10. Dr. William Schaffner: Why Getting Your Flu Shot is More Important Than Ever

Published October 14, 2020

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Show Notes

William Schaffner, M.D., Medical Director of the National Foundation for Infectious Diseases (NFID), explains why the flu vaccine is so important this year and answers questions about common questions about COVID-19.

Learn more about NFID’s Keep Up The Rates Campaign: https://www.nfid.org/keep-up-the-rates/.

Get the latest information and resources about age-related conditions, diseases and issues that impact the health of older Americans: https://www.agingresearch.org/health-topic/

Episode Transcript

Sue Peschin:

Hello, and welcome to This is Growing Old, a podcast from the Alliance for Aging Research. I’m Sue Peschin, President and CEO of the Alliance for Aging Research. Today, I’m thrilled to be speaking with Dr. William Schaffner, Medical Director of the National Foundation for Infectious Diseases. Dr. Schaffner, thank you so much for joining us today.

William Schaffner:

Good to be with you.

Sue Peschin:

The National Foundation for Infectious Diseases recently started a Keep Up The Rates campaign, aimed at encouraging people to get the vaccines they need, that they may not have gotten due to the COVID-19 pandemic. Please tell us a little bit more about why you think this campaign is so important right now, and what you hope to accomplish with it.

William Schaffner:

Well, the reason it’s so important is that, during our shutdown, people began to get their medical care through telemedicine, and you know it’s very hard to get an immunization through the computer. You have to actually have to show up in person and roll up your sleeve. So, a lot of adult immunizations and immunizations of children began to wane during that shutdown period. Now, now that we’re opening up, once again, we’re starting to immunize and we’re going to close the gap. And that’s the point behind Keep Up The Rates. We want to keep the rate of adult immunization and particularly of people aged 65 and older, back up to where it ought to be.

William Schaffner:

And of course, now it’s flu season, flu vaccination season, and we want everybody to get their flu shot and their pneumococcal vaccine if they haven’t received it yet. So, it’s very important. This season, more important than at any other time, because as we know, that nasty virus COVID is out there simultaneously, and flu will be competing with COVID for our attention. So, for reasons of personal protection, we want you as an individual to be protected, but also for the reason of trying to take some of the strain off the healthcare system, we want as many people to get vaccinated against flu as we possibly can encourage.

Sue Peschin:

Okay. That’s great. And you’re so good at communicating these things. I love it, and I think it really resonates with people. Tell us a little bit more. You mentioned older adults. Why is it especially important for older adults to get their vaccines?

William Schaffner:

Well, let’s get serious about this. As we get older, our bodies become somewhat more frail, we know we’re no longer 22, and our immune systems also wane a little bit, which sets us up for more serious disease, should we get influenza. So, we want to do everything we can to prevent that, to prevent influenza, or to mitigate its severity. And flu vaccine, we know it’s not a perfect vaccine, but it’s a very good vaccine. It prevents many diseases completely. And even if you should get the vaccine and then subsequently come down with the flu, you’ll have a milder infection, a less serious infection. You’re less likely to need medical care, be hospitalized, be admitted to the intensive care unit, and hear me now, you’re less likely to die. Hello, what’s wrong with that? The flu vaccine shifts the odds in our favor. We vaccinate each year, two-thirds of the population, age 65 and older. That’s a heck of an accomplishment. But think about it. That means a third of folks aged 65 and older, still do not take advantage of influenza vaccine. We want and need to do better.

Sue Peschin:

I just want to ask you, I know that there are two different types of flu shots available, specifically for older adults. Can you tell us a little bit more about them and whether or not this is something that older adults should ask their healthcare providers about?

William Schaffner:

I think it’s a great idea to ask about these two vaccines that are explicitly licensed flu vaccines for persons age 65 and older. Remember, our immune systems aren’t as robust as they were when we were 25 years of age. So sometimes they need an extra stimulus. These two vaccines kick start our immune systems. One is called the high-dose vaccine. It actually has four times as much flu vaccine as the usual flu vaccine. It gives the immune system a bigger punch and gets it started. And it’s been shown to be, in many studies now, more effective for people aged 65 and older than the regularly formulated influenza vaccine.

