The fall flu season in the U.S. is unfolding largely unobserved.
The CDC’s labs and surveillance programsare idle, thanks to the government shutdown, and outside experts are worried that essential data is being lost.
Indeed, a CDC spokeswoman told MedPage Today that just about all of the regular apparatus that monitors flu and flu-like illness has been shut down. Some 80% to 85% of the usual staff is on enforced leave, according to Barbara Reynolds, PhD, the agency’s director of public affairs.
That means information about such things as pediatric influenza, anti-viral resistance, admissions to hospital for flu or flu-like illness, and mortality and morbidity owing to pneumonia and influenza is not being gathered.
There is no “national snapshot” of the flu season, Reynolds said. On the other hand, she added, some staff members are still working on nonsubtypeable influenza A, in an attempt to ensure that the nation is not caught by surprise by another flu pandemic.
But it’s not just data and it’s not just flu, according to Gregory Poland, MD, an infectious diseases specialist at the Mayo Clinic in Rochester, Minn.
“There are an endless number of infectious disease threats that, as we often say, are an airplane ride away from us,” Poland said. And the CDC is the “only entity” that tracks infectious disease on a national scale, he added. “So now you’ve got a week, 2 weeks, who knows how long, where there’s no one really responsible for watching what’s happening nationally.”
He painted a grim picture of what might happen while the agency is all-but-shuttered.
“Worst-case scenario is a novel infectious disease is imported into the U.S.,” he said, with cases scattered at first across a dozen states. “Nobody understands that it’s happening simultaneously in real time and we don’t have 12 cases, we have 1,200 cases before we realize what’s going on.”
The CDC’s Reynolds noted that state health departments are still collecting flu data, but their information is not being sent to the CDC. Among other things, that means the agency has no idea of the geographic spread of the disease — something that’s often used to smooth out the delivery of vaccine.
There will be some 135 million doses of vaccine available, with about 73 million already delivered, and the government shutdown won’t affect that, she added.
But no one will know if the season is mild or severe, if the vaccine strains match those circulating in the community, or if the flu has developed resistance to anti-viral medications, Reynolds said.
Doctors who work with flu — primary care physicians and infectious disease specialists — usually track the disease using the CDC’s FluView webpage, commented Andrew Pavia, MD, an infectious disease specialist at the University of Utah in Salt Lake City.
Those data help with planning for surges in demand at hospitals and with getting vaccination campaigns ramped up, he told MedPage Today.
Importantly, he said, the CDC’s information — about anti-viral resistance, for instance — can help doctors make treatment decisions.
The CDC also has an international role in influenza: Its data is used to help define what strains should be included in next year’s vaccine. Those decisions have to be made by February and “we’re behind the curve this year,” Poland said.
Also, because the flu circulates north to south on a global scale, the agency’s data usually helps nations in the southern hemisphere tailor their flu programs. That too has been interrupted, Reynolds said.
Pavia noted that many Muslim Americans will soon be returning from the annual Hajj pilgrimage to Saudi Arabia, where the Middle East respiratory syndrome coronavirus (MERS-CoV) has been circulating for several months.
The public health response to a returning pilgrim who is ill will be “critical,” Pavia said, even if all or most are false alarms.
“This is probably a really bad time not to have the CDC on the job,” he said.
North American Correspondent
North American Correspondent for MedPage Today, is a three-time winner of the Science and Society Journalism Award of the Canadian Science Writers’ Association. After working for newspapers in several parts of Canada, he was the science writer for the Toronto Star before becoming a freelancer in 1994. His byline has appeared in New Scientist, Science, the Globe and Mail, United Press International, Toronto Life, Canadian Business, the Toronto Star, Marketing Computers, and many others. He is based in Toronto, and when not transforming dense science into compelling prose he can usually be found sailing.