SciLine interviewed: Dr. Richard Webby, a faculty member in the Infectious Diseases Department at St. Jude’s Children’s Research Hospital, and directs the World Health Organization Centre for Studies on the Ecology of Influenza in Animals and Birds. His research involves flu viruses and vaccines.
RICHARD WEBBY: Yeah, so it’s a great question, and unfortunately, it’s a little bit early to know the answer to it, really. So we’re coming into a flu season with a vaccine that we selected some six months ago. But if we look at the best information that we have – and that information actually came last week. So at the end of last week, the laboratories within the World Health Organization Global Influenza Surveillance Network, which comes up with the recommendations for the flu vaccine, met at the end of last week and reviewed information about what’s circulating and vaccines that are selected now and vaccines moving forward. And if we have a look at what that group came up with, it looks like there’s going to be a pretty good match between at least three of the four components of that vaccine. The fourth component, which covers the H1N1, that could be a little bit of a mismatch. But again, it’s unfortunately a little bit early to tell yet. If we come back in another six months, we’ll have a good answer for that question.
When would be the best time to get a flu shot this year?
RICHARD WEBBY: So now starting from here is probably a good time for people to start thinking about getting vaccinated for the upcoming Northern Hemisphere and, of course, U.S. flu season. Right now there is really low, low levels of influenza activity, so the season certainly hasn’t started yet. And it typically takes about a couple of weeks from getting that shot in the arm to when your body builds up the best protection. And so, yeah, thinking about getting vaccinated now – and we probably have a little bit of time yet. And that vaccine should see you through to the end of the flu season, which, you know, typically is somewhere in March, April next year.
How might the COVID-19 pandemic impact flu season this year?
RICHARD WEBBY: So this is a question we all wish we had a better answer to because, you know, the real answer is we’re not quite sure. And we can come up with a number of potential scenarios, one being that we’re going to have the circulation of two, you know, quite nasty respiratory viruses that, even on their own, have the potential to cause a lot of impact, a lot of social disruption, you know, and send a lot of people to the hospital. If we look at what we typically look at for giving us pointers about what might happen in the upcoming flu season – and we do that by looking at what’s just gone on in the Southern Hemisphere, who have been through their winter, you know, and they’ve been through a winter where, at least on paper, they should have had a bit of influenza activity and COVID-19 – if we look at those countries for some sort of guidance, they’re actually this year not much help.
So there’s been very, very low influenza activity in the Southern Hemisphere during their winter. And again, we have to keep in mind that it’s a possibility that we could also see very low activity. But unfortunately, there’s no way of knowing whether we’re going to be at one end of that spectrum of severe disease, with two viruses circulating widely, or it’s potential that the social distancing, the mask-wearing, the staying away if you’re sick, may actually do a really good job of protecting us from COVID-19 but also from flu. And we may actually have a low flu season. We just, unfortunately, don’t know at this stage.
If you’re taking precautions to avoid COVID-19, is it still advisable to get a flu shot?
RICHARD WEBBY: Yes, absolutely. So if we look at what might happen with the upcoming influenza season here – and one possibility is, you know, that we’ll see circulation to some extent of influenza and COVID-19 – that’s really going to complicate things.
That’s going to complicate health care. People trying to treat individuals with one or either of these is going to complicate trying to control the COVID-19 pandemic – keeping in mind that both of these diseases, influenza and COVID-19, cause very, very similar symptoms at the start. So it’s really hard to tell whether someone has one or the other. So anything we can do now to help take influenza out of that equation, you know, is a great thing to do. And the single best thing we can do is to get the flu shot. So vaccination, even in this world of mask-wearing and social distancing is just a tremendously good idea.
Are there special risks for certain populations during the overlap of COVID-19 and flu season?
RICHARD WEBBY: Yes, there is. And if we think about – these are two viruses that, you know, essentially replicate in the same part of our body – so on this respiratory tract. And unfortunately, it’s the same group of people that are most prone to the severe consequences of that. So the risk groups that we’ve heard a lot about in the context of COVID-19 – people with underlying lung conditions and, like, heart conditions, obesity – you know, those are the same types of conditions that predispose people to more severe influenza as well. Yeah, so unfortunately, it’s that same group of people that have to be particularly careful through winter.
If you are sick with the flu, are you more susceptible to contracting COVID-19? And vice versa?
RICHARD WEBBY: So unfortunately, we don’t know that – the answer to that question. You know, we would have hoped perhaps that the Southern Hemisphere given – would have given us a little bit of guidance on that, you know, as they’ve just been through their winter season. But down there, there was very little flu circulating. There have been a few cases reported in the scientific literature of people who have had both influenza and COVID-19 actually at the same time.
But the numbers of – for that have been very low. And if you look at those people and look at how severe that disease has been, it runs the gamut – so all the way from mild disease through, unfortunately, to death. But again, we really don’t have that wealth of scientific information yet to be able to predict, you know, one question – whether influenza will actually predispose us to COVID-19 or, if we get both at the same time, what we should expect.
What steps can people take to protect themselves from both flu and COVID-19?
RICHARD WEBBY: And so in some regards, we’re – if lucky’s the right term – we’re lucky in that those steps that we’ve been taking for the past six months or so against COVID-19 actually work really well against influenza as well. So the washing of hands, the washing down of surfaces, the staying away from work, staying away from colleagues, friends, if you’re feeling sick, social distancing and the mask-wearing – they work really well against COVID-19. And it looks like they work even well, perhaps even better, against influenza.
So those same things we’ve been doing for six months, let’s keep doing them through winter, and it should really reduce the impact of influenza.
What do we know about the COVID-19 vaccines being developed? Will a COVID vaccine require a yearly shot, like the flu shot?
RICHARD WEBBY: Yeah, so there is just a truly remarkable amount of effort that’s going into developing vaccines against COVID-19. You know, there are hundreds of different approaches being tried at – some of those are all at different levels. You know, just last week, it was announced that the fourth vaccine is going into the – what they call the phase three, so these last clinical trials in the U.S. What we know about these approaches is – I think, encouragingly, they are actually all a little bit different. So there are some approaches using platforms that were tried before. Others apply some approaches using platforms that are actually new, that haven’t been used in humans before. So I think there’s – from that perspective, there’s a lot of activity going on, you know, a lot of hope that at least some of those are going to prove to be very safe and very effective. The question about how often are we going to need to take a COVID-19 vaccine, that’s one we don’t have a good answer to yet.
But if we look at the difference between COVID-19 and influenza, from the perspective of the virus, there is some hope that a COVID-19 vaccine won’t have to be taken every year. One of the reasons we have to get a vaccine against influenza every year is that the flu virus keeps on changing. So it mutates a lot, and so we build up some immunity to that virus, but the virus runs away from it. We chase it. It runs away. And so that’s why we have to have this cat-and-mouse game with influenza, get vaccinated with essentially a new vaccine every year. If we look at what’s gone on with COVID-19 and the virus that causes it so far, that virus doesn’t appear to be changing at quite the same rate. So there is quite a bit of hope that, you know, if – I’d say when we get a good vaccine against COVID-19, that’s probably not something we’re going to have to get every year. Is it something we’re going to have to get every five years, every 10 years, every 20 years? You know, those are questions we don’t know the answer to just yet.