WORCESTER — The line snaked around the first parking lot and back into a second outside Community Healthlink on Thursday, and Wakana Gates was unsure she had enough time during her lunch break to wait for a COVID-19 test.
“I don’t want to hurt anyone,” Gates said as she debated joining the line.
Gates explained she tested weekly for the virus to ensure she would keep her children safe. So far, she had not tested positive.
But COVID-19 wasn’t the only virus on Gates’ mind: flu season is just around the corner.
And Gates noted the viruses’ similar symptoms complicate diagnosis, that a weakened immunity from one virus made it more likely to pick up the other or exacerbate symptoms, and that the two viruses were airborne.
“It’s very scary,” Gates said.
She is not the only one concerned.
Amid a steadily increasing number of COVID-19 cases in Worcester and Massachusetts, public health and medical experts are preparing for and trying to prevent what city Medical Director Dr. Michael Hirsh calls a “twindemic” of COVID and flu by enacting a large, state-sponsored COVID-testing and flu-vaccination effort called “Stop the Spread.”
“If we can limit the number of flu cases this year and concentrate on COVID that would be a wonderful community accomplishment,” Hirsh said at a press conference on Thursday.
It’s an important task, the reasoning for which is much like the reasoning behind preparations for the first wave of COVID: preventing hospital emergency rooms from being overwhelmed with patients.
“The main concern from a clinical and operational perspective is that during flu season, there are just tons of patients who experience respiratory symptoms,” said Dr. Kimiyoshi J. Kobayashi, chief quality control officer at UMass Memorial Medical Center, in an interview early last week. “In Wave 1, we could say most of those patients could be infected with COVID — but now, with the impending flu season, patients could have any variety of reasons for having respiratory symptoms including COVID.
“It makes it really challenging. Our concern is that that fear and that phenomenon would drive up volume for not only testing but isolating patients protectively and that it would drive up our capacity.”
Medical experts also caution that the two viruses acting together can worsen the symptoms and increase the mortality rate of each.
Like COVID, influenza is a respiratory virus that is airborne and transmitted through droplets such as from sneezing, coughing or talking. Symptoms for both viruses may be similar: fever, aches, shortness of breath, cough, congestion or runny nose, etc. Complications from, or serious cases of, both viruses can result in death.
More than 210,000 Americans have died from COVID-19 since March; an estimated 34,200 Americans died from the flu in the 2018-19 flu season, according to the Centers for Disease Control and Prevention.
Moreover, the ways to protect yourself from both viruses can be similar: wash your hands, watch your distance, and wear a mask. That could be of some help this year.
“Normally when you get the flu, we recommend that you cough into your elbow, wash your hands, if you’re sick — stay home, isolate yourself, pretty much with COVID we do exactly the same thing and are doing the same thing,” said Dr. George M. Abraham, chief medical officer at St. Vincent Hospital. “We’re hopeful we will have less of a flu season this year because everybody’s masked, everybody’s distanced, everybody’s washing hands.”
“Our ultimate hope is that with increased emphasis on hand hygiene, social distancing, masks in public, hopefully all of those things in addition to schools going virtual is that we have a mild flu season,” Kobayashi said.
But he still expressed concern about a COVID spike amid flu season.
“The reality is obviously that we’re worried about it, and we don’t want to be unprepared if it happens,” Kobayashi said.
Unsurprisingly, the primary recommendation from all medical experts was to get a flu shot.
“Generally we say every year it’s always important to get the flu vaccine,” Abraham said. This year in particular it is (important) because what we don’t want is people to get a combination of COVID and influenza.”
But some people will likely get sick. So hospitals are taking steps to be prepared.
UMMC, for example, has a three-month supply of personal protective equipment specifically for COVID in addition to its regular supply. The hospital has also developed a more “algorithmic” plan, as Kobayashi described it, where certain data thresholds will trigger responses when breached.
“We’re absolutely being thoughtful and methodical on how we approach this Wave II planning,” Kobayashi said. “We’re trying to not just rely on one number to determine our response, but investigate all different metrics to determine our response. We want to be nimble and strategic in responses.”
Meanwhile, Abraham said St. Vincent is doing everything from reeducating staff about protecting themselves and others to putting up plexiglass in break rooms.
Both doctors said their respective hospitals are better prepared to deal with a twindemic than they were for the first wave of COVID.
“We’re clearly not caught by surprise like last time,” Abraham said. “We were caught a little bit by surprise in terms of the magnitude and extent of the pandemic, and we didn’t know enough about the disease – how to control it, minimize its spread, how to treat it effectively before it becomes a problem.”
“We’re now much better prepared,” Abraham said. “We never let down our guard after last time.”
But simply walking around town and seeing maskless pedestrians and large groups suggests that some people have let down their guard a bit since the spring. With cooler weather sending more people indoors and in closer proximity with others – particularly around the upcoming holidays – health experts have long predicted a second wave of COVID cases.
That second wave appears to have arrived.
Worcester is now one of 40 Massachusetts communities “in the red,” with more than 8 cases per 100,000 residents. As of Thursday, the city had seen 141 new cases in the last week, reporting a rate of 10 cases per 100,000.
“All indicators are showing that we’re certainly seeing the cases going up, and multiple data points triangulate with that,” said Kobayashi.
He said the hospital had its lowest number of inpatients in mid-July, but a “steady simmer” since has increased numbers. Moreover, the test positivity rate — or the percentage of tests that are positive — has increased from about 1% to around 3%, Kobayashi said.
He added that the number of UMMC staff testing positive has also increased.
“Even though these don’t sound like huge differences, there is a notable difference,” Kobayashi said.
So the community is responding, hoping to “flatten the curve,” once again.
The Stop the Spread campaign involves free COVID testing as well as flu vaccinations that are free with proof of insurance. Participating organizations include UMMC, AFC Urgent Care clinics, nonprofits such as AIDS Project Worcester, college groups and Worcester public schools.
The clinics also provide opportunities to register to vote and fill out the Census.
“It brings together all the things that we need to be doing in the community,” Dr. Matilde Castiel, city commissioner of health and human services, said.
As of Thursday, the program had vaccinated 1,835 people at free clinics, more than 350 students at Worcester public schools, roughly 150 seniors at the senior center, and 496 city employees, according to City Manager Edward M. Augustus Jr.
The clinics are held throughout the city as well as at potential hot spots for infection. Particular care is focused on minority neighborhoods that have been disproportionately affected by the COVID pandemic. A team of bilingual “ambassadors” will be heading out to popular recreational areas such as Green Hill Park and Elm Park, Augustus said.
“We can go out and really teach people what needs to be happening — giving out masks, giving out sanitizers, doing the education piece to restaurants, businesses or nonprofits,” Castiel said.
“With contact tracing, trying to work around where are the clusters, and who needs to be tested.”
Castiel said that the effort also acts as a kind of trial run for distributing an eventual COVID vaccine. Hirsh predicted Thursday that the vaccine would not be widely available until 2021.
“Even though some people may feel like they’ve had enough, we know how to do it,” Castiel said. “The importance of vaccination is always important for the flu, and is even more so now.”