William Schaffner:

The other vaccine has, in addition to flu vaccine, an immune stimulant in it. We give it the fancy name of an adjuvant. It also kick starts, wakes up the immune system so it responds better to the vaccine. It also has been shown to work better in adults than the standard vaccine. Feel free, although the CDC has not expressed a preference for the use of those vaccines in older adults, most of us, and in our medical center, we’re encouraging the use of those two vaccines in people aged 65 and older. So, feel free to ask your healthcare provider, your pharmacist, whether they have the high-dose or the adjuvanted flu vaccine. Because you’re older than 65, you’d like to get one of those.

Sue Peschin:

Perfect. I’m so glad we addressed that. Good. Experts like yourself, say that the flu might make the COVID 19 pandemic worse. Tell us more about that and how you can see this flu season possibly being different for folks.

William Schaffner:

Yeah, well, we anticipate that this fall, we’ll have one heck of a respiratory virus season. One of my friends calls it a twindemic. So we have COVID, we know it’s spreading rather uncontrolled throughout most of the country, and with all of us going inside, spending more time close to each other, perhaps not observing social distancing, there’ll be more opportunities for COVID to spread. And in that setting, if that were not bad enough, along comes our old friend, or maybe I should say our old enemy, flu. Every fall, starting around November, usually, we start to see cases of influenza, and they peak in January and February.

William Schaffner:

And flu, of course, is spread entirely similarly, it’ll be hard to distinguish the two. It also preferentially hits older persons and persons with underlying chronic illnesses. So, anything we can do to prevent the impact of flu will be a great boon and will put less stress on the healthcare system. But most importantly, the vaccine helps prevent flu and gives you prevention as an individual, and also makes it less likely that you’ll spread flu to your friends and relatives. You’re less likely to be a dreaded spreader.

Sue Peschin:

I like that, “dreaded spreader.” Don’t be a dreaded spreader. So, do you think the fact that a lot of us are wearing masks can have a positive impact to protect against spreading the flu?

William Schaffner:

Yeah, you bet. Because the two viruses, COVID and flu, are spread actually in entirely similar ways. And so, all the mask-wearing, social distancing, and avoiding large groups, helps prevent both. In fact, our friends in Australia and New Zealand, remember, they have their winter during our summer, sounds weird but that’s the way it is. They’ve had the lowest flu season they’ve had in ages. They did two things. They used more flu vaccine than they ever have before. A lot more. And number two, those two nations, Australia and New Zealand, they were pretty compliant, not perfect, but the folks were pretty compliant about mask-wearing and social distancing. And our friends, the epidemiologists in Australia and New Zealand, attribute much of their low flu season to those two things. So, let’s all get our vaccine and keep our masks on.

Sue Peschin:

I love it. That’s great to have that evidence of folks who came before us, showing us the way. So, all the more reason to follow the recommendations. So, fall is also allergy season. And I’m one of the folks that experiences fall allergies. How do people tell the difference between their allergies, getting the flu, or if they got COVID-19, or even just a plain old cold? And what are the most concerning symptoms people should watch out for?

William Schaffner:

Yeah. This is not going to be so easy. I think all of us as patients and all of us as healthcare providers, are going to be challenged this winter. The allergy has a lot to do, as we all know, with runny noses and sneezing, and there’s no fever associated with allergies. And most of us can recognize that tickle in our nose when we get allergies. When it comes to the viruses, their symptoms overlap considerably. Now, colds usually affect us, for the most part, not entirely, but for the most part, from the neck up. Stuffy nose, sore throat, and usually no fever.

William Schaffner:

And some people develop a bit of a cough because of their postnasal drip with a cold, but that could be mild flu or mild COVID also. Sorting all of that out, I wish I could tell you it’s going to be easy. Even fever won’t help us because you can have both flu or COVID and not have a fever. And that’s very, very sneaky on the part of those two viruses. And I must tell you, the lack of fever is more common with those infections if you’re older. So, it will be difficult to sort all this out. One of the things we can do to make it a little easier is get that flu shot right now.

Sue Peschin:

That’s great. Okay. Just as a follow-up, what are the most concerning symptoms people should watch out for? When is it important to pick up the phone and call the doctor?

