Fears of an influenza outbreak on top of the COVID-19 pandemic never materialized last fall. Thanks to masking, social distancing and quarantining, flu was all but nonexistent.
But now kids are returning to school and adults are going back to the office and few doctors and public health experts think the state or country will escape the flu, along with its fevers and body aches, again this year.
They suspect that the public’s immune defenses are down after the past year without much flu. That could result in an early and potentially severe flu season. They are urging people to get a flu shot to shield themselves and spare the health care system additional strain.
“Now is the perfect time to get the vaccine,” said Dr. Clifford Mitchell, director of the environmental health bureau at the Maryland Department of Health. “We know that the official flu season typically kicks off in late September.”
The advice from the U.S. Centers for Disease Control and Prevention is to get vaccinated before the end of October, which would help maintain protections until the typical end of the flu season in the spring.
Flu vaccines generally work less well than COVID vaccines. But they are similar to COVID vaccines in that while they don’t prevent all cases, but can reduce the severity of an infection significantly, easing symptoms that can include fever, aches and congestion.
This year’s flu vaccines contain four strains that had been circulating in the Southern hemisphere, though in far lower amounts than in previous years.
Private manufacturers are expected to produce up to 200 million doses for the U.S. market, potentially exceeding the record doses produced last season, though many of those doses went unused. Despite warnings of a dual flu-COVID pandemic, CDC estimates only about half of adults and about 58% of children were vaccinated against influenza last year, slightly higher for adults and slightly lower for children than the 2019-2020 season.
Still, masking, distancing and other measures in the 2020-2021 season resulted in the fewest flu-related hospitalizations across the country since data was first collected in 2005. There was only one report of a child’s death from flu last season in the United States. In the past decade, pediatric flu deaths have ranged from 37 to 199 annually.
Adult deaths are not specifically recorded, and estimates for vaccine effectiveness from the past season are not yet available. But the CDC reports that the flu kills an average of about 36,000 people a year.
The upcoming flu season will be a “significant challenge,” predicted Dr. Mohan Suntha, president and CEO of the 13-hospital University of Maryland Medical System.
Hospitals are particularly concerned about complications from flu, as the number of COVID-19 patients continues to rise again. Saturday, there were 820 people in Maryland hospitals with COVID, many times higher than the low recorded last month, but still below the mid-January record of 1,952.
Suntha told Baltimore business leaders in late August he is particularly concerned for the state’s pediatric population. Children are returning to classrooms in droves and will be subject to multiple illnesses, including flu, respiratory syncytial virus or RSV, and COVID-19.
“One reality we had last winter, is that when looking at the incidence of the flu, it was dramatically low,” he said. “Washing hands, social distancing, wearing masks and decreased social interaction: All of those things were contributing factors in reducing risk of disease.”
But in this year’s modeling, Suntha said researchers are considering that much of the country has largely abandoned those practices.
Dr. John B. Chessare, president and CEO of GBMC HealthCare in Towson, said this flu season will be “totally dependent” on the public’s mask use.
Chessare, a pediatrician, said the hospital already is seeing patients with respiratory viruses, including those typically contracted in the winter. He attributes the rise to the gradual lifting of indoor mask mandates.
“If we go back to mask-wearing in public, indoors in particular, we’re going to blunt the influenza pandemic again,” Chessare said. “If there’s one thing we’ve totally learned, it’s that masking blunts the transmission of respiratory tract viruses. Another thing we’ve learned is that hand hygiene is fabulous, everyone should do it, but it doesn’t necessarily stop respiratory viruses.”
For now, there still is hospital bed space, said Dr. Ted Delbridge, executive director of the Maryland Institute for Emergency Medical Services Systems. The agency has been doing a regular hospital patient census.
The issue will be staffing, particularly trained medical professionals, during another surge of illness, he said.
“We can’t afford a flu season,” Delbridge said. “A busy flu season without COVID-19 stresses the health care system.
“The overall guidance is the same as it’s always been,” he said. “Wash your hands. If you feel sick, stay home. If you’re in a situation where you can’t be assured of someone’s vaccine status, then you should wear a mask.”
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Delbridge also stressed the particular worry among the state’s physicians about hospitals’ bed capacity for children, already stretched thin as many kids resume hanging out, playing and going to school with their peers after more than a year at home. Cases of RSV, typically seen in the winter, are already present in large numbers in Maryland hospitals, he said.
Of the state’s pediatric care beds, about 71% were filled as of Tuesday, Delbridge said. Among the pediatric intensive care unit beds, 86% were occupied. On Tuesday, 15 children were hospitalized with COVID-19.
Some doctors’ offices, health centers and pharmacies already are equipped to provide flu vaccines, including MinuteClinics at CVS. Melissa Nandy, a nurse practitioner at the clinic at the CVS store in Baltimore’s Harbor East, said she’s had sporadic patients coming for a flu vaccine. If they come for another reason, she asks whether they want the flu vaccine too.
“I offer it to everyone who comes into the clinic,” she said. “I’d rather it get in an arm now, rather than risk them not coming back.”
The CDC now says it is OK to get two vaccines at once, typically in different arms, including the COVID and flu shots. The CDC recommends the flu shot for anyone over age 6 months.
FluMist is the only non-shot version of the vaccine available to those ages 2 to 49. It should be widely available in mid-September, according to a statement Tuesday from AstraZeneca, parent of the mist manufacturer, Gaithersburg-based MedImmune.
“It’s important to get the flu vaccine to protect yourself, your family and the community, as well as to ensure critical health care resources are preserved for COVID,” Nandy said.