No flu yet, but still — get your shot

COVID-19 pandemic makes prevention measures against influenza all the more important
A woman receives a flu shot
Right now is the right time to get your flu shot at your doctor's office, place of work, pharmacy or public health clinic. Photo by Getty Images

Amid the autumn surge in COVID-19 cases throughout the U.S., infectious disease experts remain worried that a second and more worrisome scenario will eventually play out: an outbreak of seasonal influenza on top of the coronavirus pandemic.

For that reason, they are urging all Americans to get their flu shots. Now.

They are widely available, provided through some employers, colleges, at drug stores and doctor’s offices. Insurance through the Affordable Care Act, Medicare, Medicaid, and most private plans cover flu shots, and public health clinics typically provide them free or at low-cost.

Ideally, a flu shot should be taken by the end of October. It takes two weeks for vaccine to build up enough antibodies against influenza, for a season that usually peaks from December through February.

So far this year, because of mask-wearing, reduced travel and policies aimed at limiting indoor gatherings from schoolrooms to barrooms, there is very little influenza activity right now, in the U.S. or abroad. In fact, flu cases in the Southern Hemisphere, where winter occurs during our summer months,  virtually disappeared as nations there responded to COVID-19.

That is unusual. It is encouraging news. But the situation could change quickly.

Despite low flu activity in the U.S.,  there have already been a small number of reported dual infections with both COVID-19 and influenza, including one confirmed last week in the San Francisco Bay Area.

Dr. Steven Pergam
Fred Hutch infectious disease expert Dr. Steven Pergam Photo by Robert Hood / Fred Hutch News Service

Doctors worry that the same pandemic fatigue that has led to behaviors that are rapidly spreading the coronavirus today could drive a surge of influenza should that virus pick up steam in the Northern hemisphere. We don’t have a vaccine for COVID-19, but there is one for flu — nearly 200 million doses are available in the U.S. for this season.

“We think there is a good chance it is going to be a mild influenza season, but we can’t be sure — so we need to prepare as we always do,” said Seattle flu researcher Dr. Steve Pergam, a professor at Fred Hutchinson Cancer Research Center and director of infection prevention at its clinical care partner Seattle Cancer Care Alliance.

“Planning is the key. It is very important to get a flu shot now, because we don’t need an outbreak in addition to COVID-19,” he said.

Since March, more than 225,000 Americans have died from COVID-19, and most of these tragedies play out in hospital intensive care units, which are being stretched to capacity in the latest surge. A sudden influx of influenza could be catastrophic. Only three years ago, an especially hard 2017-2018 flu season led to 810,000 hospitalizations and 61,000 deaths.

chart of burden of flu over years
Graphic courtesy of Centers for Disease Control and Prevention

Find out more about the flu

The Centers for Disease Control and Prevention and other public health organizations provide a wealth of online information about influenza. Here are some important links:

Key facts about flu vaccines from the CDC

Flu Trends provides excellent interactive charts tracking flu cases.

FLUView is the CDC’s detailed weekly analysis of influenza in the U.S.

CDC estimates of influenza illness, hospitalization and deaths in recent flu seasons.

The Immunization Action Coalition provides detailed, up-to-date expert answers to questions about flu.

The nightmare that haunts doctors dealing with COVID-19 patients is that their intensive care units become overwhelmed. That is why many medical organizations, including Fred Hutch, are mandating flu shots this year for all employees.

“In bad flu season, it really puts a stress on the health care system,” Pergam said. “For a front-line physician, the more respiratory illnesses that are coming in the door, the more personal protective equipment we have to use, the more testing we have to do, and the more beds and ICUs we use. A bad flu season can really shift that in a negative way.”

As director of infection control for a cancer hospital, Pergam stresses that getting a flu shot, like wearing a mask, is an action that not only helps to protect you from disease, it can protect others from infection you might be carrying. Like COVID-19, influenza is particularly dangerous for the elderly.

Cancer patients on chemotherapy, and especially those who are recovering from stem cell transplantation, are especially vulnerable to infectious diseases.

A patient doesn’t have to look ill to be at risk — by outward appearance they might look just as healthy as anyone else. Having a flu shot can protect friends, loved ones and strangers from getting influenza from you.

Sabin Russell is a former staff writer at Fred Hutchinson Cancer Center. For two decades he covered medical science, global health and health care economics for the San Francisco Chronicle, and he wrote extensively about infectious diseases, including HIV/AIDS. He was a Knight Science Journalism Fellow at MIT and a freelance writer for the New York Times and Health Affairs. 

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