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Tom Barkin

What Could Happen if We Keep Washing Our Hands?

Tom Barkin
June 22, 2021

Tom Barkin

President, Federal Reserve Bank of Richmond

The pandemic has changed us. It reminded us how precious time with family and work-life balance are. It threatened baby boomers’ health while expanding their 401k plans, perhaps driving the recent surge in retirements. It even allowed us to discover hidden talents, like baking or gardening, increasing the value we place in our leisure time. Many of these shifts could dampen future workforce participation and productivity. But one change, if it persists, could be a force in the opposite direction — a productivity booster. We saw a dramatic reduction in flu incidence.

Flu season comes every winter. While we never know how severe it will be, we know it will be disruptive. But we’ve never seen the pendulum swing this far before. This winter, we basically bypassed the entire flu season. The Centers for Disease Control and Prevention (CDC) estimates we had 38 million flu cases the winter before the pandemic. But reported flu incidence was so low this season that the CDC hasn’t even published estimates.

We can see the same decline by looking just at the reported cases, which are much lower than the CDC’s total estimates each year. Positive flu tests dropped from tens of thousands per week during the winter of 2019-2020 to just hundreds or fewer per week this past year. According to local news coverage, reported flu cases in Japan were down more than 99 percent from the previous season’s levels. The data are clear: There has been a global drop in flu incidence.

We have a pretty good idea why. We made decisions to reduce our personal and collective risks. We stayed home and avoided crowds. If we went out or worked in person, we wore masks, distanced ourselves and were hyperaware of hygienic precautions. These individual decisions were matched with institutional actions, such as paid leave incentives and facility modifications that normalized hand sanitizer stations and socially distanced floor plans.

The realization that we may be able to mitigate the impact of flu season is powerful. We now know that the annual disruption is not necessarily a given. That leads me to wonder: What if we could retain this low infection rate beyond the pandemic? What could we gain in future years?

For one, we would see fewer deaths. While we may tend to think of the flu as an inconvenience rather than a lethal threat, tens of thousands of people die from the flu each year. The CDC estimates 22,000 individuals passed away from the illness during the 2019-2020 season. Nearly three times that many people died during the severe 2017-2018 season. And while those figures may seem low compared to our recent experience with COVID-19, the flu is an annual occurrence, not a once-in-a-generation pandemic. Influenza and pneumonia are among the top 10 leading causes of U.S. deaths every year.

The second-order benefits of fewer deaths would be considerable. The majority of flu deaths occur among older Americans, a group whose increasing labor force participation is critical to our workforce over the coming years. Reducing flu incidence could also help us avoid emotional, financial and productivity losses. A 2018 study places the financial loss from lost earnings due to flu deaths at $4 billion.1

We would also see fewer hospitalizations. Approximately 400,000 individuals were hospitalized with the flu during the 2019-2020 season, according to the CDC. More than double that number were hospitalized during the 2017-2018 season. Reducing flu cases as we have this past year could reduce hospitalizations by nearly tenfold. Fewer hospitalizations could reduce medical costs by up to $3.2 billion each year and free up scarce medical resources such as provider time and hospital beds.2

Even reducing nonsevere cases would help our economy. Fewer missed days of work would increase output, particularly for smaller firms that struggle to continue normal operations when flu outbreaks hit their workforce. Annual flu-related employment absences average 20.1 million days, at a cost of $3.8 billion, according to one estimate.3 Estimates from the global outplacement firm Challenger, Gray & Christmas place the cost of the 2019-2020 flu season at approximately three times those levels (57.3 million days and $13 billion). To put those estimates into perspective, that’s equivalent to every one of the 2.7 million workers in the grocery store subsector missing between eight and 21 days of work each year just due to the flu. Those missing days of work hurt the employer and the employee, but they also affect individual consumption — which then affects other businesses. As we’ve learned during the pandemic, we can spend less when we are home than when we are going out to lunch or popping into stores after work.

We could also see fewer low-productivity work days. It’s pretty hard to be effective while battling the flu or while taking care of a loved one who’s ill. That raises another benefit of mitigating the flu: reduced school absenteeism. Given the learning gap we face coming out of the pandemic, every day in the classroom matters.

Fewer deaths and hospitalizations. Less productivity loss at work. More consumption. Reduced school absenteeism. The benefits are compelling. But are we likely to see this lower infection rate continue?

Some flu-suppressing behaviors are going to go away. We have an understandable desire to gather, to collaborate, to shake hands or hug and to smile with more than just our eyes. As the pandemic eases, we are already relaxing.

But we don’t necessarily need to quarantine ourselves to have a real impact on flu incidence. Perhaps the lessons from the COVID-19 vaccines will enhance the effectiveness and take up of flu vaccines. Perhaps businesses will maintain policies that have helped reduce spread this year, such as remote work options, leave for sick employees, hand sanitizing stations and facility modifications. Perhaps each of us will internalize a healthier set of behaviors.

I will try to do my part and retain some of my pandemic habits. I'll be taking some extra seconds for hand-washing and reserving my hugging primarily for family. Perhaps others will do the same, and we can elbow bump our way to a healthier, more productive economy.


Putri, Wayan C. W. S., David J. Muscatello, Melissa S. Stockwell, and Anthony T. Newall. “Economic Burden of Seasonal Influenza in the United States.” Vaccine, May 2018, vol. 36, no. 27, pp. 3960-3966.


Putri et al. (2018).


Putri et al. (2018).

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