Your Team Made the Super Bowl? Better Get a Flu Shot

As an emergency medicine physician, popular spectator events such as the Super Bowl usually mean little more than a temporary slowing in the rate of patient arrivals, especially among males, a phenomenon described in several countries in addition to the U.S.

A recent Upshot post shows that the impact of widely popular spectator events extends beyond decreased visits. The post cites a study published in the American Journal of Health Economics showing that the death rate from influenza is higher among those whose home team makes it to the Super Bowl. Across all ages, 5.6 people per million die from the flu, a rate that increases to about 6.6 in Super Bowl-contending areas. Although it is too early to tell if this is relevant this year, the mortality impact is about seven times larger when the peak of the flu season occurs closer to the Super Bowl than when it is held about three weeks or more before or after the peak.

The flu virus can spread whenever a person with it sneezes, coughs or even talks (or yells loudly at a televised referee), releasing droplets of saliva within six feet of someone without it. At a Super Bowl party, people are mingling closely. Because influenza becomes contagious beginning 1 day before symptoms develop; in fact, some evidence exists that people become even more sociable than usual during that contagious, pre-symptomatic period.

Super Bowl parties are not unique in providing large numbers of people the chance to be within 6 feet of someone with influenza.  Other large gatherings have been shown to increase influenza spread, including the Salt Lake City Winter Olympics in 2002, large music festivals in Hungary and Belgium, and the Hajj pilgrimage.

As a resident of one of the towns sending a team to the Super Bowl this year, I again remind my readers it is not too late to vaccinate against influenza
. Other prevention measures recommended by the Centers for Disease Control and Prevention include

• frequent hand washing
• avoid touching your eyes, nose and mouth
• clean surfaces frequently touched in your home or workplace
• use hand sanitizer

One scourge not shown to be associated with Super Bowl Sunday is domestic violence.  The claim of a rise in domestic violence on Super Bowl Sunday was propagated by the media starting right before the 1993 Super Bowl. Myth-busting website Snopes.com traces the momentum of the myth here. For example, the AP labelled Super Bowl Sunday the “Day of Dread”, and the myth has been propagated more recently. However, the association between football and intimate partner violence (IPV) is not as unfounded as suggested by Snopes.  A study found that football game upset losses led to a 10% increase in IPV, whereas non-upset outcomes of football games led to no change from baseline rates of IPV. Of note, the study found IPV associated with other days of the year and with the weather:

The resulting estimates show large and precisely estimated effects of major holidays on the rate of IPV: for example, Christmas day +18%, Thanksgiving +20%, Memorial Day +30%, New Year’s Day +31%, New Year’s Eve +22%, and July 4th +29%. They also show a significant positive effect of hotter weather: relative to a day with a maximum temperature less than 80 degrees, IPV is 8% higher when the maximum temperature is over 80. Thus, an upset loss is comparable to the effect of a hot day, or about one-third of the effect of a holiday like Memorial Day or the Fourth of July.