Like the flu after covid – Newspaper Kommersant No. 220 (7421) of 11/28/2022
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In Moscow, twice as often as in the pre-Covid epidemic seasons, children with SARS and influenza began to be hospitalized. An increase in the incidence, according to the Moscow Department of Health, was also noted among adults. In other regions, Kommersant also reported that the statistics of epidemiological thresholds were exceeded, primarily among children aged 7-14. Experts explain the situation by the fact that due to quarantine, Russians, primarily schoolchildren, have ceased to encounter pathogens during their circulation. They call the current process “the principle of immune debt.” Among other causes of the influenza wave is the impact on the body of the transferred coronavirus and stress.
The Moscow Department of Health, citing Rospotrebnadzor, said that both in the capital and in the country as a whole, a significant increase in the incidence of influenza and SARS was recorded. Thus, the number of hospitalized children for these reasons is currently 2–2.5 times higher than the average for the pre-COVID epidemic seasons of 2016–2019. The department of health clarified that over the past two weeks the number of hospitalizations has almost doubled and approached 400 new patients per day.
“In connection with the current situation,” the Department of Health began to re-profile beds in hospitals for children with influenza and SARS – in the near future, the bed fund will be expanded to 2,000 beds. In particular, St. Vladimir’s Children’s Hospital will be completely redesigned next week.
In other regions, an increase in the incidence of seasonal infections has also been noted. According to Rospotrebnadzor, in November 2018, 1,839 people with symptoms of acute respiratory viral infections applied to medical institutions in the Kuban, of which children under 14 years old accounted for 52%. In 2019 – more than 1.6 thousand people, children – 55.7%. In 2022, an almost two-fold jump was recorded: more than 3.1 thousand people, 41.2% of them under 14 years old. In Yekaterinburg, from November 14 to November 20, 15.8 thousand cases of acute respiratory viral infections were detected, which is 12.9% higher than the long-term average. This figure is 26.5% higher than in the same period in 2018.
In St. Petersburg, an increase in the incidence compared to the previous week is observed in children aged 7-14 years – by 32.4% (9429 cases). In the Ulyanovsk region, according to the data of the local Rospotrebnadzor, the weekly incidence rate among children aged 7 to 14 exceeds the epidemic threshold by 14%.
The Moscow Department of Health clarified that in the pandemic years, the structure of the incidence of SARS was completely dominated by the coronavirus. “Now we can say that influenza dominates in this structure,” the department noted. “Moreover, the variants of influenza strains identified this year differ from those that circulated in previous epidemiological seasons. A large proportion is precisely the strain of influenza A (H1N1), or swine flu.
There is nothing surprising in the dominance of swine flu, says Evgeny Timakov, pediatrician, infectious disease specialist, head physician of the Leader Medicine clinic: the strain has been circulating since 2009 and, slightly changing, “does not lose its relevance.” The increase in the incidence of both children and adults, Mr. Timakov explains the impact on the body of those who have recovered from the coronavirus. “There are no final data yet, but the work that has been carried out has shown that coronavirus infection reduces the immune response, the so-called secondary immunodeficiency is obtained, and because of this, immunological memory is often modified, that is, a person encounters seasonal infections as if for the first time,” explains Evgeny Timakov.
The increase in the incidence of influenza and SARS could be the result of isolation measures during the pandemic, in turn, believes Ivan Konovalov, associate professor of the Department of Infectious Diseases in Children of the Russian National Research Medical University named after N. I. Pirogov. Due to quarantine in the first place, a large number of children “stopped encountering infectious pathogens during the season of their circulation.” “We explain this with such a term as the principle of immune debt,” says Mr. Konovalov. “And the restoration of collectives, including preschool and school institutions, led to an increase in cases of acute respiratory viral infections of various etiologies, that is, not only influenza, covid, but also others pathogens.” At the same time, the infectious disease specialist claims, if a natural “pro-epidemicization” takes place, as experts call this process, then next season we can expect a smoother course of seasonal SARS.
Therapist, cardiologist of the telemedicine company MK “Doctor Nearby” Yulia Fokina, confirming the increase in the number of acute respiratory infections among her patients, names another possible reason: “People have increased levels of anxiety and stress, which also indirectly affects susceptibility to viral infections” .
And Tatyana Kogut, an infectious disease specialist at the Doctis telemedicine service, sees “nothing surprising,” emphasizing that all three covid epidemiological seasons are unlike each other. In the first covid year (2020-21), statistics on influenza and SARS, according to Ms. Kogut, dipped: the flu practically disappeared, single strains were then isolated on the territory of Russia, compared with previous years, there was a low incidence of non-influenza SARS. But it was not the coronavirus itself as a dominant virus that affected, but non-pharmaceutical methods of influence – isolation, distancing, mask mode, hand washing. In the next season (2021-22), when covid measures eased, everything returned to normal. “Influenza came very early – the first cases were registered in the Russian Federation in August, and by October it was already a distinct increase, in November-December – a clear epidemic rise. The structure of respiratory infections began to recover, despite the fact that the coronavirus also persisted,” says Tatyana Kogut.
The current epidemiological season shows a different picture, the infectious disease specialist says: “There are quite a lot of non-influenza viruses and such viruses that we began to see more often compared to previous years. For example, in some regions there is quite a lot of metapneumovirus infection. Previously, there was a small proportion, now it is a lot, and children get sick with intoxication. The picture is somewhat reminiscent of the flu, and this virus, like the flu, can cause complications in the respiratory tract. In general, according to Ms. Kogut, life is returning to the direction in which it was before the emergence of a new coronavirus infection.
Alexander Gorelov, Deputy Director for Research at the Central Research Institute of Epidemiology of Rospotrebnadzor, sees nothing “extraordinary” in the rise in the incidence of SARS and influenza among children. According to him, now there is a traditional period of increasing seasonal incidence, and in the previous two years of the pandemic, the frequency of influenza registration was not so significant due to the high vaccination coverage.
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