William Schaffner:

Well, any number of things, high fever, fever continuing, not getting better, any difficulty in breathing is very, very important. So, those are the things that I think would have you call a doctor as you’re getting sicker. However, if there’s flu in the community, and we’ll all know that because we’ll see it in the newspapers and learn about it on television, if there’s flu in the community and you are older, and particularly if you’re older and have any underlying illness, you can call, I said, call or email your healthcare provider, because they may provide an antiviral medication such as Tamiflu, for example, that you can use to reduce the severity and the duration of influenza. So, that’s always very important also.

Sue Peschin:

Good. It sounds like there’s things that folks can do, even if it is flu, that you shouldn’t just sort of sit and not do anything. It’s a good idea when having kind of a fever or some intense symptoms, to pick up the phone, because if there is a medication that can shorten the course, that that can help.

William Schaffner:

Absolutely. And be advised, Tamiflu and the other medication that you can take orally, Baloxavir, and also Relenza, although that spray medication is not very much used in the United States, but all those antivirals, they work best if started early. As adults, we have a tendency to say, “Well, I’m not going to bother the doctor today. I’ll wait until tomorrow to see if my cough improves.” By waiting, if you already take an antiviral medication, you reduce its effectiveness. The moms take the little kids into the doctor right away, as soon as they get a sniffle, but we adults have to kind of train ourselves to do that also. So, call or email that healthcare provider. And I say that, of course, rather than going to the office, because whatever you have, you don’t want to spread to everybody in the waiting room.

Sue Peschin:

Okay. So as a reminder for all our listeners, can you please explain how COVID-19 spreads and the steps that we can all take to prevent the spread?

William Schaffner:

Glad to go back to fundamentals, and this applies to all respiratory viruses, including influenza. These viruses are spread via what we call the respiratory route. If I’m infected, that virus is back in my throat and in my upper chest. So, when I exhale, I exhale microscopic virus at the same time. And if you are within three to six feet of me and we’re spending a bit of time together, let’s say 15 minutes, and we’re indoors, you can inhale some of those viruses that I exhaled, and bingo, I’ve just infected you. And that sort of close-in indoor spread is how most of these viruses are spread very readily.

William Schaffner:

And so, when you think about it, it stands to reason that if, first of all, you avoid people who are coughing and sneezing, but if you’re always then wearing masks while you’re close-in with other people, that helps. And of course, we say, stay farther apart, try to keep it at six feet. And those gatherings of larger numbers of people, that’s something you want to avoid because it’s exactly in those circumstances that these very contagious viruses like to spread from one person to another.

Sue Peschin:

Good, good. And it seems like the whole sort of folks getting together in larger groups now, is where they’re seeing some of these issues come up. The events where things can spread quickly and among a lot of people in a short amount of time.

William Schaffner:

That’s true. And think about this, the virus doesn’t care. It doesn’t have faith and it will take advantage of even faith-based gatherings. So, if you’re getting together for religious services, whether in a church, a cathedral, a mosque, a temple, wherever, the virus doesn’t care. And people who attend those services, if you look at it demographically, tend to skew older. So, here we’re gathering older people at higher risk, many of whom know each other. After all, they know others in the congregation, “Oh, Susie, Tom, how are you? Good to see you.” Close in conversation. There may be even hugs, and some people going cheek to cheek, that’s exactly the environment that these viruses like. So, if you insist on going to services in the new normal, stay apart and wave at your friends, and wear the mask and say, “It’s COVID time. Let’s just blow each other a kiss and make it a hug free zone.”

Sue Peschin:

Yeah. That’s great. Yeah. So you can still do your thing, but you do it safely or do it in the parking lot, right?

William Schaffner:

Do it at the lowest risk way you can. Older persons, I keep coming back to this, are at the greater risk of severe disease, so we have to go the extra mile in keeping ourselves a bit separate and be sure to wear the mask.

Sue Peschin:

Right. The COVID-19 pandemic has changed all our lives. In your opinion, what have been the biggest lessons that we’ve learned during the pandemic?

