Flu is 'eclipsing COVID-19 as the biggest threat,' Marin County health officer says
The flu is back with a vengeance.
As the San Francisco Bay Area faces a winter "tridemic" of COVD-19, influenza and respiratory syncytial virus (RSV), Marin County health officer Dr. Matt Willis says that for the first time since before 2020, he's just as worried about the flu's impact as he is COVID's impact. According to Willis, a staggering 1 in 3 people in Marin County who are experiencing symptoms of a respiratory virus are testing positive for influenza. For reference, during the peak of the COVID-19 pandemic, a test positivity rate of 8% was considered very high.
In a Q&A with SFGATE, Willis explained that because most people haven't been exposed to the flu in over two years, they're more susceptible to infection. Willis also discussed why mask mandates are a thing of the past and shared advice for minimizing risk at holiday gatherings this year. The interview has been lightly edited and condensed for clarity.
SFGATE: As a health officer, what worries you the most among COVID, flu and RSV on a population level? Which do you expect will drive the most hospitalizations this winter?
Willis: We're in an interesting place right now where influenza is eclipsing COVID as the biggest threat. There's an equivalent number of people hospitalized between flu and COVID, and that's the first time we've seen that since COVID emerged.
Choosing between what I'm most scared of is like choosing between lions, tigers and bears. In terms of mortality, it's COVID and flu for older residents, and RSV in babies. When it comes to RSV, the most severe outcomes are primarily among our youngest residents, so infants 6 months or younger, and then older people infected with RSV can also have severe outcomes.
SFGATE: To poke on that lions, tigers and bears analogy, let's say I handed you three vials, one containing COVID, one containing flu and one containing RSV and then said, "You have to take one of these." Which one would you take?
Willis: I would take RSV, but it depends on who you are. If you're a child, you should pick COVID because we know COVID doesn't cause as severe illness in younger residents. But for young adults and adults, RSV is almost universally experienced as a mild illness; many people don't even recognize they're infected.
If you're 70 or older, though, that's a scary experiment. All three can make you sick.
SFGATE: For young adults and adults, which vial would you want to take between COVID and flu?
Willis: Assuming I'm vaccinated against both, I would probably choose the flu because COVID is so unpredictable still. While it's grown less severe because of immunity from vaccines and prior infection, there's still a wide range of outcomes, and I'm still worried about long COVID. We don't quite see that with the flu.
Flu can be a really serious illness, and that's what we're seeing right now, so with me taking that vial, I'd still be bracing myself.
SFGATE: For years, it was true you'd rather have the flu than COVID, but the fact that now you have to stop and think about it is pretty significant, no?
Willis: Absolutely. We haven't had the same type of policies to address flu like we had with COVID. In the past, even in bad flu years, we never did flu-related lockdowns or isolation orders. This is a good chance for us to signal what the future of COVID looks like; it's more like influenza now in terms of impact to the community.
We're pulling back on COVID restrictions because the nature of the threat has changed, and those restrictions are no longer necessary.
SFGATE: In Los Angeles County, Barbara Ferrer says she's going to impose a mask mandate if COVID transmission continues to rise. In Santa Clara, Sara Cody, who's typically been aligned with Ferrer in the past, says she doesn't think mandates are warranted three years in because people have the necessary information to make informed decisions. Where do you stand?
Willis: I agree with Sara. We are offering a strong recommendation that people cover their faces in indoor public settings in response to the surge in winter viruses but not a mandate.
N-95 masks are effective against all three viruses in this tridemic. So if people are very concerned, they can wear a high-quality mask. Our community is aware of the benefits of masking, but a lot has changed since mandates were used. We have vaccines, and so many of us have been infected, meaning our immune systems are primed, and people can navigate choices on their own. The consequences of infection have diminished.
Another factor in weighing mandates is that the relationship between policy and behavior is not clean. When the most recent mandates were imposed, they didn't do a lot in terms of changing behavior. We think that as a principle, it's better to work in an environment of choice and people understanding their own risk.