The flu shot provided “substantial protection” for all age groups, including elderly and immunocompromised populations, during this influenza season, the Center for Disease Control reported Wednesday.
The Advisory Committee on Immunization Practices presented new findings that showed people who received the influenza vaccination were well protected from “inpatient, emergency department, and outpatient illness among all ages” in the 2022-2023 season.
It also reduced the chance of hospitalization from Influenza A — the virus that causes flu pandemics — in children by nearly three-quarters, and in adults by nearly half, the CDC said in a press release.
“These data underscore that flu vaccination can offer substantial benefit against flu and its potentially serious complications,” the agency said.
One of the referenced studies in the presentation determined that the influenza vaccine was 45% effective among children against the predominant virus. In comparison, during previous seasons, this rate has been about 30%, the CDC wrote.
Additionally, vaccinated children were 68% less likely to be hospitalized, and 48% less likely to visit an emergency department due to a flu or flu-related sickness, the CDC found.
In a similar trend, adults overall were 44% less likely to visit an emergency department and 39% less likely to be hospitalized for a flu-related illness or complication. In comparison, adults were just 25% less likely to be hospitalized or visit emergency departments and urgent cares during the 2021-2022 season with the last vaccine.
Researchers emphasized the effectiveness of the vaccine among people above 65 years of age and the immunocompromised population, two groups that are more likely to get a more severe illness from the flu and less likely to have an immune response to the vaccine.
The 2022-2023 flu virus peaked in November and early December, when the percent of positive tests hit about 26%. The percent of positive cases is now at approximately 1.7%. Influenza-related hospitalizations have also leveled.
While the number of flu patients has gone down, the CDC noted that this season’s influenza activity was higher and more damaging than it was in the previous two seasons. In fact, there were 111 influenza-associated deaths among children.
Feb. 2, 2023 – It’s easy these days to take an at-home COVID test when you have symptoms like a fever and sore throat. But when the test is negative, the next step toward diagnosis usually means leaving the comforts of home.
But that could soon change. The FDA says it is confident that at-home rapid tests like those for COVID-19 are forthcoming for the flu and respiratory syncytial virus, or RSV.
The division of the National Institutes of Health that helped create rapid COVID tests confirmed it is partnering with developers on combination tests that can look for multiple respiratory illnesses.
Combination tests that can look for the markers of more than one disease are called multi-analyte. Europe and Australia already have over-the-counter tests that look for flu and RSV along with COVID-19.
“We will be authorizing at-home flu and/or RSV tests that are multi-analyte with COVID,” an FDA official told WebMD. “I can’t tell you exactly when that would happen, but we are eager to do that.”
Making such an at-home test possible would be in line with the FDA’s goals to expand health care equity and affordability, the official said.
Right now, the process for developing and applying for FDA approval of combination tests is less complicated and expensive for developers under special pandemic rules. Developers get extensive assistance from the National Institute of Biomedical Imaging and Bioengineering at the NIH, particularly in the area of validation studies.
The institute has already helped develop combination tests that can be used in health care settings, says its director, Bruce Tromberg, PhD.
“A couple of those have form factors that look like they should be fully at-home and over-the-counter,” he says “I’m optimistic that these will ultimately meet the performance bars that the FDA has.”
Tromberg calls the current environment for at-home testing a “paradigm shift.” His institute estimates that more than 6.5 billion COVID tests that his organization helped create have been produced.
“We’re actually going to probably stop counting, the numbers are just so big,” he says of the now universal COVID test.
From Test Tubes to Disposable Ubiquity
With millions or even billions of COVID tests used, home testing is now commonplace in American life.
“The public’s expectations for medical testing are clearly being shaped differently due to the convenience, privacy, and speed of obtaining these results at home, which is a good thing,” Shannon Haymond, PhD, president of the American Association for Clinical Chemistry, wrote in an email. She is also the director of clinical mass spectrometry at the Ann & Robert H. Lurie Children’s Hospital of Chicago and an associate professor of pathology at Northwestern University Feinberg School of Medicine.
With pandemic culture propelling demand for at-home testing, many are recalling the 1970s era known as the sexual revolution, which centered on women’s autonomy over their own bodies. During that time, pregnancy testing moved from the clinical setting to the privacy of women’s homes.
“I really liked the term from, I think it was an EPT ad, from the ’70s that it was ‘a private little revolution,’” says historian Sarah Leavitt, PhD, a former historian at the NIH whose pregnancy test timeline, “The Thin Blue Line,” is one of the NIH’s most popular historical publications. “It brings the pregnancy test into your own private sphere, you have power over it again, and it’s your story and your body, and you can tell people when you want to.”
Fifty years ago, the thin blue line wasn’t a 15-minute wait, which is about the time it takes these days to see the result of a pregnancy test or COVID test.