William Schaffner:

Oh goodness. There’re so many lessons. Well, we’ve learned, first of all, that viruses can emerge suddenly and travel around the globe within a matter of weeks. This virus, in a few short weeks, has traveled around the world and landed on every continent except Antarctica. That’s extraordinary. Number two, this virus is new to humans and it’s clear that it has differential effects in young children than it does in younger adults. By the way, it can affect those younger children, just not as severely as older adults. And we’re learning so much more about how this virus can make one sick. But another thing we’ve learned is that the simple expedience of wearing a mask, social distancing, and avoiding groups, really do work if we all do them together because we’re doing those things to protect ourselves and to protect others around us. We can create safer communities if we all do these things on behalf of each other.

Sue Peschin:

So, what can families do to support older relatives as the pandemic continues to go on? And when is it going to be safe to visit and give hugs?

William Schaffner:

Safe. That’s one of those four-letter words I don’t like, because it implies complete safety. What I’d like to talk about is another four-letter word, risk. Reducing the risk. Now, if we want to visit Grandma and Grandpa, we can do that, but we have to assure them that we’re very safe and that we have conducted ourselves prudently. Also, it’s worth calling ahead and saying, “When we get together, how are we going to behave?” Perhaps, this is a time for the five-year-old to hug Grandma around the waist rather than giving her a kiss. Discuss, in advance, if we all get together, are we going to stay socially distant when we visit, and we will wear masks even when we’re inside the house? A lot depends on how risk tolerant you are and how compulsive you want to be about really keeping the risk very low. In our family, we’re being very careful, still at the moment.

Sue Peschin:

That’s good to hear. And I think that gives reassurance to a lot of families out there who are still doing the same, because there has been a lot of mixed messaging, and it’s good to get the validation that it’s okay to keep doing all this stuff and do what you feel is the most safe for your family.

William Schaffner:

I like people to do these things carefully, rather than in a carefree way. So, let’s all be thoughtful and we can keep the risks low.

Sue Peschin:

Perfect. So now I’m going to change things up a little. I’m going to ask you a question. When you were a kid, what did you imagine growing older would be like?

William Schaffner:

Well, growing older meant different things when I was growing up. It meant not getting as old as many of us are, quite frankly. Let me tell you a little story. This goes back to when I was a fourth-year medical student, and four of us were on a ward together and we heard somebody was admitted on the other ward and we wanted to go over and see that person. Imagine, four bright young medical students, cumulative, we were in our early twenties, we had almost a hundred years of life experience, but there was somebody who was admitted to the other ward, so we decided to go over and just walk by the door and look in at that person.

William Schaffner:

And you might ask yourself, back then it was in the 1960s, what was it about that person that made us so curious? Well, you’ll be shocked to know it was a person we had heard who had been admitted to the hospital, who was over 80 years old. And we’d never seen anybody that ancient. We wanted to go by and just look at somebody that old. Growing older today is very different and very much more optimistic. Many of us are reaching that area which we used to call the old, old. Hey, that’s become the new normal. Let’s keep it that way. Let’s keep it going. And let’s keep ourselves as healthy as possible, to come back to the theme here, let’s get our flu shots, that’ll help us reach old old age.

Sue Peschin:

I love it. Good. So, what do you enjoy most about growing older now?

William Schaffner:

Well, I’m reminded of Winston Churchill, and I’ll paraphrase. He also reached a senior age and he had some disabilities and he was asked by a fresh reporter, “What about that?” And he said, “It beats the alternative young man.” And for sure, that’s the case, but many of us, fortunately, can be relatively healthy. Older persons, medical care can help us keep functional, keep us interested in what’s going on, and developing a new and sustaining old personal relationships. And it’s all wonderful. My father had a motto, “Isn’t life wonderful.” And that’s true in older age too.

Sue Peschin:

That’s great. I love it. Dr. Schaffner, thank you so much for being on our show today. It’s been really wonderful talking to you.

William Schaffner:

It’s been obviously, for me, a great pleasure. And everybody out there, keep enjoying life, get that flu shot, make sure your immunizations are up to date, and take good care and all best wishes for your continuing health.

Sue Peschin:

Thank you. That’s all for this week’s episode. We encourage you to follow the Alliance on Facebook, Twitter, and Instagram. Visit www.agingresearch.org to learn more about age-related conditions, diseases, and issues that impact the health of older Americans. Please subscribe now and rate us on Apple Podcasts, Google Podcasts, Spotify, or anywhere else you listen to podcasts. Thanks again, and have a great day.