Some fear 'twindemic' could overwhelm hospitals
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Nathan Jeffay is The Times of Israel's health and science correspondent

In the eye of the Omicron storm, some Israeli doctors are watching aghast as flu cases also rise, fearing that the so-called twindemic effect could overwhelm hospitals.

The major concern is there could be an unbearable burden on the medical system that could cost in lives, Prof. Ran Nir-Paz, infectious diseases specialist at Hadassah Medical Center in Jerusalem, told The Times of Israel, stressing that he sees this scenario not as pessimistic, but as realistic.

After a virtually flu-free winter last year, significant case numbers are a worry, he said, noting that the flu challenge is accentuated by the low number of people getting flu shots and an apparent low effectiveness of this year’s flu shot.

Resources that were previously given to COVID alone would need to split between COVID and flu, and this would mean too much strain and could cost in lives, he said.

But theres no consensus on this bleak outlook. Former coronavirus czar Prof. Ronni Gamzu gave a much more optimistic assessment of the threat from influenza during a press briefing last week, insisting that the specter of a joint threat is not a real issue.

Concern surrounding flu focuses on the growth of cases, and disappointment over take-up of flu vaccines. Health Ministry figures released last week showed that since September 2,825 people have been hospitalized for the flu, including 863 children and 181 pregnant women and new mothers. A spokeswoman for Leumit, one of Israels four healthcare providers, told The Times of Israel that doctors are seeing more cases than expected.

Community health teams are reporting a subdued demand for flu vaccines. Acceptance of flu shots is down 32% in Leumit, the spokeswoman told The Times of Israel. Only 75,000 of Leumits 720,000 members got flu vaccines this year compared to 110,000 last year and 100,000 the previous year.

The largest healthcare provider, Clalit, is witnessing a similar lethargy. We are at two-third to three quarters of the usual immunization of previous years against flu for adults and children, said Prof. Amnon Lahad, head of the Jerusalem district for Clalit. And its largely because the populations are tired. If you tell people to get immunized for flu people say Ill do it another time.

Gamzu, CEO of Tel Aviv Sourasky Medical Center, better known as Ichilov Hospital, said that he doesnt see flu hospitalizations as particularly high, and thinks coronavirus precautions are also protecting against its transmission.

I dont see a real issue here, he commented. Our internal medicine departments are crowded but it’s not causing the very high peaks we were used to seeing in the very overloaded winters, so Im not sure that we have a tough situation in this regard.

In his analysis, hospitals are well stocked and well prepared, and ready to cope with the challenges of the winter.

But Nir-Paz insists that the equation is simple: two potentially serious infectious diseases spreading quickly is a threat. If many people are sick with influenza and mortality gets higher, people will pay a price, he said.

We were lucky last year to see virtually no flu cases because of social distancing and any other factors we dont fully understand, but this year the take-up of vaccine by the community is lower for many sociological reasons, with people taking a gamble and thinking theyll protect against COVID but can take a chance with the flu.

The effectiveness of the flu vaccine in preventing infection is 20% to 60% each year, but also prevents disease among a higher percentage of people. This year, he said, effectiveness is believed to be at the low end of the spectrum.

Apparently the strain is H3N2 which has major shifts in the virus that reduces efficacy of vaccinations, he observed. Its part of the vaccine but not in its exact form. So we have a combination of lower take-up of vaccines and lower efficacy of vaccines.

Preliminary research on flu vaccines suggests that this seasons edition has limited effectiveness as the flu strain that is spreading picked up mutations that make it mismatched to the vaccine. A team of American researchers wrote in a study, which is not yet peer reviewed: Our studies suggest that the new 2a2 H3N2 replicates efficiently in human airway cells and can partially circumvent antibodies elicited by egg-adapted 2021-2022 Northern Hemisphere influenza vaccines.

Commenting on the challenges for the coming weeks, Nir-Paz said: Omicron is a tsunami, influenza is a storm, and the combination of both is unpredictable. We need to try to manage both.

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