Flu, COVID-19, and Chronic Illness: Why Your Risk May Be Higher

Flu and COVID-19 pose a higher risk for people living with chronic illnesses like heart disease, lung disease, and diabetes.
People living with several chronic conditions are at higher risk of serious illness from both flu and COVID-19. FG Trade/Getty Images
  • People who are living with serious chronic illnesses like heart disease, lung disease, or diabetes are at increased risk of serious illness from the flu and COVID-19.
  • However, despite this increased risk, new data finds many people who are living with chronic conditions are unaware of the potential danger they face.
  • The research also found serious gaps in effective flu vaccine messaging between healthcare professionals and their adult patients who are living with a chronic illness.

This year’s winter flu season is in full force. At the same time, COVID-19 numbers are rising with the continued presence of both the Delta and Omicron variants of the coronavirus.

The current danger from developing either of these two respiratory infections, or both at once, is high.

This poses a serious health risk to people who are especially vulnerable to severe infections, such as those who are living with serious chronic illnesses like heart disease, lung disease, and diabetes.

Getting the flu can pose a risk for people with these kinds of chronic diseases due to the threats of inflammation that could be caused by serious, long lasting, acute flu infection.

However, despite this increased risk, new data released by the National Foundation for Infectious Diseases (NFID) finds many people who are living with chronic conditions are unaware of the potential danger they face.

In particular, the research found serious gaps in effective messaging and awareness between healthcare professionals and their adult patients who are living with a chronic illness about the importance of getting flu vaccinations.

Surveying people with chronic conditions and their doctors

The NFID conducted two online surveys between Oct. 28 and Nov. 8, 2021, to get a sense of what the current practices and attitudes are around flu and pneumococcal vaccination.

The NFID also wanted to uncover what kind of communication currently exists between healthcare professionals and their patients living with these chronic conditions.

The two surveys were conducted by Wakefield Research and commissioned by the NFID. One survey involved 400 healthcare professionals (endocrinologists, primary care physicians, cardiologists, as well as pulmonologists).

The other survey included 300 patients who have been treated for diabetes, chronic lung conditions (think chronic obstructive pulmonary disease, or COPD, and asthma) and cardiovascular conditions like heart failure, heart attack, and heart disease.

According to survey results, just 45 percent of people with chronic conditions reported receiving a yearly flu shot by early November, while 40 percent said they “plan” on getting the vaccination during this current flu season.

The survey also showed that 75 percent of people who received or plan on receiving a flu vaccination are doing so to “protect themselves,” while 61 percent are doing so “to protect their family.”

Additionally, 62 percent said they are planning on getting it to avoid “getting sick with the flu during the COVID-19 pandemic,” according to the NFID’s press release.

The survey shows 93 percent agree that an annual flu shot is the best way to prevent hospitalizations and deaths tied to the flu.

Looking at healthcare professionals, the data reveals that just 31 percent reported they recommend an annual flu vaccination to all their patients who have chronic health conditions.

Beyond this, 44 percent recommend an annual flu shot to “most of their patients with chronic health conditions”; 20 percent recommend an annual flu shot to “about half of their patients with chronic health conditions”; and 5 percent recommend it to “about a quarter of their patients with chronic health conditions,” according to the press release.

The survey shows 86 percent of people with chronic conditions report that their healthcare professional recommended they get a flu vaccine in the past year, while 56 percent said they received this recommendation from their primary care physician.

Leading the way in specialists are cardiologists, as 72 percent of people with cardiovascular conditions said their cardiologist recommended they get a flu shot.

Just 32 percent of people with lung conditions said their pulmonologist recommended they get vaccinated for the flu, while 10 percent of people with diabetes reported their endocrinologist said they should get the shot.

Recommendations for doctors

When asked about these findings, Dr. William Schaffner, medical director of the NFID, told Healthline that while primary care physicians tend to be the ones who recommend that people get the flu vaccine the most, they’re not always doing this effectively.

For instance, he said that often at the end of a visit, the doctor might say, “It’s that time of year, you should think about a flu vaccine.”

