Flu Season, Elective Care, and COVID-19: How Healthcare Providers Can Brace for the Perfect Storm

By Lisa Romano

Eight months into the COVID-19 pandemic, after struggling to gain their footing following the initial outbreak, hospitals and health systems are staring down the barrel of a new confluence of factors that threaten to strain capacity, readiness, and staff safety and well-being. 

Just as we see spikes in respiratory illnesses as the weather turns colder, public health experts worry that a second, perhaps much larger wave of COVID-19 infections will tax healthcare providers in the coming months. At the beginning of October, the CDC predicted an increasing rate of hospitalizations, with 2,300 to 5,700 new COVID-19 hospitalizations per day over the ensuing four weeks. 

If that second wave materializes, it will do so amid a twin set of additional factors placing further strain on hospitals:

• The annual flu season: Despite comparisons in some circles of the flu to COVID-19, we know they’re very different – although their cumulative effect on healthcare systems could be more harmful than the sum of their parts. Last winter saw more than 400,000 flu-related hospitalizations and 18 million visits to healthcare providers – and this was a moderate flu season when compared with previous years. 
• Deferred elective care: At the beginning of the pandemic, medical professionals urged patients to delay screenings and procedures to reallocate resources to COVID-19 care and prevent viral exposure. That guidance has been reversed, but some patients still feel unsafe returning to doctors’ offices. Now, it’s incumbent upon care providers to get their patients back in for delayed and forgone care.

Navigating this “perfect storm” will require healthcare leaders to engage in smart and proactive patient outreach programs, both to mitigate the effects of the seasonal flu and to bring patients, especially those who are most at-risk, back for elective care. 

Beating back the flu

Every year, we talk about flu prevention. This year, we need to shout about it. 

The flu vaccine can’t take a backseat to COVID-19 care. In fact, it needs to be prioritized this year more than ever. According to Dr. Rachel Levine, Pennsylvania’s Secretary of Health, “No one knows what happens if you get influenza and COVID [simultaneously].”

The first case of both viruses occurring together has been reported in the Bay Area as of October 30th.

Hospitals may also face capacity challenges if the flu season ends up being more severe than normal. To ensure there are enough beds, ventilators, PPE, and other critical resources, hospitals and health systems need to put vaccine education at the forefront of their educational efforts. To that end, there are a few key messages healthcare organizations need to share with their communities: 

• The vaccine is available and free.
• The vaccine is safe (And no – it won’t “give you the flu”).
• Appointments are available at doctors’ offices, hospitals, and retail clinics.
• Get the timing right: patients should aim to get their vaccine by the end of October, but can still get it later, if needed.  

Getting the word out, however, needs to be done in a united, concerted push that reaches  wide swaths of patients quickly and effectively. UCSF Health, for example, used automated patient outreach to build a campaign that was specifically targeted at patients that hadn’t already received vaccinations at a Primary Care clinic. 

UCSF Health scaled their outreach to educate every patient on why, how, and where to get their flu shots – while simultaneously collecting data to inform future population health initiatives. Through the targeted, automated outreach, UCSF Health expanded the reach of their flu campaign, increasing vaccination rates by 38% among patients aged 50 and older. 

The safe return of elective care

In early spring, as the pandemic first grew in the United States, non-emergent and preventive care was put on the back burner, almost universally. Screenings, physicals, and other types of medical visits were canceled or postponed to free up resources to deal with the crisis at hand and to avoid additional spread of COVD-19. While seen as a necessary move at the time, the consequences of it are already beginning to be seen. 

In fact, in the first three months of the pandemic, an estimated 420,000 cancer screenings were skipped. Those missed screenings, along with missed appointments for patients with chronic conditions like hypertension, heart failure, and diabetes, will undoubtedly have a cascading effect of negative outcomes and increased strain. 

While it may seem counterintuitive to bring patients back onsite as the pandemic continues, deferring care even further may have catastrophic effects. Health providers need to take a comprehensive approach to outreach as they begin to work through the backlog of delayed or foregone care amid the pandemic. 

As hospitals and clinics leverage preventive health outreach programs, it’s best to tie those efforts directly into EMR and workflow systems so providers can identify and prioritize outreach to patients with chronic conditions and those who are most at risk. It’s also important for hospitals to leverage appointment reminders to reduce no-shows and give patients the option to reschedule. 

Bracing for the storm

As we turn the page to the colder months and COVID-19 cases continue to tick upwards, there is certainly a storm brewing. In addition to proactive outreach to bolster flu vaccination rates and get at-risk patients back in for deferred care, hospitals and health systems should also take time to optimize and finalize surge capacity plans, identify overflows, assess PPE and equipment supply availability and readiness.  Most importantly, they must have a consistent and transparent communication plan in place. Through a multi-tiered and collaborative approach, hospital leaders can work to ensure that the perfect storm doesn’t hit us head on. 

Lisa Romano is Chief Nursing Officer at CipherHealth, a patient engagement company.