Friday Fluday Thread: Influenza-Like Illness Data for MMWR Week 15, ending April 17, 2021
United States Influenza testing, MMWR week 15.

CDC flu view. https://cdc.gov/flu/weekly/index.htm

2016 to 2019 4-year average: 2,637 cases; 13.34% positive
2020: 97; 0.59%
2021: 18; 0.05%

https://docs.google.com/spreadsheets/d/1JXUW_6CF4e04iAWyC_MU23SY6scEYUo4GKEXmQUhHbo/edit?usp=sharing
United States Influenza testing, season to date (28 weeks, MMWR 40 to 14)

Five-year average: 201,794 cases; 18.72% positive

This year: 2,009; 0.15%
Season-to-date U. S. flu hospitalizations down 98.9% from last year.

Flu hospitalizations total (29 weeks) in FluSurv-NET catchment is 223 (+3 from last week). Through week 15 last year (28 weeks) it was 19,845 (+43).

Rate last year: 68.3 per 100K
This year: 0.8 per 100K
Season-to-date U. S. flu hospitalizations down 98.9% from last year.Flu hospitalizations total (29 weeks) in FluSurv-NET catchment is 223 (+3 from last week). Through week 15 last year (28 weeks) it was 19,845 (+43).Rate last year: 68.3 per 100KThis year: 0.8 per 100K
Season-to-date U. S. flu hospitalizations down 98.9% from last year.Flu hospitalizations total (29 weeks) in FluSurv-NET catchment is 223 (+3 from last week). Through week 15 last year (28 weeks) it was 19,845 (+43).Rate last year: 68.3 per 100KThis year: 0.8 per 100K
Influenza-Like Illness (ILI) continues to track well lower than the mild 2015-16 and 2011-12 seasons, flat after ticking up two previous weeks (HCoVs?).
Latest U.S. non-SARS-CoV2 syndromic data from BioFire.

Lots of rhinoviruses (rising again sharply) and some adenoviruses all year.

Flu A, B micro-wave already over. RSV, and PIV back at low levels.

https://syndromictrends.com/metric/panel/rp/percent_positivity/organism/main
Latest U.S. non-SARS-CoV2 syndromic data from BioFire. Lots of rhinoviruses (rising again sharply) and some adenoviruses all year.Flu A, B micro-wave already over. RSV, and PIV back at low levels. https://syndromictrends.com/metric/panel/rp/percent_positivity/organism/main
Latest U.S. non-SARS-CoV2 syndromic data from BioFire. Lots of rhinoviruses (rising again sharply) and some adenoviruses all year.Flu A, B micro-wave already over. RSV, and PIV back at low levels. https://syndromictrends.com/metric/panel/rp/percent_positivity/organism/main
Out-of-season HCoV surge continues after a year of absence as SARS-CoV2 recedes. HCoV-NL63 potentially post-peak. HCoV-OC43 rise stalls. HCoV-229E accelerating. Still almost no HCoV-HKU1, last year's dominant HCoV.
Out-of-season HCoV surge continues after a year of absence as SARS-CoV2 recedes. HCoV-NL63 potentially post-peak. HCoV-OC43 rise stalls. HCoV-229E accelerating. Still almost no HCoV-HKU1, last year's dominant HCoV.
Out-of-season HCoV surge continues after a year of absence as SARS-CoV2 recedes. HCoV-NL63 potentially post-peak. HCoV-OC43 rise stalls. HCoV-229E accelerating. Still almost no HCoV-HKU1, last year's dominant HCoV.
Out-of-season HCoV surge continues after a year of absence as SARS-CoV2 recedes. HCoV-NL63 potentially post-peak. HCoV-OC43 rise stalls. HCoV-229E accelerating. Still almost no HCoV-HKU1, last year's dominant HCoV.
Out-of-season HCoV surge continues after a year of absence as SARS-CoV2 recedes. HCoV-NL63 potentially post-peak. HCoV-OC43 rise stalls. HCoV-229E accelerating. Still almost no HCoV-HKU1, last year's dominant HCoV.
CDC data confirms this HCoV picture.
https://www.cdc.gov/surveillance/nrevss/coronavirus/natl-trends.html
CDC HCoVs by regions.
https://www.cdc.gov/surveillance/nrevss/coronavirus/region.html
CDC HCoVs by regions. https://www.cdc.gov/surveillance/nrevss/coronavirus/region.html
CDC HCoVs by regions. https://www.cdc.gov/surveillance/nrevss/coronavirus/region.html
CDC HCoVs by regions. https://www.cdc.gov/surveillance/nrevss/coronavirus/region.html
CDC HCoVs by regions. https://www.cdc.gov/surveillance/nrevss/coronavirus/region.html
Florida. Schools open all year. No lockdowns since September. Rhinoviruses and some adenoviruses but still nearly no flu. But ILI rising, driven by rhino, RSV, adeno, and especially PIV, which accelerated.

