Get your Flu Shot
MEDICAL AND MENTAL HEALTH UPDATE
Fall is my favorite season. Since I was a kid, I’ve always loved the crisp air, warm colors, and earthy aromas of autumn. Maybe it’s also that my birthday is in October. Or that I love the color orange. And candy corn. Who the hell knows.
Regardless, just as autumn beckons us to mass-purchase oversized bags of Halloween candy at CVS, it also signals the start of flu season.
Because so many of my patients are inquiring about the flu and how it relates to COVID-19, today I present you with a Q & A all about the flu.
Q: What exactly is the flu?
A: The flu is a respiratory illness caused by a virus called Influenza. Every year we get a few new strains in circulation. Similar to coronavirus, the influenza virus typically causes symptoms like cough, sore throat, fever, body aches, headache, and fatigue. It can also cause pneumonia and other more severe symptoms—and can be fatal.
Q: When does flu season officially start?
A: In the U.S., the annual flu season generally starts in October and lasts till early spring, with a big uptick in December, depending on the part of the country.
Q: How many people die from the flu every year?
A: The CDC estimates that, depending on the season, approximately 12,000-60,000 people die from influenza every year in the U.S.
Q: What factors impact mortality from year to year?
A: Three major things affect how deadly the flu will be each year: 1) virulence of the dominant strain of the influenza virus, e.g. how sick is it making people, 2) the effectiveness of the vaccine that year, and 3) vaccine “uptake,” e.g. what proportion of the population actually takes the vaccine.
Q: How effective is the flu shot?
A: The effectiveness of the flu vaccine varies from 20-60% depending on the year. But it’s important to know that even when vaccine effectiveness is low, it can have a major impact on morbidity and mortality. For example, despite a mere 29% effectiveness of the flu vaccine in the 2018-2019 flu season, the CDC estimates that the vaccine prevented 3500 deaths. That’s a lot of lives saved!
Q: Is it possible for people to get COVID and the flu together? And if so, how bad will that be?
A: Yes, it is possible, and it has happened. Cases of co-infection in the U.S. and overseas already have been observed. But we don’t have enough data to know exactly if and how much sicker patients will get if infected with both viruses. It stands to reason, however, that infection with flu and coronavirus together would lead to worse clinical outcomes than either alone.
Q: How will doctors be able to tell the difference between COVID-19 and the flu?
A: Great question. Since both viruses present in similar ways—with cough, fever, body aches, etc—having good diagnostic testing for both viruses will be CRUCIAL. Right now we have great PCR (nasal swab) testing for the flu, but as you well know, testing for coronavirus is sorely inadequate.
Q: How important is getting a flu vaccine this year?
A: Very. Both coronavirus and flu cause significant morbidity and mortality. And outbreaks of both could quickly overwhelm the healthcare system. The vaccine is our most powerful tool against the flu. Every year our goal should be increased vaccine uptake, but this year it is especially critical to get your flu shot.
Q: Are flu and COVID-19 spread in the same or different ways?
A: Both viruses are predominantly spread by respiratory droplets. Therefore some of the interventions we’ve employed to decrease the spread of COVID have also decreased the spread of flu. For example, at the end of flu season this spring, there was a dramatic drop-off in the number of cases of flu which is likely attributable to the handwashing, social distancing, and masks people were wearing back in March/April. Let’s hope that ongoing MOSH PIT measures will help mitigate the damage from the flu this season and beyond. And maybe in the future we’ll be able to bring down the annual death rate from the flu. Why do we tolerate up to 60,000 deaths every year when we have simple behavioral interventions that we know work well to mitigate risk? (This question of how much death we are willing to “accept” due to preventable illness is a philosophical/ethical/societal question I’d love to explore further another time.)
Q: Are the same people at highest risk for COVID-19 also at highest risk for flu?
A: Generally yes. Advanced age, underlying conditions like heart, lung, and kidney disease, immune deficiencies, and obesity, for example, put people at higher risk from both viruses. But, unlike the flu, coronavirus seems to spare young children. Children under the age of 5—and particularly under the age of 2—are considered in the highest risk categories for flu.
Q: When should people get the flu shot?
A: The short answer is: whenever you can. The more sophisticated answer is this: ideally two weeks before the virus starts circulating on our communities (which, as above, can be as early as October). Our bodies need two weeks after the flu shot to develop protective antibodies, so I generally recommend getting the flu shot in September or early October.
Q: Should I get two flu shots this year, one in fall and one in early 2021 as a booster?
A: Currently there is no recommendation from the CDC or other expert group on giving two flu vaccines this year, but this can be an individual discussion with your doctor. For now, the main focus should be getting one this fall!
Q: Are there medicines available to treat the flu? And is it treated differently than COVID-19?
A: Oseltamivir (aka “Tamiflu”) and the newer Baloxavir (aka “Xofluza”) are prescription antiviral medications that target influenza. They work by halting replication of the virus and work best when started early on in the course of infection. Sadly, these medications have no effect against coronavirus. The only antiviral medication available for COVID-19 is Remdesivir. It is given only intravenously and only to hospitalized patients—and still only has modest effects. What we desperately need is an oral antiviral medication for mild to moderate COVID-19 to prevent getting sicker, but we have yet to have anything like this approved.
Q: But do I still need a flu shot if a) I “never” get sick or b) I only got sick the one year I got the flu shot?
A: Yes. It’s important to understand that a) the flu shot not only protects you; it protects others as well, and b) the flu shot cannot cause the flu. The flu shot can indeed cause transient flu-like symptoms (muscle aches, low-grade fever) that signal your body getting ready for the real thing. But I promise you: the flu is a whole lot worse than the potential side effects from the flu shot!
Q: But why should I get the vaccine if it’s only 20-60% effective?
A: Because even if not 100% effective, the flu shot will blunt the effects of the virus, reduce your likelihood of infecting others, and saves lives.
Q: But, but, but….I don’t like shots. Waaaah!!
A: Every year I treat many unvaccinated patients for the flu. Without me saying a peep (e.g. to the tune of “next year you really should…..”), every one of them feels so sick that they swear never to skip the shot again! So consider getting it—not only to protect yourself but to help others. It’s our best weapon against the virus. And it’s something we can actually control in these uncertain times.
In other news, join me and Dr. Clay Ackerly at 8 pm TONIGHT on FACEBOOK LIVE! This is our 5th live “Q & A with Lucy and Clay” gig to bring you the latest news, information and practical guidance on COVID-19. Bring your questions!