*While Alan and Barry were employees at the time this article was published, they have since left Roche and Genentech.
Even as potentially game-changing vaccine news offers our first glimpse of an eventual end to the COVID-19 pandemic, we face a daunting reality as we get further into the winter months and flu season. A virus that has infected more than 16 million Americans and claimed more than 290,000 lives1 is surging across the country, with no vaccine likely to be widely available until spring.2 Large segments of the public still are not engaging in social distancing, hand washing and mask-wearing precautions despite scientific evidence and medical recommendations that suggest these measures may limit the spread of COVID-19.3 Now, levels of influenza may start to increase while COVID-19 continues to surge, raising the specter of an already mammoth public health task becoming even more challenging.
However, there are still many uncertainties around this influenza season. The experience of flu in the Southern Hemisphere last summer suggests there could be a milder flu season in the U.S. Nonetheless, Roche and Genentech are working to make COVID-19 and flu testing, and flu antivirals widely available as demand ramps up. Healthcare professionals have new guidance from the Centers for Disease Control (CDC)4 to use their clinical judgement and potentially treat patients empirically if they are presenting with flu symptoms.5 Ultimately, though, how well we mitigate the impact of these viruses, manage the two diseases and avoid co-infection with both during this once-in-a-century pandemic rests in large part on how the public responds.
High-Stakes Testing
“To confess ignorance is often wiser than to beat about the bush with a hypothetical diagnosis.”— Sir William Osler
The physician Sir William Osler, father of modern medicine, succinctly summarized the vital importance of a differential diagnosis. Because COVID-19 and influenza (as well as any number of other seasonal, respiratory viruses), share many symptoms—fever, chills, cough, muscle pain and body aches—healthcare professionals face a uniquely difficult task this flu season.6 Timely testing, especially for COVID-19, will be critical for healthcare professionals to make more informed decisions to optimize care and management of patients in certain cases. We also anticipate increased testing demand as more patients seek testing from healthcare professionals for flu-like symptoms. Last year, influenza caused between 39 and 56 million cases and between 24,000 and 62,000 deaths in the U.S., according to the latest CDC estimates.7
Based on our long heritage in influenza treatment, and standing as a leader in diagnostics, we have innovated rapidly to help ensure that hospitals, clinics, primary care facilities and emergency settings have the tests needed to determine if a patient has a current SARS-CoV-2 or influenza A/B infection or antibodies against SARS-CoV-2. The latest advancements in diagnostics include a combined test that screens for both SARS-CoV-2 and influenza A/B infection. Coordinating with government and industry, we have made substantial investments to ramp up production of both tests and lab supplies.
The Case for Timely Flu Treatment
Despite hopes that people would rush to get the flu vaccine, there has turned out to be wide variance in vaccination rates across the country.8 Vaccines are still our best first line of defense, and the CDC recommends that all people six months of age and older be vaccinated annually. But even if someone is vaccinated, they could still get the flu.9 And the one thing we know: many Americans may get the flu. In its guidance to providers for the 2020-2021 flu season, the CDC advises healthcare professionals to begin antiviral treatment for high-risk patients presenting with flu as soon as possible, and not wait for lab results to come back. Healthcare professionals may also consider early antiviral treatment on non-high-risk patients based on their clinical judgement.5
Physicians have long made the case for more ready use of antivirals. They are effective and safe in their indicated populations to reduce symptom duration if initiated as early as possible, but no later than 48 hours after symptom onset. In addition, flu antivirals may reduce ER visits, health utilizations costs, and hospitalizations.10 With healthcare systems already strained by COVID-19, optimized and timely flu treatment could potentially help to ease personal health and societal burdens and help reduce any additional strain on systems caused by the seasonal flu. While there is no substitute for vaccination, clinicians should also bear in mind the option of prophylactic antiviral treatment for unvaccinated individuals who have had contact with someone with influenza.
We are collaborating closely with the U.S. Food and Drug Administration (FDA), the U.S. Department of Health and Human Services (HHS) and the CDC regarding influenza antivirals. We’re also working to ensure availability of influenza antivirals to meet this season’s demands.
The Public’s Vital Role
The effort to get control of COVID-19 and limit flu spread won’t work without the cooperation and resolve of our most important partners—the 328 million people who live in this country. Cheap, effective methods to limit spread are available to everyone: Social distancing, hand washing and wearing masks. They may be low tech, but they work. Scientists credit these measures collectively as the most likely explanation for the mild flu season in the Southern Hemisphere. And there’s more good news about masks: New studies show they protect not only others but the mask-wearer as well, when worn properly to cover both the nose and mouth.11
We know that people yearn to gather with family and friends after so many months of isolation, loss and hardship. We know that mask and social distancing fatigue is real. But now is not the time to let COVID-19 or the flu take advantage. We can do no greater service to ourselves and one another than to double down, keep up our guard, and help ensure better, healthier days to come.