As always, influenza (flu) is in the news this time of year, along with recommendations that all eligible individuals get vaccinated against it. As many as 50% of eligible people typically skip a flu shot, and this year the temptation to skip may be stronger than usual.
After facing COVID-19, some people may be quick to dismiss the relatively much smaller risk posed by the flu, and persisting disinformation around COVID-19 vaccines casts a shadow on other vaccines. Several factors, however, suggest that this year's flu season comes with new risks and the potential for a new public health crisis.
If you haven't yet decided to get a flu shot, keep this mind:
- This year's flu wave started earlier than usual and may turn out larger than usual.
A surge in respiratory syncytial virus (RSV) infections in children made nationwide news at the end of the summer by filling up hospital beds. Like the flu, RSV is typically seasonal and self-limiting, but this year's RSV wave was unprecedented because of its size and early onset. Experts blame the RSV surge on epidemiologic measures taken against COVID-19, which also prevented other respiratory viruses from spreading. Because of the few RSV cases in the last two years, many young children were never exposed and are now susceptible. Experts refer to this as an "immunity debt." A similar debt may exist for influenza. CDC surveillance data shows that the 2022 flu season started four to six weeks earlier than usual and is progressing at a faster pace. What happened with RSV strongly suggests that we should expect a broader and taller peak to flu season. If you are unvaccinated, you will be more likely to get the flu now than in previous seasons.
Hospitals are stretched thin because of COVID-19 and RSV.
With the rapid surge in flu cases, hospitals are rapidly reaching capacity, with pediatric services being the most affected. This is not surprising given the increase in RSV cases, which has not fully abetted yet. Also, COVID-19 spread remains low but significant. Perhaps more importantly, hospitals are still dealing with chronic staff shortages in the wake of the pandemic, which exposed healthcare workers to enormous stress, trauma, and burnout, driving many to resign or retire. Because of this, many hospitals are not in optimal shape to handle a large surge in flu cases, and this may lead to delays in diagnosis and treatment and worse patient outcomes. Those who get the flu this season and get seriously ill will be less likely to receive timely and appropriate care.
- COVID-19 may pose additional risk to those infected with the flu.
Influenza risks are well-characterized and limited outside of defined patient groups; however, COVID-19 is a new factor that may scramble influenza's prognosis. COVID-19 and influenza co-infection is now known to occur, and is expected to become more common during the flu season now that social distancing and masking have largely ended. Whether co-infection results in more severe disease is still unclear, but recent data from the United Kingdom found a four-fold higher risk of severe disease and a two-fold higher risk of death in patients with COVID-19 and influenza co-infection. Another potential risk is that the infections may mask one another, leading to misdiagnosis and treatment delays, including in patients initially infected with one virus who get the other while being treated at a hospital. Additionally, there is no data to predict how the flu might affect patients with long COVID syndrome, whose number is estimated to be in the millions in the United States. Thus, if you are unvaccinated, you are at risk of getting the flu and COVID-19, a combination with unknown risks at this time.
Learn more about ECRI's COVID-19 guidance and resources.