Preparing for flu season amid COVID-19: What PCPs need to know
Amidst the threat of a fall wave of COVID-19 cases in the United States, primary care physicians face another challenge: the 2020-2021 influenza season.
“This has the potential to be a challenging season with COVID-19 and influenza both impacting vulnerable populations,” Steven J. Kravet, MD, MBA, president of Johns Hopkins Community Physicians, told Healio Primary Care. “The best strategy is to be ready, to begin now to reinforce prevention and to assess workforce capacity, equipment and community resources.”
Encouraging data have emerged that suggest efforts to curb the COVID-19 pandemic — including masking and physical distancing — led to a global decline in influenza cases.
However, there are still concerns that the influenza season could stress hospitals that are already strained due to the pandemic.
Healio Primary Care spoke with Kravet, Anjali Mahoney, MD, a family medicine specialist with Keck Medicine of USC and vice chair of clinical affairs in the department of family medicine at the Keck School of Medicine of USC, and John Schirripa, MD, regional medical director of Mount Sinai Doctors - Westchester and an assistant professor of general internal medicine at Mount Sinai, to learn more about what PCPs can do to prepare their practices for the upcoming influenza season.
To help protect patients, Schirripa said it is important that PCPs educate them about guidance from the CDC on infection prevention measures, and to remind them that “we still are in a pandemic.”
“Although things have significantly improved, that’s only because of the measures that were instituted by Anthony Fauci, MD, and the CDC,” he said.
Schirripa also said PCPs should emphasize the importance of influenza vaccination to patients so that “in the event they contract COVID-19, they will at least be protected from influenza, as the combination of infections could lead to a major medical emergency.” He recommended that PCPs inform patients with diabetes or cardiac issues that vaccination is especially important for them, as “becoming ill with influenza will exacerbate their underlying conditions.”
According to the CDC, other high-risk populations in which influenza vaccination is particularly important include adults aged 65 years and older, young children and pregnant women.
Kravet said there are multiple modalities that PCPs can use to remind patients about preventing influenza, such as sending reminders on patient portals, phone on-hold messaging, providing information in practice marketing messages, placing informational signs in offices and EHR protocol orders for vaccinations during patient visits.
“PCPs play a key role in ensuring prevention of influenza,” he said. “In these unprecedented times, we need an all-hands-on-deck approach.”
Because a large influx of patients presents a challenge to practices due to COVID-19 prevention efforts, Kravet said practices can consider holding off-hour influenza vaccination clinics during evenings and on weekends to allow more patients to be seen without crowding the office.
Mahoney said a drive-through vaccination clinic could be an option for patients who are nervous about visiting the office. Practices that are able to set up a drive-through clinic would need to take on the costs of acquiring a tent, one to two staff members — depending on patient demand — swabs, a refrigerator to hold vaccines, and a provider if there are more acute patients, Mahoney said. While this may be challenging and not possible for all practices to implement, she noted that a drive-through vaccination clinic “saves PPE, staff, provider time and exam room space.”
Certain pharmacies and urgent care centers also provide influenza vaccines, but Schirripa said patients should be encouraged to visit their PCP “not just for the flu vaccine, but for their general physical that they probably put on the back burner during the period of staying in isolation.”
“This way, they can get their general physical, bloods, cardiogram, et cetera, along with the flu vaccine, in one visit,” he said.
Alternative strategies for influenza care
In addition to ensuring patients are vaccinated, PCPs can explore alternative care options to cater to patients who may be hesitant to visit the office for influenza treatment.
“Because patients may still fear visiting the office, it is important to consider virtual care for influenza-like illness, especially as flu and COVID testing and treatment have important implications in control and spread of both,” Kravet said.
Mahoney noted that if a PCP has a telehealth visit with a patient who may have influenza, he or she can “prescribe Tamiflu for high-risk patients, and that could reduce the length of influenza and the complications.”
In a recent survey of primary care clinicians, the Larry A. Green Center and Primary Care Collaborative found that one in three practices consistently struggle to obtain PPE. In addition, 33% of primary care clinicians have staff positions they are unable to fill, and 23% have clinical positions they cannot fill.
Some primary care practices may still be closed due to limited staff and resources or financial strain caused by the pandemic. To ensure patients have access to care, Mahoney suggested transforming closed practices into mobile or drive-through clinics. These types of clinics “might reduce the need for more staff and space, and also protect the staff and clinicians from being exposed [to COVID-19],” she said.
While urgent care centers and EDs are important venues for care during the COVID-19 pandemic and the influenza season, Kravet said primary care practices are crucial for managing the influx of patients during influenza season.
“If primary care is unable to manage its share of influenza-like illness due to PPE concerns or staffing issues, we would be at risk of overwhelming the urgent care and emergency room resources in our communities,” Kravet said.
To help provide primary care practices with the resources to respond to both the COVID-19 pandemic and influenza season, Mahoney said “there needs to be more investment on the state and federal level in primary care practices, especially those small practices that are struggling to stay open.”
She added that more PPE needs to be mobilized to primary care practices across the U.S., and that more influenza vaccines should be made available to prevent shortages.
“It’s really important that there’s a concerted effort to make sure that all primary care practices have what they need to take care of their patients,” Mahoney said.
CDC. Prepare your practice to fight flu. https://www.cdc.gov/flu/pdf/professionals/vaccination/prepare-your-practice-deck.pdf. Accessed September 29, 2020.
Primary Care Collaborative. Quick COVID-19 Primary Care Survey, Series 20 fielded September 4-8, 2020. https://www.pcpcc.org/sites/default/files/news_files/C19%20Series%2020%20National%20Executive%20Summary.pdf. Accessed September 28, 2020.