In these cases, “the doctor thinks they recommended it, but that’s not much of a recommendation. It permits you to think about it and mull it over,” Schaffner said.

“It would be very different if the doctor said, ‘It’s that time of year, you should get your flu vaccine,’ and then on the way out, ‘Nurse Sally or Nurse Tom will give it to you before you head out the door,’” said Schaffner, who also serves as NFID liaison to the Advisory Committee on Immunization Practices (ACIP) at the Centers for Disease Control and Prevention (CDC).

“I say to my colleagues, don’t be a vaccine recommender, be a vaccine insister,” he added.

Schaffner said it’s crucial specialists start centering the need to make these recommendations, especially given they interact a lot with vulnerable older populations who often see these types of healthcare professionals more frequently than their primary care physicians, whom they might just see for that once-a-year physical.

He added it’s not necessarily embedded in the training of these specialists to make that kind of recommendation. Instead, they “just leave that to the primary care doctor.”

“They should explicitly instruct, not recommend, that you get your influenza vaccine at the pharmacy, at the senior citizen center, at the clinic, or at their primary care physician’s office. These specialists might not necessarily stock influenza vaccines in their practice,” he added. “The firmer the recommendation, the better.”

Schaffner remarked that it’s an “absolute delight” that cardiologists have been “at the forefront of accepting this responsibility.”

“Influenza vaccinations should be part of the routine care of all their heart disease patients, and we are really making inroads there. Now, we need to be working more with pulmonologists — you would think that would be obvious, but it isn’t — as well as other specialties.”

The need for people with chronic conditions to get vaccinated

Schaffner said it’s “hugely important” for people with chronic conditions to get their flu shots right away if they haven’t done so already.

“There is vaccine fatigue out there, and we’ve been so preoccupied with COVID, understandably, but the other nasty respiratory virus, influenza, has really dropped off people’s radar screens,” he said. “As I’ve been speaking with both patients and even professional colleagues and journalists, I’ve had to remind them that ‘influenza is back.’”

Schaffner recalled that we had a “remarkably mild influenza season” last year due to the fact that everyone was sheltering at home during the height of the pandemic.

Children weren’t in school, social events were canceled, commutes to an office took a back seat to walking a few feet to the home office.

As a result, flu transmission was remarkably low.

“This year, we reversed all those things. Kids are back in school, we are back in work circumstances, we are going back to recreational activities, to houses of worship. Clearly, flu has returned,” he said, underscoring the need to get vaccinated.

Ryan Miller, DO, an infectious disease specialist at Cleveland Clinic, told Healthline that “it takes time for the body to develop immunity after vaccination.”

Since both influenza and COVID-19 are concurrently circulating, he stressed that it’s necessary to get “the vaccine as soon as possible,” which is “the best way to gain protection by the time you are exposed.”

“Waiting any longer may result in you getting exposed to the virus before your body has had enough time to develop an appropriate defense,” Miller said.

When it comes to people with chronic conditions, Miller said that influenza can “cause serious respiratory disease that can be complicated by or even exacerbate other medical conditions.”

“Some individuals with chronic health conditions may not have a strong immune response to vaccination, so taking other precautions like face masks and social distancing are paramount,” Miller explained. “Each intervention provides some degree of protection, but when used in combination, they can significantly decrease someone’s risk of contracting the flu.”

Dr. Gregg Sylvester, MPH, chief medical officer and head of medical affairs at Seqirus, one of the largest global influenza vaccine providers, echoed those thoughts, saying that people with chronic conditions such as asthma, diabetes, heart disease, and COPD “face a higher risk of having long-term complications if their case is severe.”

“According to the CDC, 9 out of 10 people hospitalized with the flu had at least one underlying health condition. And for people with certain chronic conditions, a flu vaccine can help reduce the risk of their chronic conditions worsening as a result of the flu and prevent flu-associated hospitalizations,” Sylvester said.

