Flu Vaccines and Holiday Safety During the COVID-19 Pandemic

Jamie DePolo: Hello. Thanks for listening. Dr. Elizabeth Robilotti is assistant attending physician and associate medical epidemiologist at the Memorial Sloan Kettering Cancer Center. An infectious disease expert, she joins us today to talk about why getting a flu shot is so important during the COVID-19 pandemic, as well as how people diagnosed with breast cancer can stay safe during the holidays. 

Dr. Robilotti, welcome to the podcast. 

Dr. Elizabeth Robilotti: Thank you very much for having me. 

Jamie DePolo: So, we’re excited you're here. I have read reports that the number of COVID-19 cases are again rising in a number of areas, and many experts have stressed the importance of getting a flu shot this fall. I also saw a story, just yesterday, talking about how some parents didn't really understand how important getting a flu shot is for their children. 

So, with all that as background, could you tell us why is getting a flu shot so important, why it's especially important this year, and whether you think it's a good idea for people diagnosed with breast cancer, in particular? 

Dr. Elizabeth Robilotti: Sure, these are all really important topics, so, thanks for having me on to discuss them. 

Cancer patients, in general, including breast cancer patients, can have more severe outcomes and complications from influenza, and that’s why it's especially important to get an influenza shot, or a flu shot, every year. This year, in particular, with exactly what you mentioned — interruptions to people's regular schedule of visiting their doctors or perhaps some reluctance to go in for healthcare — makes it even more important for cancer patients because the surrounding populations may not be as well vaccinated. 

Now, a couple of things about the flu shot, in general. The flu vaccine is safe for breast cancer patients, and they should speak with their oncologist about the timing of receiving that vaccine in the context of their ongoing care. 

Jamie DePolo: Okay. Now is there any — I don’t think there is but I want to hear it from an expert. There's no real connection between COVID and the flu, and getting the flu vaccine is not going to protect anybody from getting COVID-19, but I think the concern is that if you do then contract the flu, you may be more susceptible to COVID-19 or you may have a more severe case of COVID-19. Is that what's going on with that? 

Dr. Elizabeth Robilotti: You're right that the flu vaccine won't provide any protection against COVID, and there are sparse reports of people infected with both viruses. That’s very rare in the literature. 

One positive thing I can tell you is that a lot of the mitigation strategies that we’re doing because of the COVID-19 pandemic are thought to actually be protective for the flu, as well. So, one of the ways we know this is we look at the southern hemisphere to see what their influenza experience is to sort of predict how bad our flu season will be, just based on the way flu circulates. And so far, those reports are saying that it was a much less severe influenza season in the southern hemisphere. And there are no guarantees, but we're expecting similar in the northern hemisphere, and we think that’s a direct relation to the things that everybody is doing because of COVID. Keeping distant. Wearing masks, et cetera. 

Jamie DePolo: Okay. Okay. Thank you. Now, whenever the push comes for a flu vaccine, invariably there's a person that says, “No, I'm not getting it because last time I got the flu from the vaccine.” Now, I am almost positive that that is impossible, but I would like to hear you say that. 

Dr. Elizabeth Robilotti: Thank you, thank you for asking this question. It's really important to dispel this misinformation, and I'm happy to tell your listeners that the flu vaccine, or the flu shot, cannot give you the flu. 

Just a little bit about vaccines. So, flu vaccine is made either with inactivated, which means dead, virus, or with only a protein, which means part of the virus. And on its own, that part can't cause the flu. 

So, some younger people in your families or friends may get a nasal spray vaccine, and this is made from a live virus, but it's what we call attenuated. And attenuated means weakened, so much so that it also cannot cause the flu. 

So, despite everything I've told you about the ways that we try to ensure that the flu vaccine does not give you the flu, there are some people who absolutely insist that they got the flu from their flu vaccine. And I think that this can happen in two scenarios. Not that the flu shot gives them the flu, but that they have this perception. 

One of them is someone who may have been already exposed to the flu when they decide to go get their flu shot, and then a couple of days after getting their flu shot, they come down with the flu. And then they blame their shot. So in reality, they'd already been exposed, and so the timing was off, which is why it is important to discuss the timing of your flu shot with your oncologist. 

The second one, which is probably the more common one, is that there are several other viruses that cause similar symptoms to influenza, and they circulate at the same time of the year. So, you’ve gotten your flu shot, which is protective against influenza, but it doesn’t provide protection against these other viruses. And when people get sick from them, they think it's the flu, and they got it from their shot. 

