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Flu Season and COVID-19 Collide. Now What?

Updated: Oct 5, 2020

Experts share when to get the influenza vaccine and how the coronavirus pandemic may get more dangerous without it.

Flu Season and Covid-19 Are About to Collide. Now What?

Autumn is here! Although we are still in a but of a heat wave, the morning air will soon start to feel crisp. And, for some of us, leaves will start changing into beautiful, vivid colors. And, you will also probably notice the "Flu Shots Available" signs outside your surrounding pharmacies.

Now, we normally hear, or read about, health authorities urging us all to get our year influenza vaccine. However this year, they are really hoping they will be heard and people will see the importance behind getting your flu shot with while the COVID-19 pandemic is at play.

The overlap of the flu season and the coronavirus pandemic is projected to overwhelm the health care system if people don’t take the vaccine and the incidence of flu is high. Hospital planners are worried about renewed pressure on hospital beds and protective equipment, and the less visible pressure on laboratories - which have to use the same machinery and supplies to analyze diagnostic tests for both Covid-19 and flu.

“Coronavirus and influenza are going to compete for the same ER space, the same hospital beds, the same ICU beds, the same ventilators, the same personal protective equipment, the same staff,” says Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security who also works in several Pennsylvania hospitals as an infectious disease and critical care physician. “It's going to be extremely difficult in terms of hospital surge planning and capacity.” We tend to underestimate the flu in the US. In a normal year, flu kills up to 60,000 people in the US and can put more than 800,000 in the hospital. You can read more about this from US Centers for Disease Control and Prevention researchers and director Robert Redfield, who wrote last month in The Journal of the American Medical Association. It is routine, at the height of flu season, for emergency rooms to be so slammed that they refuse to accept ambulances and turn patients away. “This could be the worst fall, from a public health perspective, we've ever had,” Redfield warned recently in a video interview with WebMD.

In efforts to prevent this worst case scenario, more attention is being applied to stressing the importance of Americans receiving the flu shot this year. However, this may prove to be an effort of persuasion, for, in an average year, fewer than half of US adults get vaccinated for influenza. Last season, fewer than half of U.S. adults, 45%, got a flu vaccine, CBS2’s Dr. Max Gomez reports. To offer support, the CDC is investing millions to provide more shots than usual.

Polls show most people who don’t get the flu shot say they are concerned about side effects, which are typically mild, believe it doesn’t work very well, or think they can get the flu from the vaccine.

That is contradicted by evidence that shows it is not possible to get the flu from the vaccine. The effectiveness of the vaccine varies by year, but research shows the illness is less severe in people who do get their shot If you have ever felt like you had gotten the flu after receiving the flu shot, it was probably a strain a flu that you were not vaccinated for - be sure to ask your doctor or pharmacist for the 4-strain vaccine.“The increase in vaccine hesitancy and misinformation around vaccines adds to the perfect storm in the fall,” said Adriane Casalotti, chief of government and public affairs for the National Association of County and City Health Officials. Unfortunately, many of the venues that usually provide flu vaccines (and on-site reminders to get them) —workplace campaigns, back-to-school fairs—can’t be held this year. And meanwhile, supply chain slowdowns that affected Covid-19 testing through the summer, holding up sampling swabs, transport media, and laboratory reagents, have never caught up and may stymie flu testing, too. Thus, distributing flu vaccines may be a bit more challenging than in previous years.

According to the CDC, 17 percent of adults get vaccinated at their workplaces. But millions of Americans have been working from home to slow the spread of COVID-19, and it’s not clear how many will be back in their offices in the fall. Experts are hoping people go to pharmacies instead, which performed about one-third of all flu vaccinations last year. Between people just not getting vaccinated against the flu, flu shots being less assessable, the cooler weather, in-person schooling (if that happens!) with shared are and surface, Covid-19 and flu transmission are much more likely; making this flu season likely to be a dire one.

“People forget that even before Covid we always had a crunch during flu season,” says Helen Boucher, an infectious disease physician and head of several programs at Tufts University Medical Center. “Our hospitals are not designed to have excess capacity—we run at 100 percent capacity every day.” Needless to say healthcare workers and hospital staff are bracing for the results.

What lies ahead will not just be as simple as more flu cases + more Covid cases. This equation will have overwhelming results which mean, less beds, labs being backed up and not able to distinguish the more severe cases and which treatment is needed or best suited per case - the same steroids and antivirals are not used for Covid and the flu! Not to mention possible medication shortages. In short, coinciding flu and COVID-19 outbreaks could overwhelm hospitals and drain resources, threatening lives and the response to the pandemic. 

“Labs are already at or near capacity for testing of respiratory specimens, and it's going to be the same people, the same equipment, the same space, where flu testing will be conducted,” says Kelly Wroblewski, director of infectious disease programs at the Association of Public Health Laboratories. “We need to focus, right now, on getting people vaccinated and reemphasizing masking, physical distancing, and hand washing,” says Georges Benjamin, a physician and the executive director of the American Public Health Association. “We’d like to take the influenza problem off the table.”

Getting better uptake in flu shots might accomplish several things. A flu vaccine won’t prevent Covid-19, of course, as they are caused by different viruses. But it will reduce the number of people coming into hospitals with illnesses that need to be sorted out, and it will cut back the occurrence of rare but serious cases in which someone comes down with both illnesses at once. Getting vaccinated could keep thousands of flu patients out of the hospitals and preserve resources that are urgently needed for COVID-19, experts say. 

But also, the door swings both ways when it come to a matter of benefits from protection. “In South Africa this summer, flu cases went down, because of greater distancing and wearing of masks,” says Julia Swann, a professor of industrial and systems engineering at North Carolina State University, who consulted for the CDC during the 2009 H1N1 flu pandemic. “That is possible for us, if people can remain vigilant.” It’s also possible that might happen inadvertently, she added: If enough universities or cities have to go back into lockdown as Covid-19 spikes, the social distancing that follows could squelch the pandemic curve and the flu season at the same time.

Well over half a year into the pandemic, the behavior of the novel coronavirus is still uncertain: Viruses’ behaviors can change as they adapt to new hosts, and their sensitivity to seasonal change can be affected by indoor temperatures and ventilation as well as conditions outside. And while flu season can last well into spring, that is a long period to try to predict the interactions of two diseases that are insufficiently understood. This could unfold and a few ways: there could be a bad flu season, or a mild one; a severe wave of Covid-19, or something no one has foreseen. Although we cannot control what roles these two virus' play in the upcoming months, we can take some control back by getting a flu shot!

When's The Best Time To Get A Flu Shot During The COVID-19 Pandemic?

Get your flu shot in early fall if you want the best chance at protection.

The Centers for Disease Control and Prevention recommends getting a flu shot in September or October. While flu season can last well into late spring, it typically ramps up in the fall and peaks between December and February.

REMEMBER: After getting the flu shot, it takes about two weeks to build up antibodies. Getting vaccinated at the beginning of fall allows ample time to build up immunity that will last through the worst months of flu season.

Please check the Centers for Disease Control and Prevention for the most updated recommendations



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