Autumn has now begun, after a long hot summer which lasted until the whole month of October, autumn has arrived and seasonal flu has begun to circulate. We are still far from the peak, which, like every year, is expected between the end of December and the beginning of January, but the first cases are already here.
A large circulation of the virus is expected this year, for the lowering of the anticovid measures which in the previous two winters also protected us from flu contagion. In short, few infections in the previous two winters meant less exposure to immune stimuli and therefore now more likely to get infected. For this the doctors advice is to get vaccinatedespecially the categories most at riskand use, where appropriate, the prevention measures that we have learned from the pandemic: masks in crowded places and washing your hands often, mainly.
What should we expect from winter, both on the flu and on the Covid front, we spoke to the Dr. Raffaella Angelini, Head of the Public Hygiene Office of the Romagna Local Health Authority.
THE INTERVIEW
Doctor, how is the flu announcing this year? What symptoms will she have and will she be particularly aggressive or not?
At the moment we are not able to say whether it will be more or less serious in terms of symptoms, but the expectation of a greater spread of the virus is enough to warmly invite vaccination, which is the main bulwark. Maybe, as with Covid, it won’t completely protect against infection, but it certainly does against the complications of the disease.
Who is it recommended for?
The vaccination campaign is aimed in particular at the elderly population and the chronically ill. The vaccine is given free of charge to those over 60 and is strongly recommended over the age of 65. To these subjects, we can then add people of all ages with a chronic disease of any type: diabetes, cardiovascular, respiratory, neurological pathologies, etc … The gratuity is then extended to some professional categories, health, military, law enforcement, teachers , i.e. employees of essential public services, to avoid their jobs being cut off at peak times. And also farmers and veterinarians, due to the danger that the flu could mix with that to which some animals, such as chickens, are subject.
How is the campaign going? Have frequent anticovid calls brought us closer to vaccines or is there the opposite effect?
In this regard, I don’t have certain data, but based on feelings I would say that there is a little more resistance to getting vaccinated. We have seen this for example with the campaign for the Zoster virus, against the so-called “shingles”. We sent a text message to all the target people of the campaign (over 65) and set up ad hoc vaccination sessions. About 12% of those called up showed up, despite it being a frightening disease and on which a national television campaign is also active to raise awareness among the population. At the end of the year it may even reach 15-16%, but there hasn’t been massive participation. We attributed it to this tiredness due to the Covid period. Unfortunately, however, it is an irrational and wrong instinctive reaction, in the sense that the Covid vaccine does not protect against the flu and vice versa, both viruses cause potentially serious diseases, they must be done and there is no risk of doing them together. I made them myself on the same day.
With reference to the Ravenna hospital, the flu peak has always generated many accesses and blockages to the emergency room. How are we organising?
Unlike other years, the covid experience has also taught a lot about flexibility in the use of beds and emergency management, but it is clear that the flu epidemic is quite a trauma for the hospital system. There is a bit of a paradox: in common parlance, when we want to say that a disease is not serious, we compare it to the flu. This makes people think that the flu is a trivial disease, but it is not. If in young and healthy people it can be limited to fever, cough, cold and various discomforts resolve themselves in a week to 10 days, in subjects at risk it frequently leads to the decompensation of precarious health conditions. Some end up in hospital with bronchopneumonia, which is a frequent complication of the flu in frail people. Others are bedridden for long periods and, in the case of the elderly, end up acquiring disabilities they did not have before. Vaccination remains a major prevention measure, especially for the categories at risk.
Let’s move on to Covid: infections are decreasing, as is the occupation of beds. Have we bypassed the pandemic? Can we leave it behind? What is covid today compared to 2020?
I’d say no, we haven’t put it behind us. Covid is still among us, but we are in a transition phase towards the end of the pandemic. Every day in Romagna we still register 5-600 new cases, so circulation is sustained. In the coming months we must expect a resurgence of viral circulation, linked to the arrival of colder temperatures which lead to spending more time indoors, such as offices, schools, etc…
Today, however, it is a disease that is no longer as scary as it was in the beginning, not so much because the virus has changed significantly but because the population has changed: we are practically all vaccinated. Consequently, the virus continues to infest us, because vaccines do not fully protect us from infection, but they are extremely effective in protecting us from complications and serious forms, so we no longer end up in hospital as frequently as then and with alarming pictures.
It is presenting itself in lighter forms, with which we can live without the need for measures that limit our freedom too much.
But you have to be aware of reality. The covid is still there. When we talk about living with the virus, we don’t mean to pretend it doesn’t exist anymore. It means being aware that it exists and with a few simple measures it is possible to avoid getting sick or having it in a serious form: first of all get vaccinated and then use masks in crowded places and wash your hands frequently. If I get on the bus or travel by train, even if there is no longer the obligation to wear a mask, it is good practice to use it. It is a protection that costs us little, takes nothing away from us and at the same time gives us a lot. Now that everything is allowed, we need to pay more attention to our behavior, because even if interstitial pneumonia from Covid is no longer seen, it is still an annoying disease, which in a certain number of cases turns into long covid, with asthenia, weakness and other long-term ailments. Better to avoid it.
Has that famous herd immunity been created which was mentioned above all at the beginning of the vaccination campaign or will the Covid virus escape this logic and will the calls be a constant?
We have to get used to living with covid because the virus won’t abandon us. The famous herd immunity that applies to other viruses doesn’t work with covid, due to the frequent mutations it’s subject to. However, people’s immune situation has nothing to do with what it was in 2020. At the time, the world‘s population did not know this virus and it massacred it, now we are all abundantly protected, by vaccinations, by having encountered it and our immune system is able to respond and protect us. Unfortunately, the protection that these vaccines offer, such as natural immunity, does not last long, so it will be necessary to make boosters periodically. I hope that in the future it will be possible to vaccinate only frail subjects (elderly and chronically ill), once a year in combination with the flu. It would lead us to normalize the situation.
Are vaccination hubs still needed or will they soon be dismantled?
Thanks to the agreement with the general practitioners, we will be able to remodulate the openings of the hubs until they are significantly reduced, but until the end of the year we will maintain the current structure, to continue to promote the administration of the fourth dose well. Currently, in the Ravenna area, 61% of the over 80s who could receive it did it (that is, those who had already done the third year, around 87% of the reference population). In addition, 36% of those between 60 and 79 years. These are the two categories that have a high risk of complications.
On the other hand, according to what has been learned, all the prescriptions have fallen, those who have not been vaccinated return to work, these are not choices that push towards vaccination. Instead you need to get vaccinated because the virus is still circulating and can still do damage.