In addition to people with chronic conditions, Sylvester told Healthline that we also have to consider the safety and well-being of older adults and other at-risk populations.

“Children younger than 5 years old, particularly those younger than 2, are at increased risk of developing serious influenza-related complications, including pneumonia, dehydration, ear infections, and worsening of their asthma. In very rare cases, death,” he said.

“Children 6 months to 5 years of age who are otherwise healthy can be at high risk of influenza-related complications simply due to their lack of prior immunity,” he added.

“According to the CDC, during the 2019-20 U.S. influenza season, an estimated 50,000 influenza-related hospitalizations and approximately 486 influenza-associated deaths occurred in children under 18 years of age,” Sylvester said.

Additionally, he highlighted adults who are 65 years old or older. He cited “age-related immune decline” in this age group that “makes it more difficult for the body to protect against the influenza virus.”

Sylvester said the CDC estimates that each year, adults ages 65 and over account for up to approximately 85 percent of influenza-related deaths and 70 percent of influenza-related hospitalizations.

On top of that, 80 percent of adults ages 65 and over live with one or more chronic health conditions — many of which are associated with increased risk of influenza-related complications and severe outcomes.

Navigating COVID-19 and the flu at the same time

Schaffner said that we are in something of a “twindemic” right now, with rising flu numbers compared with last year smashing against the wave of rising COVID-19 numbers due to coronavirus variants and low vaccination rates.

Dealing with a robust flu season on top of a continued pandemic presents a major public health challenge.

Schaffner said one positive is the sheer availability of vaccinations for both viruses. For many people, they can go into any local pharmacy and are likely able to get either a flu or COVID-19 shot, or both, without much trouble.

Sylvester also cited the bleak reality that U.S. hospitals continue to be overwhelmed by COVID-19. Due to this, he said it’s paramount that we collectively minimize “the additional burden of influenza.”

“The CDC recommends everyone 6 months of age and older without contraindications receive an influenza vaccine annually, and it’s important for older adults to be protected against seasonal flu.

“One way to do this is through the use of enhanced seasonal influenza vaccines, such as those that utilize an adjuvant, which are designed to help boost the immune response to influenza vaccination in adults 65 years and older who experience age-related immune decline,” Sylvester said.

Miller added that experts do not yet know the full scope of what a “coinfection with both influenza and COVID-19” can be.

“We can assume it will be serious given both viruses cause respiratory disease and individually can be lethal,” he added.

In short, get vaccinated for both, especially if you have a chronic condition or are immunocompromised in some way.

Given that there are so many unknown variables swirling around COVID-19 and virus variants, Sylvester said that “it’s important to control what we can.”

“Being vaccinated against influenza and COVID-19 is crucial to prevent illness and hospitalizations. As studies show, and as the CDC and the Advisory Committee on Immunization Practices (ACIP) recommend, both the COVID-19 and influenza vaccines are able to be administered at the same time and help to reduce illness, hospitalizations, and death. The side effects are not any worse than if you were to receive these shots individually,” he added.

It’s not too late to get vaccinated

Looking back at the NFID surveys, results also show that nearly half of respondents with chronic conditions have never been told by a healthcare professional that “flu would put them at increased risk for serious complications.”

On the flip side, 77 percent of the healthcare professionals who do recommend flu vaccinations report that they tell patients with chronic conditions that their condition puts them at greater risk.

The survey points to the reality that communication is key.

Sylvester said that while we are well into the current flu season in the United States, it is still important to protect yourself and others from the flu.

“There is always a chance of resurgence, and flu seasons have been known to extend into April or May,” he added.

Schaffner emphasized that if you have a chronic condition, or if you don’t but have yet to get vaccinated, get the flu vaccine right away.

“Let’s recognize it’s December, it’s not too late to get vaccinated. While flu has picked up here and there, it has not picked up steam. Statistically, February is the worst month [for flu] in the United States, so there is still time to get vaccinated,” Schaffner said.

“If we get vaccinated now, it will make all of those holiday gatherings safer for the individual with a chronic condition and other people around them,” he said.

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