“One big difference is that, when the first at-home pregnancy test hit the market in the 1970s, testing technology was a lot less advanced than it is today,” explained Haymond. “This means that the first home pregnancy test was very complicated to perform – it involved 10 steps and equipment like test tubes, and users had to keep the test tubes in a place free from vibrations for two hours. The easy-to-use stick tests that we’re familiar with today weren’t developed until 1988.”
Both at-home COVID and pregnancy tests drew early concern from the medical community regarding test accuracy and potential for user error.
“In retrospect, these concerns might seem overly cautious, but this push-pull between innovation and caution is integral to ensuring that medical advancements are made with patient safety foremost in mind,” Haymond said.
The best approach is one that leverages the benefits of home testing with the expertise available from health care providers, who can advise when to test, how to interpret results, and determine if any extra medical care is needed, she said.
The Future of At-Home Diagnostics
Television can be a mirror for how science finds its place in our culture, Leavitt says.
“I was trying to envision when COVID tests will show up as a cultural marker in television shows,” she says, noting that beyond pregnancy tests, HIV tests and paternity tests have found their way into plots. “I don’t know what the plot point would be – maybe the test that’s found in the garbage and whose test was it?”
By the time COVID tests show up in television, the pace of technology may have already brought a new forefront for at-home testing. Haymond foresees artificial intelligence on the horizon for at-home diagnostics.
“Of course, like almost all areas of healthcare, we in laboratory medicine are anticipating data analytics as another major area of innovation and transformation,” she said. “This involves using technology such as artificial intelligence to find patterns and trends in healthcare datasets, and then using these findings to identify vulnerable patients before they become ill, better personalize testing and treatments, and augment human workflows in clinical testing and result interpretation.”
In the more near-term, Tromberg at the National Institute of Biomedical Imaging and Bioengineering can envision a program that would help people in rural areas – sometimes called “health care deserts” – test at home and then easily be connected to care. The institute is already helping pilot such a program involving at-home COVID testing and connection to treatment in Pennsylvania. He could see a program like that easily using at-home flu and RSV tests.
“People clearly would like to test at home if they could,” Tromberg says. “It’s not such a stretch, given that many people are already having telemedicine visits anyway.”
Dec. 12, 2022 – The number of Americans hospitalized because of the flu has hit the highest levels the country has seen in at least a decade, the CDC said Friday.
But the number of deaths and outpatient visits for flu or flu-like illnesses was down slightly from the week before, the CDC said in its weekly FluView report.
There were almost 26,000 new hospital admissions involving laboratory-confirmed influenza over those 7 days, up by over 31% from the previous week, based on data from 5,000 hospitals in the HHS Protect system, which tracks and shares COVID-19 data.
The cumulative hospitalization rate for the 2022-23 season is 26.0 per 100,000 people, the highest seen at this time of year since 2010-11, the CDC said, based on data from its Influenza Hospitalization Surveillance Network, which includes hospitals in select counties in 13 states.
At this point in the 2019-20 season, just before the COVID-19 pandemic began, the cumulative rate was 3.1 per 100,000 people, the CDC’s data shows.
On the positive side, the proportion of outpatient visits for influenza-like illness dropped slightly to 7.2%, from 7.5% the week before. But these cases from the CDC’s Outpatient Influenza-like Illness Surveillance Network are not laboratory-confirmed, so the data could include people with the flu, COVID-19, or respiratory syncytial virus (RSV).
The number of confirmed flu deaths for the week of Nov. 27 to Dec. 3 also fell slightly from the last full week of November, 246 vs. 255, but the number of pediatric deaths rose from two to seven, and total deaths in children are already up to 21 for 2022-23. That’s compared to 44 that were reported during all of the 2021-22 season, the CDC said.
“So far this season, there have been at least 13 million illnesses, 120,000 hospitalizations, and 7,300 deaths from flu,” the agency estimated.
The dire shortage of pediatric hospital beds plaguing the nation this fall is a byproduct of financial decisions made by hospitals over the past decade, as they shuttered children’s wards, which often operate in the red, and expanded the number of beds available for more profitable endeavors like joint replacements and cancer care.
To cope with the flood of young patients sickened by a sweeping convergence of nasty bugs — especially respiratory syncytial virus, influenza, and coronavirus — medical centers nationwide have deployed triage tents, delayed elective surgeries, and transferred critically ill children out of state.
A major factor in the bed shortage is a years-long trend among hospitals of eliminating pediatric units, which tend to be less profitable than adult units, said Mark Wietecha, CEO of the Children’s Hospital Association. Hospitals optimize revenue by striving to keep their beds 100% full — and filled with patients whose conditions command generous insurance reimbursements.
