Takeaway: ER Visits for Influenza Like Illness Reported to CDC by Sentinel Providers 2022-23 v 2018-19

Editor's Note: Hedgeye Health Policy analyst Emily Evans explores Health Policy in a post-Covid world. For more research and analysis, click to learn more about Health Policy Unplugged.

"Everything, Everywhere, All at Once" | Pandemic Policies and Immune Response  - 2022 10 25 09 39 10

The flu season is off to a strong start. In week 40, the start of the flu season calendar, Emergency Room Visits for Influenza-like Illness was 2.6% of all total patients seen.

In the 2018-19 season - what I would call the last "normal" period in health care - the share was 1.4%. In that year we did not arrive at 2.6% until Christmastime...

The share of young people visiting the ER with ILI symptoms is higher than the pre-pandemic period, 32% v. 28% in the 2018-19 flu year.

The difference could be accounted for by better reporting, 3800 hospitals are now reporting to the CDC, an increase of 1200 since 2018. However, the share of the older people visiting the ER for ILI symptoms remained about the same for the two periods.

It could also be yet another one of the harms visited upon children as traditional infectious disease vectors were disrupted for a couple of years by school, day care closures, mask wearing and the like. Immune systems are like pearls, you need to get them out and around regularly.

An infectious respiratory disease like the flu should have washed through a community for a couple of years allow kids to develop their adaptive immune system and limiting the disease's potential targets with each wave.

Instead, many children, kept at home and away from social and educational activities are poorly armed. So a larger population than normal is susceptible to illness and hospitalization. 

And it shows.

The trend at this point does not bode well for flu season. In normal years we might think of a strong flu season as a net positive for health care providers. With labor in short supply we probably need to think about it a little differently.

Health systems and health plans are going to be motivated to treat as many flu patients virtually as they can. TDOC usually does well when flu is bad. This year, however, with telehealth and virtual first platforms fully deployed, that pattern should not persist. 

Failing that, and especially now that everyone seems to have gotten out of the habit of visiting the ER, urgent care centers can treat most flu cases. 

Whereas a few years ago hospitalization may have been an acceptable response even if it was not entirely necessary, today's answer is to triage patients and admit only those whose welfare is genuinely at risk.

For hospitals it is a necessary reality that they look at case load, not in terms of gross numbers, but in terms of need, and of course, margin.

"Everything, Everywhere, All at Once" | Pandemic Policies and Immune Response  - 2022.10.24 COTD