8/27/20 COVID-19 Brief: Seasonal Flu + COVID-19 = Trouble: Avoiding the Double-Whammy

Just when you thought the pandemic couldn’t get much worse, it turns out that it can. But it doesn’t have to.

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

Seasonal Flu + COVID-19 = Trouble: Avoiding the Double-Whammy

Just when you thought the pandemic couldn’t get much worse, it turns out that it can. But it doesn’t have to.

First, let’s consider the facts:

  • If this year is like years past, between 9 and 45 million US citizens will become sick with the seasonal flu, resulting in 140,000 to 810,000 hospitalizations, and causing 12,000 to 61,000 deaths.
  • Both the seasonal flu and SARS-CoV-2 viruses survive better in the cooler and dryer temperatures of fall and winter, so flu-related hospitalizations and deaths will layer onto what is expected to be a resurgence of COVID-19-related illness, hospitalization and death.
  • It is possible for people to be sick with both the seasonal flu and COVID-19 at the same time, or for them to contract the diseases one after the other. At-risk populations will be particularly vulnerable to this one-two punch.
  • Because the symptoms of the seasonal flu and COVID-19 are similar, those who become sick from the flu will be presumed to have COVID-19, which means testing and – until results are confirmed - contact tracing and quarantining of close contacts. The bottom line for employers is higher direct costs, productivity losses and business disruption from the flu this year.

Pretty grim, so let me lighten the mood a bit. Consider these facts:

  • Countries in the southern hemisphere have experienced a very mild flu season, with cases, hospitalizations and deaths at just a fraction of what they normally experience. As the flu shifts to the northern hemisphere, there is hope that our experience could parallel what has happened south of the equator.
  • Researchers believe that the pandemic-related precautions that have been in place around the world have played a key role in moderating the flu in the southern hemisphere. The things being done to curtail COVID-19 are also slowing the spread of the flu.
  • Unlike COVID-19, we already have safe and effective vaccines to help prevent the flu.

In summary, as we go into fall the stage is set for a tragedy of illness, death and further economic loss. But employers can help re-write the script for a happier (if not happy) time ahead.

Two Key Goals

To avoid the double-whammy of Flu + COVID-19 employers should focus on two key goals:

  • Flu shots: Last year, less than 50% of US adults were vaccinated against flu. This year, the CDC’s goal is at least 65%. The minimum goal for employers should be 65% of employees and adult dependents get a flu shot, whether they’re on your insurance plan or not; and
  • COVID-19 Prevention: Maintain vigilance in implementing your COVID-19 prevention strategy, because the things you’re doing to protect employees from COVID-19 will also prevent the spread of the flu.

Seven Urgent Action Steps

I say “urgent” because the flu season kicks off in early October. If you’ve not yet begun intensive and creative planning for this coming flu season, you must start now to avoid the double-whammy. The seven steps I recommend:

1. Engage Key Stakeholders: Share this article with the stakeholders who need to be involved in planning and executing your flu prevention plan. Help them understand the threat and necessity of focusing on flu while also remaining vigilant in COVID-19 prevention.

2. Double-Down on Your COVID-19 Strategy: The things you’re doing to protect employees while they’re at work, and the efforts you’re making to educate, encourage and equip employees to be safer away from work will also help prevent the flu. This is not the time to let down your guard.

3. Plan to Re-Invent: Our tendency with things like flu prevention is to repeat whatever we did in years past. Even if you don’t have a significant chunk of your workforce working from home, this year is not like last year. So, before you press “repeat,” think critically about your situation and how your strategy to prevent flu needs to adapt.

4. Engage Your Vendors to Problem-Solve: If you have trusted vendors that have helped you with flu vaccinations in the past, bring them into your process early, share with them the details of how your landscape has changed, and press them to help you problem-solve the issues that need to be addressed.

5. Engage Employees: Start your communication campaign early, keep your messaging fresh, and stick with it until you have reached your goal. Use guidance provided in this article as you plot your communication strategy.

  • Also, consider a creative approach to incentives that connects your company’s health to the health of the community…perhaps for every employee vaccinated, you donate $5 toward providing flu vaccines to uninsured people in your community.
  • Note: We’re developing a set of posters that companies can use to promote flu vaccinations this fall. To receive the set of six customizable posters, click here.

6. Focus on High Risk Employees and Dependents: Engage your data vendor, health plan or broker/consultant to use claims data to identify and then reach out to at-risk employees and dependents with information and encouragement to get vaccinated against the flu this year. On top of that, use other communication channels to educate employees about who is at risk and the importance of getting a flu shot.

7. Track and Monitor: This is not the year to wait until the flu season is over and then figure out if you hit your vaccination targets. Ask your vendor-partners to set up a dashboard so you can see on an at-least monthly-basis, and ideally at the site-level, whether you’re on track to hit your goals or not.  

Laying the Foundation for COVID-19 Vaccination

A recent HBR titled Why Businesses Must Help Build Trust in a COVID-19 Vaccine notes that “Even safe and effective vaccines only work to protect the population if enough people are immunized. Unfortunately, there is already ample public opinion data to suggest that, egged on by anti-vaccine activists, large numbers of people won’t accept immunization.” The article suggests that companies can play a role in improving health literacy overall and can help employees recognize the important role vaccination will play in enabling a return to the full reopening of workplaces and the economy.

The HBR blog mentions CONVINCE, an organization that has recently launched to advocate workforce use of new COVID-19 vaccines once available. An old friend/colleague of mine, Dr. Scott Ratzan, is involved and WorkSTEPS is exploring ways we might help support their efforts. More to come, but in the meantime, follow the link above to learn more.  

