There Has Been Minimal Flu This Season. Have Masks Been The Reason?
With universal masking, is an influenza vaccine even necessary?
Every year, as a healthcare professional, I am mandated to get the influenza vaccine. In past years, if I did not get the flu vaccine or could not get it for whatever reason, then I was forced to wear a mask in the hospital throughout the flu season. That was before COVID was even a twinkle in a bat’s eye.
Fast forward to the 2020–2021 flu season, and there has been almost no flu activity. According to the CDC, there have been a total of 1,639 cases of flu since September 27, 2020. That’s it.
Compare that to the previous season, 2019–2020, when there were an estimated 39–56 million flu illnesses, between 410,000–710,000 flu hospitalizations, and between 24,000–62,000 flu deaths. What a difference a year makes.
Now, of course, a global pandemic has erupted since the 2019 flu season, and it is quite possible that the COVID crisis has obscured a worse flu season than is actually reported. At the same time, even in my own practice, I have not seen one case of flu in my ICU. Not one. Is there something else going on here?
Is it the masks? Is widespread masking making flu essentially nonexistent? And if this is true, this begs the question: if everyone wears masks during the flu season, is vaccination against flu even necessary?
After all, the flu vaccine is not a home run. According to the CDC, the flu vaccine is typically only 40–60% effective against preventing the flu. And, given that public health authorities have to guess which strain will be the most likely before the vaccines are manufactured, if health authorities guess wrong, the effectiveness can be even worse than that.
But, if all the masking, social distancing, and hand washing have been the reason that we have had almost no flu this year, could this be enough? Do we even need to vaccinate against the flu?
To answer this question, a clinical trial would need to be conducted where two groups are randomized to receive either vaccination with no masking or masking with no vaccination and see if there is a difference. Such a study would be difficult to conduct thoroughly, as there will be so many variables that cannot be controlled for.
Yet, our real-life experience during this pandemic has demonstrated that we have had very, very little flu this year. Last year, I remember being super worried about a “twin-demic” of flu and COVID afflicting us in the Fall and Winter. Such a thing has, thank God, never materialized.
Was it because of the masks? I really wonder.
Now, of course, for this theory to work, masking during the flu season will have to be nearly universal, and everyone needs to wear masks all the time during the entire flu season. As intriguing as this thought is, I highly doubt public health authorities will stop recommending flu vaccines and wearing masks instead. I highly doubt my hospital will allow me to wear a mask instead of getting a flu vaccine this coming Fall.
Nevertheless, given the negligible flu activity this year, I just wonder: was it the masks?