RSV may be forming peak.

http://floridahealth.gov/diseases-and-conditions/influenza/_documents/2021-w15-flu-review.pdf
Florida. Schools open all year. No lockdowns since September. Rhinoviruses and some adenoviruses but still nearly no flu. But ILI rising, driven by rhino, RSV, adeno, and especially PIV, which accelerated.RSV may be forming peak. http://floridahealth.gov/diseases-and-conditions/influenza/_documents/2021-w15-flu-review.pdf
Florida. Schools open all year. No lockdowns since September. Rhinoviruses and some adenoviruses but still nearly no flu. But ILI rising, driven by rhino, RSV, adeno, and especially PIV, which accelerated.RSV may be forming peak. http://floridahealth.gov/diseases-and-conditions/influenza/_documents/2021-w15-flu-review.pdf
Florida. Schools open all year. No lockdowns since September. Rhinoviruses and some adenoviruses but still nearly no flu. But ILI rising, driven by rhino, RSV, adeno, and especially PIV, which accelerated.RSV may be forming peak. http://floridahealth.gov/diseases-and-conditions/influenza/_documents/2021-w15-flu-review.pdf
Florida. Schools open all year. No lockdowns since September. Rhinoviruses and some adenoviruses but still nearly no flu. But ILI rising, driven by rhino, RSV, adeno, and especially PIV, which accelerated.RSV may be forming peak. http://floridahealth.gov/diseases-and-conditions/influenza/_documents/2021-w15-flu-review.pdf
Sweden week 15. No masks, no lockdowns, no school closures under age 16 -- and a full year with no Flu A, Flu B, or RSV; RSV rises slightly after reappearing finally last week. HCoVs tick down but still higher than recent years this week.

https://karolinska.se/globalassets/global/2-funktioner/funktion-kul/klinisk-mikrobiologi/epidemiologi/rapport-influensa--och-rs-virus-och-andra-luftvagspatogener.pdf
Sweden week 15. No masks, no lockdowns, no school closures under age 16 -- and a full year with no Flu A, Flu B, or RSV; RSV rises slightly after reappearing finally last week. HCoVs tick down but still higher than recent years this week. https://karolinska.se/globalassets/global/2-funktioner/funktion-kul/klinisk-mikrobiologi/epidemiologi/rapport-influensa--och-rs-virus-och-andra-luftvagspatogener.pdf
Sweden week 15. No masks, no lockdowns, no school closures under age 16 -- and a full year with no Flu A, Flu B, or RSV; RSV rises slightly after reappearing finally last week. HCoVs tick down but still higher than recent years this week. https://karolinska.se/globalassets/global/2-funktioner/funktion-kul/klinisk-mikrobiologi/epidemiologi/rapport-influensa--och-rs-virus-och-andra-luftvagspatogener.pdf
Sweden week 15. No masks, no lockdowns, no school closures under age 16 -- and a full year with no Flu A, Flu B, or RSV; RSV rises slightly after reappearing finally last week. HCoVs tick down but still higher than recent years this week. https://karolinska.se/globalassets/global/2-funktioner/funktion-kul/klinisk-mikrobiologi/epidemiologi/rapport-influensa--och-rs-virus-och-andra-luftvagspatogener.pdf
Sweden week 15. No masks, no lockdowns, no school closures under age 16 -- and a full year with no Flu A, Flu B, or RSV; RSV rises slightly after reappearing finally last week. HCoVs tick down but still higher than recent years this week. https://karolinska.se/globalassets/global/2-funktioner/funktion-kul/klinisk-mikrobiologi/epidemiologi/rapport-influensa--och-rs-virus-och-andra-luftvagspatogener.pdf
Germany week 15. The opposite of last week. Rhinoviruses and HCoVs turn up as SARS-CoV2 turns back down. Still no flu.
https://influenza.rki.de/Wochenberichte/2020_2021/2021-15.pdf
Brazil. Very lax control measures, and a president who urges people to disregard them. A completely skipped flu season.
https://apps.who.int/flumart/Default?ReportNo=7
The global flu chart from WHO.
https://apps.who.int/flumart/Default?ReportNo=10
But flu did not disappear everywhere.
https://apps.who.int/flumart/Default?ReportNo=4&ITZRegion=
But flu did not disappear everywhere. https://apps.who.int/flumart/Default?ReportNo=4&ITZRegion=
But flu did not disappear everywhere. https://apps.who.int/flumart/Default?ReportNo=4&ITZRegion=
It wasn't masks, which were never used in many countries where flu disappeared and have also been shown to be ineffective for stopping influenza in many, many studies.