“It really has to do with dollars,” said Dr. Scott Krugman, vice chair of pediatrics at the Herman and Walter Samuelson Children’s Hospital at Sinai in Baltimore. “Hospitals rely on high-volume, high-reimbursement procedures from good payers to make money. There’s no incentive for hospitals to provide money-losing services.”
The number of pediatric inpatient units in hospitals fell 19% from 2008 to 2018, according to a study published in 2021 in the journal Pediatrics. Just this year, hospitals have closed pediatric units in Boston and Springfield, Massachusetts; Richmond, Virginia; and Tulsa, Oklahoma.
The current surge in dangerous respiratory illnesses among children is yet another example of how covid-19 has upended the health care system. The lockdowns and isolation that marked the first years of the pandemic left kids largely unexposed — and still vulnerable — to viruses other than covid for two winters, and doctors are now essentially treating multiple years’ worth of respiratory ailments.
The pandemic also accelerated changes in the health care industry that have left many communities with fewer hospital beds available for children who are acutely ill, along with fewer doctors and nurses to care for them.
When intensive care units were flooded with older covid patients in 2020, some hospitals began using children’s beds to treat adults. Many of those pediatric beds haven’t been restored, said Dr. Daniel Rauch, chair of the American Academy of Pediatrics’ committee on hospital care.
In addition, the relentless pace of the pandemic has spurred more than 230,000 health care providers — including doctors, nurses, and physician assistants — to quit. Before the pandemic, about 10% of nurses left their jobs every year; the rate has risen to about 20%, Wietecha said. He estimates that pediatric hospitals are unable to maintain as many as 10% of their beds because of staffing shortages.
“There is just not enough space for all the kids who need beds,” said Dr. Megan Ranney, who works in several emergency departments in Providence, Rhode Island, including Hasbro Children’s Hospital. The number of children seeking emergency care in recent weeks was 25% higher than the hospital’s previous record.
“We have doctors who are cleaning beds so we can get children into them faster,” said Ranney, a deputy dean at Brown University’s School of Public Health.
There’s not great money in treating kids. About 40% of U.S. children are covered by Medicaid, a joint federal-state program for low-income patients and people with disabilities. Base Medicaid rates are typically more than 20% below those paid by Medicare, the government insurance program for older adults, and are even lower when compared with private insurance. While specialty care for a range of common adult procedures, from knee and hip replacements to heart surgeries and cancer treatments, generates major profits for medical centers, hospitals complain they typically lose money on inpatient pediatric care.
When Tufts Children’s Hospital closed 41 pediatric beds this summer, hospital officials assured residents that young patients could receive care at nearby Boston Children’s Hospital. Now, Boston Children’s is delaying some elective surgeries to make room for kids who are acutely ill.
Rauch noted that children’s hospitals, which specialize in treating rare and serious conditions such as pediatric cancer, cystic fibrosis, and heart defects, simply aren’t designed to handle this season’s crush of kids acutely ill with respiratory bugs.
Even before the autumn’s viral trifecta, pediatric units were straining to absorb rising numbers of young people in acute mental distress. Stories abound of children in mental crises being marooned for weeks in emergency departments while awaiting transfer to a pediatric psychiatric unit. On a good day, Ranney said, 20% of pediatric emergency room beds at Hasbro Children’s Hospital are occupied by children experiencing mental health issues.
In hopes of adding pediatric capacity, the American Academy of Pediatrics joined the Children’s Hospital Association last month in calling on the White House to declare a national emergency due to child respiratory infections and provide additional resources to help cover the costs of care. The Biden administration has said that the flexibility hospital systems and providers have been given during the pandemic to sidestep certain staffing requirements also applies to RSV and flu.
Doernbecher Children’s Hospital at Oregon Health & Science University has shifted to “crisis standards of care,” enabling intensive care nurses to treat more patients than they’re usually assigned. Hospitals in Atlanta, Pittsburgh, and Aurora, Colorado, meanwhile, have resorted to treating young patients in overflow tents in parking lots.
Dr. Alex Kon, a pediatric critical care physician at Community Medical Center in Missoula, Montana, said providers there have made plans to care for older kids in the adult intensive care unit, and to divert ambulances to other facilities when necessary. With only three pediatric ICUs in the state, that means young patients may be flown as far as Seattle or Spokane, Washington, or Idaho.
A young child with RSV is treated at the Community Medical Center in Missoula, Montana.
Community Medical Center
Hollis Lillard took her 1-year-old son, Calder, to an Army hospital in Northern Virginia last month after he experienced several days of fever, coughing, and labored breathing. They spent seven anguished hours in the emergency room before the hospital found an open bed and transferred them by ambulance to Walter Reed National Military Medical Center in Maryland.
With proper therapy and instructions for home care, Calder’s virus was readily treatable: He recovered after he was given oxygen and treated with steroids, which fight inflammation, and albuterol, which counteracts bronchospasms. He was discharged the next day.