Jamie DePolo: Thank you. Thank you for dispelling that myth. That’s very important to me. And as somebody who has a number of friends who perhaps are in treatment or are immunocompromised, I just wanted to ask you, when I get a flu vaccine, I get it for those people. I don’t really get it for myself, because I would hate to infect somebody else. Like I would hate to have a mild case and be a carrier and infect somebody else. And I hear people say, “Well, I never get the flu, so I don’t need the flu vaccine.” And I'm wondering if you could talk about that. How it really is important for other people as well as for yourself. 

Dr. Elizabeth Robilotti: Yes. For those among the listening audience who are the caregivers or family members of patients going through breast cancer treatment, it is very important that they also get the flu shot to provide exactly what you're describing, which is this sort of protective cocoon around patients who could be more susceptible. 

And one of the important reasons for that is, even though we get the flu vaccine, sometimes it's not 100% protective against the flu, but it can lead to getting a much more mild case. And that’s very important for cancer patients, specifically, but also for their caregivers, because it's enormously burdensome to have your caregiver be sick when you're also undergoing treatment. So, thank you for doing your part to help keep your friends and family safe. 

Jamie DePolo: Okay. Thank you. Now I kind of want to transition a little bit, because we’re in fall. It's October here, and holidays are coming up in addition to flu season. And we also have this pandemic going on, so it seems like things are going to be very different. Holidays are going to be celebrated very differently, but people are already talking about how they still want to get together. So, do you have some suggestions for, say, people who have been diagnosed with breast cancer, especially for people who are in active treatment with chemotherapy, so maybe immunocompromised — what can they do to safely celebrate the holidays, but still feel “holiday”? 

Dr. Elizabeth Robilotti: Yes. This question comes up from lots of different circles, both personal and professional. So, celebrating virtually is the lowest-risk way to enjoy the holidays with friends and family, and there are things that you can do, like setting a time that works for everyone, despite time zone differences, or trying to match your meals, so you feel like you're together and actually maximize that feeling of togetherness. 

But I would say that many people don’t really consider the virtual holiday as a celebration, and they're craving that opportunity to get together in person. I think it's important for breast cancer patients to consider where they are in the course of their treatment before engaging in that type of in-person visit with friends and family, and they should discuss this with their oncologist, in terms of their plans. 

Now, that said, I have a couple of suggestions for how, if everybody deems that this is the time to celebrate in person, a couple of ways you can minimize, but not necessarily eliminate, the risk. So, one thing I would say is meet outside to the extent possible. Have a small number of attendees at your gathering. Maintain social distance of at least 6 feet apart as well as have participants wear masks. So, the things that have already been recommended for COVID prevention, they also work for influenza. You can consider bringing your own food and utensils to minimize the number of people touching different things. 

And a couple of other things that you might not be aware of is monitoring local circulating COVID and influenza rates. And you may be able to get this data either from local news or from the local department of health. A lot of them are posting this information. And consider cancelling if those rates are rapidly increasing. 

And if you do meet up, keep it short. 

Jamie DePolo: Okay. But definitely outside. It sounds like anything inside is probably not a good idea. 

Dr. Elizabeth Robilotti: It would be very hard for me to say that’s a good idea for cancer patients. I mean, I don't expect most of them have access to an airline hangar with large enough air exchange to accommodate gatherings. 

But this brings up another important question, which is that within any group of friends or family, there are different levels of risk that people are willing to tolerate, and I think one of the most important messages about celebrating the holidays safely and happily is being respectful of everybody's boundaries with that and not wanting to put anyone in a position where they feel they have to be in the room if they're not ready to do so. 

Jamie DePolo: Yeah. That’s a very good point. And finally, I guess, I'm wondering — you’ve given us some very good suggestions there. Have you thought about how you and your family might be celebrating the holidays? Has that come up yet? 

Dr. Elizabeth Robilotti: So, as far as my own family celebration, it's likely to be virtual. I'm very lucky to have people on both ends of the age spectrum who I love very dearly, but I want to keep everybody safe. So, it's likely to be virtual and my hope is that it's not at work. 

Jamie DePolo: Okay. Yeah, I guess that’s true! Being a doctor, you might have that. Well, Dr. Robilotti, thank you so much. This has been very informative and helpful. I appreciate your time. 

Dr. Elizabeth Robilotti: I really appreciate speaking with you. Thank you.