https://apps.who.int/iris/bitstream/handle/10665/329439/WHO-WHE-IHM-GIP-2019.1-eng.pdf?ua=1
Japan masks every year, and pushed masks hard in 2019 with no apparent effect. But in 2020-21 flu disappeared with low stringency COVID intervention.
https://apps.who.int/flumart/Default?ReportNo=7
The idea mitigations worked but unmitigated SARS-CoV2 just has a higher R (popular now among the same crowd that said "twindemic!" when flu had been gone for months) is way too facile.
Outside of testing ramp up, I don't think we've seen R > 2, even in places without NPIs.

Rhinoviruses bounced right back despite lower R and RSV was gone until recently with comparable R to SARS-CoV2.

HCoVs were gone until SARS-CoV2 declined, then returned even with lockdown.
Plus, as Biden adviser Dr. Michael Osterholm points out, our mitigation just hasn't been very effective.

Maybe in places like Australia and New Zealand where mitigations stopped SARS-CoV2 they also stopped other viruses.

But in countries where SARS-CoV2 went wild? No.
Osterholm: "There is this viral interference"
Viral interference is a well-known (but poorly understood) phenomenon. Interference from rhinovirus is generally thought to have ended the swine flu epidemic in 2009. https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30114-2/fulltext
Interference between rhinovirus and influenza A virus: a clinical data analysis and experimental...

These findings show that one respiratory virus can block infection with another through stimulation of antiviral defences in the airway mucosa, supporting the idea that interference from rhinovirus...

https://www.thelancet.com/journals/lanmic/article/PIIS2666-5247(20)30114-2/fulltext
This great short article from @m_soond explains the viral interference theory of this respiratory season: https://medium.com/illumination-curated/the-unexpected-case-of-the-disappearing-flu-64fd1fa5e909
The Unexpected Case of the Disappearing Flu

Some endemic respiratory viruses on hiatus during the 2020–21 season

https://medium.com/illumination-curated/the-unexpected-case-of-the-disappearing-flu-64fd1fa5e909
Overall the season has been so mild that drug store chains took big losses.

Rite Aid CEO Heyward Donigan: "During the fourth quarter our industry was impacted by a historically soft cough, cold and flu season." https://www.forbes.com/sites/brucejapsen/2021/03/24/rite-aid-soft-cough-cold-and-flu-season-triggers-bigger-annual-loss-than-expected/?sh=4874c892269f
Rite Aid: Weak Cold And Flu Season Triggers 2021 Loss

Rite Aid warned of a soft cold and flu season that’s going to hit the company’s bottom line worse than expected for its fiscal 2021.

https://www.forbes.com/sites/brucejapsen/2021/03/24/rite-aid-soft-cough-cold-and-flu-season-triggers-bigger-annual-loss-than-expected/?sh=4874c892269f
Pediatric internships and residencies have to be extended because they just didn't have enough patients to gain the normal amount of clinical experience.

( @DrKristenW has quit twitter, apparently, and I can't find her link on this.)
CDC still reports just one pediatric flu death this season.
Given limited testing, those pediatric flu death numbers are substantially lower than CDC's best estimates, which are published separately.

Here is a comparison of those best estimates with reported pediatric deaths with COVID.
Also note COVID death definition is broader than flu. The CDC examined 182 pediatric death certificates that included COVID in calendar year 2020 and found that 64 of them (35%) had a cause of death with no plausible connection to COVID. https://twitter.com/andrewbostom/status/1379861668847566849
We are now near the end of the *safest* respiratory season for children ever recorded. (And yes, that includes places where schools never closed.)

Yet many places locked children out of school, and some places are still doing so. Many more kids are masked. It's a disgrace.
*error in third tweet of the thread. Too lazy to delete and reissue them all.

This should say "(29 weeks, MMWR 40 to 15)." https://twitter.com/kerpen/status/1385613072111386625
You can follow @kerpen.
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