With Covid-19 hospitalizations spiking again in many parts of the country, public health officials have expressed concerns about a perennial source of strain on the health care system: seasonal flu. As threats of a “twindemic” loom, health care workers have stressed the need for vaccination and other preventive measures to slow the spread of flu.
One insurance company is going further to try to mitigate the effects of flu season: UnitedHealthcare, the country’s largest health insurance company, plans to provide at-risk patients with 200,000 kits that include Tamiflu, the prescription antiviral treatment; a digital thermometer; and a coronavirus P.C.R. diagnostic test. People can take the test at home and then mail it in for laboratory analysis, helping patients and doctors determine the cause of their symptoms, which is particularly important because the coronavirus and flu have similar symptoms but differ in treatment.
“These viruses have proven themselves highly capable of putting strain on our health care system alone,” said Dr. Kelly Moore, an associate director of the Immunization Action Coalition. “Their combined impact is really worrisome.”
In late September, UnitedHealthcare began inviting its Medicare Advantage members to sign up for the kits either online or by phone, starting with a focus on those at highest risk of complications from Covid-19 and the flu based on their age and health status. Since then, 120,000 people have enrolled, and the company has begun shipping the kits. The company has more than five million Medicare Advantage members.
The company said supplying people with Tamiflu in advance could help to mitigate the severity of flu infections because the antiviral medication gets less effective with every hour that passes from onset of symptoms and is virtually ineffective after 48 hours. Tamiflu on average shortens the duration of illness by one to two days if taken rapidly, according to Dr. Moore. It can also help prevent illness in someone at high risk of complications who has been exposed to the flu, but is not routinely recommended for preventive use in most populations.
All members signing up for the flu kits had to confirm the state where they live so that the Tamiflu prescription could be dispensed by a physician in their state. They had to attest, either over the phone or through an online form, that they would wait to take the prescription drug or the coronavirus test until after receiving direction from a physician through a telemedicine appointment, though there is no additional system for verifying this process once they receive their kits. Members also had to agree not to give the medication to others.
“We thought, ‘Imagine if you start getting sick and already had a mini pharmacy at home,’” said Dr. Deneen Vojta, executive vice president for research and development at UnitedHealthcare. The goal, she added, is to decrease the number of emergency room visits, hospitalizations and deaths resulting from seasonal flu.
There is no charge for the Tamiflu or the coronavirus test, as long as people receive advice from a doctor via telemedicine. A company spokesman said that the kits could produce savings by reducing hospitalizations through preventive care.
Flu kit recipients will be directed to schedule virtual doctor’s appointments if they experience viral symptoms. The initiative has become possible largely because of the public’s increased acceptance of telemedicine amid the pandemic. A national survey from Deloitte released in August found that the proportion of health care consumers using virtual doctor’s visits rose to 28 percent in April 2020 from 15 percent in 2019, as patients have avoided in-person visits to clinics where they are at increased risk of coronavirus exposure.
UnitedHealthcare’s initiative targeted Medicare patients because the elderly are more at risk of severe infection from both the coronavirus and the flu. Covid-19 patients who are over the age of 80 are hundreds of times more likely to die from the disease than those under 40. They are also more likely to die from the flu — between 70 and 85 percent of flu-related deaths occur in people 65 or older, according to data from the Centers for Disease Control and Prevention.
UnitedHealthcare also plans to collect data on co-infection with the coronavirus and flu. Analysis from Public Health England showed that people infected with both viruses were more than twice as likely to die, and most cases of co-infection were in elderly populations.
While no other insurance company has said it plans to send out prescription antiviral drugs, Aetna announced it would send its 2.7 million Medicare members kits containing a thermometer, hand sanitizer and face masks. Anthem has partnered with community organizations to create 500 local pop-up clinics administering free flu vaccines.
There is some cause for optimism about efforts to mitigate the spread of the flu this year, according to Dr. Marc Lipsitch, an epidemiologist at Harvard. Australia reported a 99 percent decrease in reported flu infections this year compared with 2019, partly as a result of widespread social distancing.
Americans should still be making every effort to prevent flu infection through vaccination. “If there’s an overlapping demand from the two viruses, it will compound the problem of delivering health care,” Dr. Lipsitch said. “Our health systems are already usually stretched by flu season, and could be even more stretched by Covid.”
