• Fresh Perspectives

    Preparing for Flu Season During Pandemic

    When I saw my patient Ashley last year, the highly sensitive "eyeball test" indicated she had the flu. She was feverish, coughing and, most telling, exhausted. A rapid flu test confirmed my suspicions.

    child getting vaccinated

    Ashley eventually recovered after several sleepless nights and missed days of work. This year, she's already reached out to me to inquire about getting a flu shot. She was never a vaccine skeptic, but she was one of those patients who just "never got around to it." This year, she's made vaccination a priority.

    Every flu season, like many other family doctors, I hear two common refrains from patients.

    One: "I can't get the flu vaccine because it once gave me the flu." (Note: The flu vaccine does not cause the flu.)

    And two: "I need a note to stay home from work because I'm sick." (Employers, please don't make your team members get a doctor's note when they're sick. Just let them stay home so they don't expose others to a potentially deadly disease.)

    This flu season has filled me with both optimism and concern because many patients are eager to get the flu vaccine amid the backdrop of a global pandemic. COVID-19 brought with it waves of uncertainty and change, from personal protective equipment to testing to treatment modalities to managing longer-term effects of the illness. The next challenge is around the corner: a flu season superimposed on COVID-19.

    The CDC estimated that out of as many as 56 million Americans who caught the flu last season, up to 740,000 were hospitalized and as many as 62,000 died.

    There is, of course, reason for hope: Many of the COVID-19 mitigation strategies we’re now using will also be effective against the flu, including universal masking, physical distancing and hand hygiene. (Additionally, people are less likely to travel this flu season.) In fact, we are already seeing evidence of this in the Southern Hemisphere, where New Zealand, Australia and Chile are reporting far lower rates of the flu this season compared to prior years.

    However, the United States is in an unfortunate position compared to many other countries. COVID-19 cases continue to spread in several states. Flu season is also coinciding with the opening of in-person classes at schools and universities.

    Flu season overlapping with the COVID-19 pandemic will pose diagnostic challenges for family physicians, especially if we don't have access to timely COVID-19 diagnostic tests. Turnaround times for molecular tests are still a week or even longer in some parts of the country. Neither the rapid influenza test nor the rapid COVID-19 antigen test is readily available in many doctor's offices. With this uncertainty, we can expect many more requests from patients asking for prescription antiviral medications, which are indicated for the flu only in limited circumstances.

    The other major challenge with the flu and COVID-19 coinciding is that even a moderate number of flu cases threatens to strain our health care resources, whether through increased ER visits, greater hospital utilization or diminished ICU capacity.

    There is one important, simple step we can take as family physicians: Encourage all of our patients to get vaccinated. The influenza vaccine can help prevent the flu as well as lessen the severity of illness, but only 45% of Americans get vaccinated against the illness. Family physician offices around the country, including mine, are preparing to meet the (hopefully) increased demand for the flu vaccine.

    The CDC's Advisory Committee on Immunization Practices recently released updated recommendations, for this flu season, which the AAFP agrees with. Even those with egg allergies should receive any licensed flu vaccine.

    Flu strains vary from year to year. This season's quadrivalent egg-based vaccine will include two influenza A and two influenza B components (the trivalent vaccines will contain only one influenza B component). The trivalent vaccine components are influenza A/Guangdong-Maonan (H1N1), influenza A/Hong Kong (H3N2) and influenza B/Washington (updated from last year). The additional quadrivalent component is influenza B/Phuket, which is the same as last year. The influenza A components of the cell culture-based and recombinant vaccines are also updated this year.

    As for my patient Ashley, I let her know she can walk into our office without an appointment to get the flu vaccine. And I told her to encourage her friends to get vaccinated as well.

    Natasha Bhuyan, M.D., is a board-certified family physician in Phoenix. You can follow her on Twitter @NatashaBhuyan.


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