Flu Season Could Be Rough This Year : Shots

Health officials predict this winter could see an active flu season on top of possible COVID spikes. In short, it’s a good year to be a respiratory virus. Left: Image of SARS-CoV-2 omicron virus particles (pink) replicating in an infected cell (teal). Right: Image of an inactive H3N2 influenza virus.

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NIAID/Science Resource


Health officials predict this winter could see an active flu season on top of possible COVID spikes. In short, it’s a good year to be a respiratory virus. Left: Image of SARS-CoV-2 omicron virus particles (pink) replicating in an infected cell (teal). Right: Image of an inactive H3N2 influenza virus.

NIAID/Science Resource

The flu disappeared for nearly two years as the pandemic raged. But the flu looks set to make a comeback in the US this year and threatens to trigger a long-feared ‘twin epidemic’.

While the flu and coronavirus are both notoriously unpredictable, there’s a good chance that COVID cases will increase again this winter, showing troubling signs that the flu could also return.

“This could very well be the year we see a twentieth epidemic,” said Dr. William Schaffner, a professor of infectious diseases at Vanderbilt University. “That is, we have an increase in COVID and at the same time an increase in flu. We can have both of them hitting our population at the same time.”

The strongest indication that the flu could hit the US this winter is what happened during the southern hemisphere winter. The flu returned to some countries, such as Australia, where the respiratory infection started to increase months earlier than usual, triggering one of the worst flu seasons in recent years.

What happens in winter in the Southern Hemisphere often foreshadows what’s to come north of the equator.

“If we have a severe flu season and if the omicron variants continue to cause mostly mild illnesses, the coming winter could be a much worse flu season than COVID,” Schaffner warns.

And the combination of the two viruses could put a serious strain on the health system, he says. The Centers for Disease Control and Prevention estimate that flu causes between 140,000 and 710,000 hospitalizations each year.

“We should be concerned,” said Dr. Richard Webby, an infectious disease specialist at St. Jude Children’s Research Hospital. “I don’t necessarily think it’s an uphill concern. But we should be concerned.”

The main reason the flu actually disappeared over the past two years has been the behavioral changes people have made to avoid COVID, such as staying at home, avoiding public gatherings, wearing masks, and not traveling. That also prevented the spread of flu viruses. But those measures have largely been abandoned.

“As community restrictions around the world begin to roll off and people return to their normal activities, the flu is starting to circulate around the world,” said Dr. Alicia Fry, who leads influenza epidemiology and prevention for the CDC. “We can certainly expect a flu season this year.”

Young children at particularly high risk

The CDC reports that the flu is already beginning to spread in parts of the South, such as Texas. And experts warn that very young children are especially at risk this year.

While COVID-19 has generally been mild for young people, the flu typically poses the greatest threat to both the elderly and children. The main flu strain currently circulating, H3N2, tends to hit the elderly hard. But health experts are also concerned about young children who have not been exposed to the flu for two years.

“You have the 1-year-olds, the 2-year-olds, and the 3-year-olds who will all see it for the first time, and none of them have pre-existing immunity to the flu,” says Dr. Helen Chu, assistant professor of medicine and allergy and infectious diseases and adjunct assistant professor of epidemiology at the University of Washington.

In fact, the flu seems to have hit especially young people in Australia hard.

“We know that schools are really the places where flu spreads. They’re really considered the drivers of transmission,” Chu says. “They will be the spreaders. They will then take it home to the parents. The parents will then take it to the workplace. They will take it to the grandparents who are in assisted living, nursing homes. And then those populations will getting pretty sick with the flu.”

“I think we’re going to have a bad flu season,” Chu says.

‘Viral interference’ could offset the risks

Some experts doubt that COVID and flu will hit the country at the same time because of a phenomenon known as “viral interference,” which occurs when infection with one virus reduces the risk of contracting another virus. That’s another possible reason why the flu has gone away in the past two years.

“These two viruses can still both occur in the same season, but my feeling is that they will happen sequentially rather than both at the same time,” Webby says. “So I’m less concerned about the twentieth century.”

Nevertheless, Webby and others are urging people to make sure everyone in the family gets a flu shot as soon as possible, especially if flu season also starts early in the US. (Most years, officials don’t start pushing people to get their flu shot until October.)

So far, it appears that this year’s flu vaccines are a good fit with the circulating strains and should therefore provide effective protection.

But health officials fear fewer people will get flu shots than usual this year because of anti-vaccine sentiment that rose in response to COVID vaccinations. The flu vaccinations are already lagging behind.

“We’re worried that people won’t get vaccinated. And the flu vaccine is the best prevention tool we have,” says the CDC’s Fry.

Fry also hopes that some of the habits people have developed to fight COVID will continue and help mitigate the impact of the flu.

“The wildcard here is that we don’t know how many mitigation practices people will use,” Fry says. “For example, people now stay home when they are sick instead of going to work. They keep their children out of school. Schools are strict about not letting children come to school when they are sick. All of these things can reduce transmission .”

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