PROVIDENCE, R.I. (WPRI) – Rhode Island has seen a staggering decline of flu hospitalizations and deaths this season compared to past years, which health officials attribute to good timing and shifting behaviors tied to the pandemic.
A Target 12 analysis of various public health metrics provided by the R.I. Department of Health shows the coronavirus crisis has both positively and negatively affected other illnesses, diseases and health outcomes over the past year.
On the positive side, the state has reported only two influenza hospitalizations and zero flu-related deaths through the first three-quarters of the flu season, which runs from October through the third week of May. For comparison, the state averaged more than 1,000 flu hospitalizations and 33 deaths per season during the past five years. (The five-year high was 60 flu deaths in 2017-18.)
“It’s remarkable,” Dr. James McDonald, medical director at the R.I. Department of Health, told Target 12.
McDonald, who has become a well-known figure during the pandemic, said the decline is attributable to two major factors. The first is a lower annual rate of influenza in the Southern Hemisphere, where the seasonal flu typically starts before traveling up to the Northern Hemisphere.
Second, more people are washing their hands, keeping their distance from one another and wearing masks – all public health measures that help prevent contagious respiratory illnesses.
“That’s the benefit of all the same measures that protect us against COVID,” McDonald said. “Keep in mind, the same strategies we do that prevent us from getting COVID work against getting the flu.”
The statistics are backed up anecdotally by emergency care doctors, who have marveled at the absence of flu cases seen coming into hospitals across the state.
Dr. Otis Warren, Rhode Island president of the American College of Emergency Physicians, said the lack of flu hospitalizations couldn’t have come at a better time, as local hospitals were inundated with more than 6,200 COVID-19 patients from October through February, according to Health Department data.
“Just looking at past years and how many people have been admitted to the hospital every flu season, you can only imagine if that was layered on top of the COVID hospitalizations,” Warren said.
But the pandemic hasn’t had such a positive impact on some other health metrics.
The number of fatal drug overdoses jumped to 371 people during 2020, a 20% increase from 2019 and the highest total in at least five years. McDonald described the situation as a syndemic, meaning Rhode Island is experiencing multiple epidemics at the same time: COVID-19 and fatal drug overdoses.
Overdose deaths were rising even before the pandemic started, a trend law enforcement and public health officials attribute partly to the illicit drug market becoming flooded with more deadly narcotics, notably fentanyl.
But there’s widespread agreement in the medical community that the pandemic has exacerbated the problem. Isolation and stress that people have experienced over the past year has spurred heightened anxiety and depression, and mental health illness and drug use are often related.
One potential silver lining in the Health Department data is that suicides remained relatively stable compared to previous years. But Warren underscored that mental illness is a nuanced topic.
“We are seeing complications of mental health that might not be directly described as mental health or categorized by the Department of Health as mental health issues,” Warren said. “While suicides are fairly stable, we are seeing higher than prior years of overdose deaths, and mental health presents in many different ways.”
Another potentially troubling trend seen in the state’s public health data is related to childhood immunizations, which fell about 14% between March and December compared to the same period a year earlier. That’s about 55,000 fewer children who received their shots.
The decline was especially pronounced during the early months of the pandemic, as families were cautious about leaving their homes for any reason during a time when little was understood about COVID-19.
Looking back, McDonald noted that a robust public health campaign launched last spring, which he said helped boost the slumping immunizations. But he acknowledged that the messaging could have been clearer in the early days of the pandemic.
“The message was out there – particularly in March, April, May – we want people to stay at home,” he said. “I wish we were a little more clear about: go to the doctor.”
The medical director, a pediatrician by trade, is concerned the decline in immunizations could result in an outbreak of highly contagious illnesses, such as whooping cough and measles. But he and Warren agreed the challenge should be short-lived, since while children are on an age-based schedule for immunizations, that doesn’t mean they can’t catch up after missing some.
McDonald said he’s optimistic that is what will happen throughout this year, adding that he will only become seriously concerned if immunization rates remain low in future years.
“[Whooping cough] is something that we see every year and that can be very harmful to both the elderly and the very young,” McDonald said. “Measles is something you just don’t want to have an outbreak of because that is very contagious. We haven’t had a problem with measles yet and I want to keep it that way.”
In other areas of public health, the pandemic appears to have had a mixed effect.
In a year when people were mostly trying to distance themselves from one another, sexually transmitted infections fell across the board, though to varying degrees.
For example, new infections of chlamydia and gonorrhea both fell during 2020 compared to 2019, although not too far out of line with numbers reported in recent years. HIV infections, meanwhile, tumbled 26% to 54 cases during 2020, marking at least a five-year low.
McDonald said it will take further study to understand more clearly how the pandemic has affected those trends directly. And while fewer HIV cases are always a welcome development for physicians, McDonald stressed that the number was still too high for his comfort.
“Fifty-four is still a lot of cases,” he said. “We really need to get cases down to zero, because HIV is a preventable disease, and a disease well worth preventing. So I think we have more work to do in that space.”
Moving forward, both McDonald and Warren said the pandemic could have long-term positive effects on public health, both within the medical community and more broadly across the state, region, nation and globe.
McDonald said he now will always wear a mask when treating ill children, pointing out it’s helped prevent him from being sick personally for more than a year. Warren expects people more broadly will choose to permanently adopt some of the recently mandated public health measures – even after they’ve been lifted.
“We’re going to see a cultural shift,” Warren said. “Even though mask mandates might not be there, we’re going to see people wearing masks, particularly in transportation, crowded places and airplanes. We have learned so much – not just in the medical field, but as a society – about how to protect ourselves from these very contagious respiratory viruses. These are things that are not going to go away.”
Personally, Warren continues to go home after each shift in the emergency room, change his clothes in his garage and shower before interacting with his family. He picked up the routine at the beginning of the pandemic, but now plans to stick with it – even beyond COVID-19 – because of how often he interacts with people with infectious diseases at work.
“I should have been doing this years ago,” he said.