After being nearly absent in 2020 and 2021, influenza cases are making a comeback. In fact, cases are up-ticking unusually late in the year. The Centers for Disease Control and Prevention (CDC) reported on April 15 that the majority of cases are H3N2, “antigenically different from the vaccine reference viruses.” This explains why the latest flu vaccine is only 16 percent effective in reducing the chances of a moderate to severe infection. As of April 15, the CDC reported at least 4.3 million flu illnesses, 42,000 hospitalizations, and 2,500 deaths from the flu.

Public health experts attribute the rise in flu cases to the resumption of pre-COVID social activity. People are crowding in public places with less social distancing along with less mask-wearing. While the former undoubtedly is a contributing factor, the latter is more uncertain. Although debate continues over the efficacy of wearing face masks for COVID, prior to 2020 most public health researchers agreed masks have no proven efficacy, whether N95 or surgical, for preventing influenza.

However, another factor not receiving enough attention is the phenomenon called viral interference. This is where two or more viruses compete for the same host. When the 2009 H1N1 pandemic hit continental Europe, an ongoing rhinovirus infection in France delayed the H1N1 influenza virus from impacting that country for several months. Similarly, the more contagious Delta variant of COVID outcompeted and replaced its predecessor Alpha variant and then was replaced by the more contagious Omicron variant. And the BA.1 Omicron subvariant is being replaced by its more contagious cousin, the BA.2 subvariant. It is likely that a combination of increased socialization and reduced competition from a now-waning COVID-19 pandemic is responsible for the re-emergence of the influenza virus. In fact, one might view the return of influenza as a sign that the COVID virus’s presence is declining.

People with symptoms of an upper respiratory infection are, understandably, testing themselves for COVID. When they test negative, some seek professional medical attention and, if they test positive for influenza, many are then prescribed the antiviral Tamiflu. Tamiflu works best if taken during the first two days of the illness.

Unfortunately, unlike the COVID tests, the Food and Drug Administration (FDA) has only approved at-home, self-administered influenza tests that require the patient to send in the specimen to a lab, and they get results in a couple of days—often too late to take Tamiflu. On the other hand, a doctor’s office or urgent care center can perform flu tests that give an answer in 15 to 30 minutes. Because many people don’t want the expense and inconvenience of a visit to the doctor’s office or urgent care center, many don’t bother to get tested for influenza—they just tough it out without the benefit of Tamiflu. This also means the CDC is likely undercounting influenza cases.

In response to the COVID emergency, the U.S. Department of Health and Human Services recommended that states permit pharmacists to perform COVID tests without a doctor’s supervision, and most states followed suit. This past March the Biden Administration implemented “test to treat,” where patients can bring their at-home, self-administered positive test result to a designated pharmacy and the pharmacist will then prescribe one of the new and effective COVID antiviral pills. One problem is that the only pharmacies designated to participate are those that house pharmacy-based clinics. This severely limits patients’ options and many are unable to take advantage of the “test to treat” program. The administration should let all pharmacists—not just those working in pharmacy-based clinics—to prescribe the antivirals.

Yet people with influenza currently get less access to diagnosis and treatment than people suspected of having COVID. There’s no “test to treat” program for influenza. Policymakers should apply the lessons learned from the COVID pandemic and allow patients to purchase, and use at home, the same self-administered rapid result influenza antigen tests that health care practitioners use. Patients with positive tests should then be able to purchase Tamiflu directly from pharmacists.

In 1971, Faraday labs began direct-to-patient marketing of the same urine pregnancy test it had marketed to physicians. The FDA objected but lost a federal lawsuit when it demanded Faraday cease direct-to-patient sales. Unfortunately, this led Congress, in 1976, to pass the Medical Device Amendment (MDA) to the Food, Drug, and Cosmetic Act of 1938. As attorney Shelby Baird wrote, and Professors Nita A. Farahany and Jessica Flanigan discussed at an online Cato Institute policy forum in January, 2021, the FDA has abused the MDA to infringe on the fundamental right of individuals to test themselves for medical conditions.

Many states have expanded their scope of practice laws to take advantage of pharmacists’ expertise. Some allow them to prescribe hormonal contraceptives, HIV pre- and post-exposure prophylaxis, and perform most vaccinations. And during the COVID pandemic, most states permitted pharmacists to perform COVID tests. Yet only one state, Idaho, permits pharmacists to perform influenza nasal swab tests and prescribe Tamiflu to patients who test positive. Other states permit pharmacists to test and treat, but only if they have “collaborative practice authority” (CPA) from a physician. CPAs are agreements that physicians and pharmacists negotiate that expand pharmacists’ scope of practice. The pharmacists agree to being supervised by a physician in the community or state. While a step in the right direction, this still restricts patients’ options and access to affordable care. Pharmacists should be allowed to practice to the full extent of their training without requiring CPAs with physicians. As Courtney M. Joslin and I wrote here, states should greatly increase pharmacists’ scope of practice to improve health care access and affordability.

When policymakers removed many of the regulatory obstacles to COVID testing and treatment to address the public health emergency, they tacitly recognized how federal and state regulations block patients from quick, convenient, and affordable health care. Policymakers should avoid tunnel vision. Quick, convenient, and affordable health care should not be restricted to COVID patients—or to people with the flu, for that matter. It should be available to everyone.