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Not-So-Super Result of the Big Game: More Flu

flu coming to super bowl host cities story

Feb. 1, 2018 -- Cities that send teams to the Super Bowl don’t just snag bragging rights; they may also catch more flu.

A 2015 study by health policy experts at Tulane University in New Orleans that looked at 35 years of data found an 18% increase in flu deaths among seniors in cities that send teams to the Super Bowl.

That’s just an average, though.

In years where the circulating flu strain causes more severe illness or the Super Bowl coincides with the peak of flu season, the effect can be 2 to 7 times worse. Both of those multipliers are true this year.

If historical trends play out, says study author Charles Stoecker, PhD, Boston and Philadelphia could see a jump in flu deaths in people who are over age 65. The New England Patriots, based outside Boston, and the Philadelphia Eagles will face off at Super Bowl LII on Sunday in Minneapolis.

The flu bug infecting most people this year is a strain called H3N2, which tends to make people sicker and land more patients in the hospital.

“So if you’re spreading around a really deadly strain of flu -- like this year -- you’re going to see more deaths, ultimately,�� says Stoecker, an assistant professor in the department of global health management and policy at Tulane.

Last week, Dan Jernigan, MD, who heads the Flu Division at the CDC, estimated that we were near the season’s peak, or halfway point.

“It also looks like it might be a particularly bad year for the Super Bowl coinciding with the peak,” Stoecker added.

For the study, Stoecker and his co-authors counted flu deaths in metro areas that send teams to the Super Bowl and compared them to deaths in cities with NFL teams that didn’t make post-season play. They tallied these deaths for each flu season between 1974 and 2009. They also adjusted their numbers to account for other things that might have an impact on flu deaths, like age, race, and weather.

They found measurable bumps in flu deaths for all ages in cities that send teams to the Super Bowl. Those increases were largest for adults who are over age 65, the age group that’s already most vulnerable to the flu. In a team’s hometown, there were about seven more deaths for every million seniors during Super Bowl years, an increase of about 18%.

A Different Kind of Super Bowl Spread

Why would sending a team to the big game put seniors at risk? In academic terms, it’s a phenomenon called population mixing. You and I might call it a Super Bowl party.

“It’s a lot of small group gatherings, people getting together over chips and dip,” Stoecker says.

As more people get together to watch, they trade germs; and flu germs are particularly easy to spread.

“Influenza can travel through the air 6 feet just by talking or sneezing. That’s a pretty big radius,” Stoecker says. It’s tough to protect yourself when you’re somewhere that's fully enclosed.

Adults over age 65 are at greatest risk from the flu. When they catch it, they’re more likely to be hospitalized and more likely to die than younger folks.

“It makes sense,” says Steve Alles, MD. He’s the director of the Division of Disease Control for the city of Philadelphia.

Alles says flu is raging through Philadelphia right now. They’re in the second week of what they hope is their peak. Once they knew the Eagles were on their way to the big game, Alles says, he and his team talked about the idea that the Super Bowl could stretch their flu season even longer.

“Entering into a weekend where we're expecting a lot of gatherings to watch the game on Sunday, and then we’ve been thinking through the potential for a big parade and celebration if the Eagles win, there is potential for continued transmission of the flu,” he says.

A Focus on Prevention

Alles says they’ve already been pushing preventive measures like staying home when you’re sick, covering your cough, washing your hands, and getting vaccinated.

They’ll send out another alert to doctors about the possibility that the Super Bowl could mean more flu patients. He said he’ll encourage doctors and hospitals this week to take measures to limit the flu’s spread. He says they don’t want doctors’ waiting rooms to become another gathering place where the infection could spread.

He says he’s going to stress the importance of separating infectious patients from others and offering them things like surgical masks to further limit the spread.

“That can help quite a bit,” Alles says.

The Tulane researchers also checked to see whether the Super Bowl might cause an increase in flu deaths in the city that hosts it. They didn’t see one. Stoecker isn’t sure why. One theory is that the Super Bowl has mostly been held in cities that are warmer and wetter during the winter, like New Orleans.

Another theory is that hosting the Super Bowl, while it provides a nice boost to tourism, doesn’t move enough people to affect the spread of the flu.

“We looked at the size of these stadiums. They hold tens of thousands of people. Maybe one hundred thousand. It’s not necessarily big enough” to have the same kind of impact as lots of smaller parties held citywide, he says.

A Skeptical Patrioit

In Boston, Jenifer Jaeger, MD, interim medical director for the Boston Public Health Commission, says she was intrigued by the study but is  skeptical that they’ll see a bump.

For one thing, Boston’s flu numbers have been trending slightly lower than the rest of the country this year.

For another, Boston’s fans are kind of used to it. The Patriots have been to the Super Bowl three times in the last four years, and Sunday's game will mark the 10th time in the history of the franchise.

She says they haven’t tracked flu deaths during years when the Patriots go the Super Bowl; but taking a look back at the past three seasons, she doesn’t see any increases.

“We’re such passionate fans that we get together every weekend to watch the game, no matter what,” she says.

WebMD Article Reviewed by Neha Pathak, MD on February 01, 2018


Charles Stoecker, PhD, department of health management and policy, School of Public Health and Tropical Medicine, Tulane University, New Orleans.

Steve Alles, MD, director, Division of Disease Control, Department of Public Health, city of Philadelphia.

Jenifer Jaeger, MD, interim medical director, Boston Public Health Commission.

CDC, Weekly Influenza Surveillance Report, Updated Jan. 26, 2018

Tulane Economics Working Paper Series, Working Paper 1501, January 2015.

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