By implementing a robust seasonal flu vaccination effort this fall, your company is effectively laying the foundation for success in vaccinating employees and dependents against COVID-19 when a vaccine becomes available.

I know – yet another plate to spin. This crisis has taxed corporate health and safety resources. If your organization needs help managing COVID-19, thinking through your seasonal flu strategy or better communicating with employees about all of this, get in touch with us here. You can learn more about our COVID-19 services here.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

For more from Dr. Hoffman, connect with him on LinkedIn.


Area Reported Cases Deaths Recovered
Global 24,208,293 826,539 16,713,080
United States 5,971,184 182,9944 3,258,082


Nationally: After coronavirus cases surged in June and July, the number of new reported cases in the United States began to level off, then drop, though the infection rate remains one of the world’s highest. By Wednesday morning, more than 5,792,900 people in the US have been infected with the coronavirus;  at least 178,400 have died.

Internationally: Fresh outbreaks are cropping up in Europe in countries that had initially flattened their curves. In the last few days France, Germany and Italy have experienced their highest daily case counts since the spring. Spain is in the middle of a major outbreak. According to the WHO, the proportion of young people age 15 to 24 who are infected in Europe has increased from 4.5% to 15% in the past five months.

Reinfection: The first known case of COVID-19 reinfection has been documented. Researchers at the University of Hong Kong sequenced the virus from the patient’s two infections and found that they did not match, indicating the second infection was not tied to the first. There was a difference of 24 nucleotides ( that make up viral RNA) between the two infections. On Tuesday, two more cases of reinfection were reported in Europe.  The reports are of concern because they suggest that immunity to the coronavirus may last only a few months in some people. And it has implications for vaccines being developed for the virus.

Projections: The CDC now projects that 3,700 to 9,600 new COVID-19 deaths will be reported during the week ending September 12 and that 187,000 to 205,000 total COVID-19 fatalities will be reported by that date.


Flu Season: As the flu season approaches, public health officials are concerned about the likelihood of a COVID-19 resurgence combined with a severe flu season. During the 2018-19 flu season, only 45.3 percent of adults over 18 received the flu vaccine. Public health officials worry that if a large portion of the public doesn’t get influenza vaccines this fall out of distrust or lack of access — it would increase the risk of a widespread outbreak and possibly overwhelm U.S hospitals already battling coronavirus. Physicians believe a  flu infection can leave people vulnerable to a severe case of COVID-19. If patients were to contract both at the same time, it could be disastrous. To increase flu vaccination capacity, the federal health officials  announced a directive last week allowing pharmacists in all 50 states to administer all childhood shots to children, including flu shots.

CDC updated recommendation for travelers

On Tuesday, the CDC dropped its recommendation that travelers quarantine for 14 days after flying overseas or arriving in areas with a high number of confirmed coronavirus cases. The update currently states arriving travelers should stay six feet from other people, wear masks and wash hands frequently. These are the same recommendations for people who have not traveled. CDC now advises travelers to follow restrictions set by state, local and territorial governments, which may require arrivals to "to stay home for up to 14 days." States vary in restriction requirements for travelers from travels overseas or from other states. These states require travelers to self-quarantine or present negative COVID-19 test in lieu of a blanket quarantine policy.



Congregate Housing: Last week CDC released updated guidelines on COVID-19 mitigation in congregate housing. Considerations exist for the prevention of COVID-19 in shared housing situations, and some of the following guidance covers a wide range of scenarios. This guidance on shared housing includes: apartments, condominiums, student housing, staff housing, transitional housing, and shelters can be found here.

CDC guidance on COVID-19 testing: This week CDC revised the guidance on COVID-19 testing. Notable changes have been made to recommendations on testing of asymptomatic people and close contacts.

1. Close contacts:  If you have been in close contact but do not have symptoms: You do not necessarily need a test unless you are a vulnerable individual or your health care provider or State/  local public health recommends testing. Self-monitoring for symptoms is recommended.

2. Asymptomatic testing:

  • In areas with a limited number of new cases, State or local public health officials may request to test a small number of asymptomatic “healthy people,” particularly from vulnerable populations.  
  • If there is significant spread of the virus in your community, State or local public health officials may request to test more asymptomatic “healthy people,” particularly from vulnerable populations.

The Work From Home WorkSTEPS Medical Team:

Ben Hoffman, MD, MPH
Chief Medical Officer

Tony Nigliazzo, MD
Medical Director

Loraine Kanyare, MSN, MPH, RN
Director of Case Management

Robert L. Levitin, MD
Physician Consultant

Lynda Phillips, LVN
Nurse Case Manager

Codey Church, LVN
Nurse Case Manager

Kerry Womack, LVN
Nurse Case Manager

Chuck Reynolds
Strategic Communications Consultant

This Guidance (“Guidance”) is provided for informational and educational purposes only. It is not intended as Legal Advice or Medical Advice. Adherence to any recommendations included in this Guidance will not ensure successful diagnosis or treatment in every situation. Furthermore, the recommendations contained in this Guidance should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. Similarly, this Guidance is based on current advice, comments, and guidance from the EEOC, CDC and the CMS made publicly available. The ultimate judgement regarding the propriety of any specific employment action must be made by the company and attorney in light of all of the circumstances presented by the company, state and federal rules existing at the time and the then current state of the National Pandemic. This Guidance and its conclusions and recommendations reflect the best available information at the time the Guidance was prepared. The results of future studies or changes in rules, regulations or laws may require revisions to the recommendations in this Guidance to reflect new data. WorkSTEPS does not warrant the accuracy or completeness of the Guidance and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Guidance or for any errors or omissions.

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Newsletter written by WorkSTEPS CMO Dr. Ben Hoffman and WorkSTEPS’ expert medical team.