Health systems brace for 'twindemic' with calm confidence

As health system leaders confront the possibility of a COVID-19 and flu "twindemic" this year, they aren't focused on new strategies to handle a potential influx of patients. Instead, they're doubling down on what they know from their experience with the last four COVID-19 surges

Public health experts have feared the nation could see coinciding surges of flu and COVID-19 since the start of the pandemic. While that never materialized, experts worry this could be the year that changes, since masking and other prevention measures are no longer commonplace. Another factor that raises the twindemic risk this year are signs that the U.S. is in store for a severe flu season, based on trends from the Southern Hemisphere, where flu season runs from April to September. 

Already, flu season is off to an early start in the U.S., CDC data shows. In the week ending Oct. 15, the U.S. reported a 4.4 percent test positivity rate and recorded 1,674 new flu hospitalizations.

"We've noted that flu activity is starting to increase across much of the country," especially in Southern states, CDC Director Rochelle Walensky, MD, told NBC News. "Not everybody got flu vaccinated last year, and many people did not get the flu. So that makes us ripe to have a potentially severe flu season." 

A number of new omicron descendents gaining prevalence in the U.S. add another level of concern and uncertainty about how case numbers and disease severity will unfold across the fall and winter months. 

"I don't think additional planning is really the formula," for how to prepare for an influx of hospitalized patients, Robert Jansen, MD, chief medical officer of Atlanta-based Grady Health System, told Becker's. "It's doing what you already know how to do. It's not a new pandemic; [it would be] a continuation of what we've been dealing with since 2020." 

Health systems emphasized three main priorities they'll focus on this fall and winter with regard to flu and COVID-19:

1. Capacity management. Past COVID-19 surges forced health systems to develop new strategies to predict and quickly respond to rising patient volumes, tools that have left them well-prepared for what this winter may bring. 

If a twindemic does materialize, Dr. Jansen said Grady will look to cohort infected patients in certain units and reduce elective surgeries if needed. 

"We've proven in the past that we can handle the patients. We now know how to treat people, how to effectively isolate patients, use appropriate PPE and restrict visitation, etc.," Dr. Jansen said. The main factors complicating planning efforts are the unknowns surrounding whether a possible surge will bring more severe disease and how hospitalization numbers will compare to prior surges. (Last year, daily COVID-19 hospitalizations at Grady peaked at nearly 190 patients). Grady is also concerned about the scope of the volume increase it will see in the wake of Wellstar's planned closure of Atlanta Medical Center Nov. 1. 

"We still don't have a good idea of how many of those patients who did traditionally go to that facility will come to Grady," Dr. Jansen said. 

Rochester, Minn.-based Mayo Clinic is also closely monitoring flu positivity rates on a local, state and national level to identify when the system may need to ramp up bed capacity and staffing levels. 

"Obviously, we've learned a lot through COVID," Abinash Virk, MD, an infectious disease specialist and professor of medicine at Mayo Clinic, told Becker's. "COVID has prepared us over the last few years, particularly during the winters, for some of that capacity management." 

Robert Wyllie, MD, chief of medical operations at Cleveland Clinic, said the system is also leaning on strategies from prior surges. In April 2020, Cleveland Clinic set up a 1,000-bed surge hospital for COVID-19 patients in the commons area of its main campus, and the infrastructure was left in place to stand up hundreds of beds if needed. 

2. Vaccinations. Like many systems, Mayo Clinic is focusing on flu and COVID-19 booster vaccination efforts for patients, employees and community members. Similarly, Cleveland Clinic's flu vaccination campaign runs through the end of October. The health system has tried to make it as easy as possible for staff to get their vaccines during their shifts by setting up vaccination sites in all primary care areas, and setting up a mass vaccination site on its main campus.

Dr. Wyllie said Cleveland Clinic has had "very high compliance" with its flu vaccination mandate and was intentional with the timing of its vaccination campaigns so that protection doesn't wear off during Ohio's peak influenza months. Placing a strong focus on staff vaccinations is key because if staff are out sick, other surge capacity efforts are of little use. 

"If the staff is getting ill at the same rate the population is getting ill, then that really cuts your capacity to open up another tent or another building … because there's nobody to put there to man them," Dr. Wyllie said. 

Health systems are also of course focused on increasing flu and omicron booster shot rates among the general population and are working with state and community partners on that front. 

"The thing that we are most fearful of is whether people in the community will take both vaccines," Grady's Dr. Jansen said. Despite broad awareness that vaccines are the best tool against severe disease, "the question is what is the community's appetite for continuing that," he said. "There's a lot of fatigue and vaccine hesitancy." 

3. Testing. Alongside vaccinations, flu and COVID-19 testing will also play a critical role in limiting both viruses' spread this winter, Dr. Virk said. Before COVID-19, Mayo Clinic would conduct flu testing from October through December until the system's test positivity rate got so high that most clinicians could assume anyone coming to the emergency department with flu-like symptoms had the virus. COVID-19 complicates the diagnostic process. 

"Now, we just don't know," Dr. Virk said. "We have to test; we have no other way of knowing."


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