months and immunocompromised individuals are more likely to suffer from severe infection and may need hospitalization.
Complications associated with influenza:
- Some individuals with influenza will develop complications such as pneumonia, bronchitis, and sinus or ear infections. These complications can be life-threatening and are more common in individuals with underlying chronic medical conditions.
Complications associated with COVID-19:
- Symptoms may worsen to difficulty breathing, pneumonia, and organ failure - especially in those with underlying, chronic medical conditions.
Complications associated with RSV:
- Individuals can experience pneumonia or bronchiolitis which can result in hospitalization of infants or individuals with chronic heart or lung problems, including the need for mechanical ventilation to help them breathe.
2. Encourage Proper Coughing Etiquette and Hand Washing
It is extremely important for employers to teach and remind employees of the proper way to cover coughs and sneezes, and also to regularly wash their hands with soapy water (or alcohol-based hand sanitizer) throughout the ILI season.
Proper coughing and sneezing etiquette:
- Cover coughs and sneezes with a tissue and dispose of the used tissues in "no-touch" wastebaskets.
- If a tissue is not available, cough and sneeze into your elbow or upper sleeve.
Basic hand hygiene:
- Wash hands after blowing your nose, coughing, sneezing, or encountering mucus or contaminated objects and surfaces.
- To wash hands appropriately: apply soap and water, rub soapy hands together for at least 20 seconds, rinse hands with water, and dry completely.
- If soap and water are not available, using an alcohol-based hand rub is a helpful interim measure until hand washing is possible. When using an alcohol-based hand rub, apply the liquid to the palm of the hand, cover all surfaces of the hand with the liquid, and rub hands together until dry.
3. Keep the Workplace Clean
Since the ILIs spread on contaminated surfaces or objects, it is important that employers develop procedures and policies that ensure all commonly touched work surfaces, work areas, and equipment - for example, telephones, doorknobs, lunch areas, copy machines, etc. - are cleaned frequently. Routine cleaning agents are sufficient to disinfect surfaces against influenza, but employers should provide easy access to cleaning supplies.
4. Encourage Immunization
The effectiveness of a vaccine depends on how well-matched the vaccine is to the active viruses; vaccination therefore remains an important defense against seasonal influenza and COVID-19 infection. However, misconceptions regarding vaccine safety remain high and is arguably the most difficult obstacle. For example, individuals continue to believe that the influenza vaccine can cause people to become ill; even though, the standard influenza vaccine contains inactivated virus that is unable to make people sick. In addition, many non-influenza respiratory illnesses have symptoms that can be described as “flu-like,” which many individuals incorrectly attribute to recent vaccination, rather than illness due to a different flu strain or other infectious agent.
For some, the effectiveness and safety of COVID-19 vaccines remains a concern because of the speed at which the vaccine was developed. However, the first two COVID-19 vaccines developed by Pfizer/BioNTech and Moderna, respectively; are 95-percent effective and cause no serious or life-threatening side effects to individuals. These vaccines were created using a method that the companies developed over many years; as a result, vaccine development during the pandemic was quick and efficient. Some individuals believe that receiving a COVID-19 vaccine means they will be infected with COVID-19. On the contrary, COVID-19 vaccines are produced using authorized messenger ribonucleic acid (mRNA) that instruct your cells to reproduce a protein that is like SARS-CoV-2 (the virus causing COVID-19), helping the body recognize and fight the virus in the future.
Employers should consider hosting a combined seasonal influenza and COVID-19 vaccination clinic at their place of business. Health authorities recommend providing vaccines to employees at little-to-no cost and promoting vaccination within the local community. If hosting a combined seasonal influenza and COVID-19 vaccination clinic on-site is not plausible, employers should consider notifying their employees of local pharmacies and clinics offering influenza vaccinations, especially those close to the office. Especially since many pharmacies and clinics are only open during normal business hours. Additionally, employers should consider allowing their employees the time to go to these clinics during work hours.
Unlike COVID-19, seasonal influenza and RSV do not need to reach pandemic status to negatively impact business continuity. Has your office properly prepared for the current ILI season? With the surge in seasonal influenza and RSV activity expected to continue in the coming weeks, it is not too late to implement preventative measures.
Crisis24 provides in-depth intelligence, planning, and training, as well as swift and actionable responses to keep your organization ahead of emerging risks. Contact us to learn more.