Although hospitalizations for RSV are falling, rates remain well above the norm for this time of year. And hospitals may not get much relief.
People can be infected with RSV more than once a year, and Krugman worries about a resurgence in the months to come. Because of the coronavirus, which competes with other viruses, “the usual seasonal pattern of viruses has gone out the window,” he said.
Like RSV, influenza arrived early this season. Both viruses usually peak around January. Three strains of flu are circulating and have caused an estimated 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths, according to the Centers for Disease Control and Prevention.
Krugman doubts the health care industry will learn any quick lessons from the current crisis. “Unless there is a radical change in how we pay for pediatric hospital care,” Krugman said, “the bed shortage is only going to get worse.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
Dec. 2, 2022 – The flu virus made the most of the Thanksgiving holiday by reaching the highest level of national activity seen since the 2017-18 influenza season, according to the CDC.
The biggest 1-week increase in what is becoming an unprecedented flu season had flu-like activity at 7.5% for the week of Nov. 20-26, as measured by the proportion of outpatient visits reported to the CDC that involved respiratory illness, which may also include respiratory syncytial virus (RSV) and COVID-19.
That 7.5% is the highest level of flu-like activity recorded in the United States since early February 2018, at the peak of the 2017-18 flu season, and the highest rate recorded in November since the CDC began tracking such data in 1997. Flu-like activity reached 7.7% in October of 2009 but then dropped below 7% by the first week of November and did not rise again for the rest of that season, the CDC’s data shows.
There are more signs of a worse flu or flu-like season this year.. The total hospitalization rate for confirmed cases of flu, 16.6 per 100,000 people, is higher than the rate seen at this point in the season during any season since 2010-2011, the CDC said.
The high rate of hospitalizations from Nov. 20-26 is nearly double the the previous week’s numbers, the CDC noted in its weekly Fluview report.
So far this season, the CDC estimates, “there have been at least 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths from flu.” In 2018-19, the last full influenza season before COVID, there were 148 deaths through the first 8 weeks, based on CDC data.
Flu-like activity at the state and territory levels, which the CDC categorizes on a scale range from 1-13 – from minimal (1-3) to very high (11-13) – puts 31 states at very high for the week, compared with 19 the week before. Only New Hampshire and the Northern Mariana Islands are in the minimal range, according to the CDC.
Nov. 29, 2022 – Reports of respiratory illness continued to rise as the 2022-23 flu season maintained its early surge through mid-November, according to the CDC.
Nationally, 6% of all outpatient visits were because of flu or flu-like illness for the week of Nov. 13-19, up from 5.8% the previous week, the CDC’s Influenza Division said in its weekly FluView report.
Those figures are the highest recorded in November since 2009, but the peak of the 2009-10 flu season occurred even earlier – the week of Oct. 18-24 – and the rate of flu-like illness had already dropped to just over 4.0% by Nov. 15-21 that year and continued to drop thereafter.
Although COVID-19 and respiratory syncytial virus (RSV) are included in the data from the CDC’s Outpatient Influenza-like Illness Surveillance Network, the agency did note that “seasonal influenza activity is elevated across the country” and estimated that “there have been at least 6.2 million illnesses, 53,000 hospitalizations, and 2,900 deaths from flu” during the 2022-23 season.
Total flu deaths include 11 reported in children as of Nov. 19, and children ages 0-4 had a higher proportion of visits for flu like-illness than other age groups.
The agency also said the cumulative hospitalization rate of 11.3 per 100,000 population “is higher than the rate observed in [the corresponding week of] every previous season since 2010-2011.” Adults 65 years and older have the highest cumulative rate, 25.9 per 100,000, for this year, compared with 20.7 for children 0-4; 11.1 for adults 50-64; 10.3 for children 5-17; and 5.6 for adults 18-49 years old, the CDC said.
The U.S. is facing a “tripledemic” with cases of the flu, COVID-19 and respiratory syncytial virus (RSV) rising simultaneously as winter approaches.
Increasing cases of the three viruses are causing a record number of parents to miss days of work in order to take care of their sick children, data from the Bureau of Labor Statistics shows.
Last month, 104,000 workers didn’t show up because they had child care issues, according to the data.
“We’ve seen a big spike in RSV, in flu, COVID has yet to really hit this season. And a lot of kids are getting really sick,” Dr. Celine Gounder told CBS News.
Parents with sick kids at home must then figure out how to take care of them.
“If you can’t send your child to school, a lot of parents are stuck having to stay home with their child and that really takes a hit on people’s pocketbooks,” Dr. Gounder added.
Employees who have to physically show up for work as well as those whose employers don’t provide paid sick leave suffer the most. Numbers of parents taking time off from work to care for sick children are only expected to increase as flu season intensifies and winter weather rolls in, public health officials say.
“We’re getting sicker”
Parents with no other options may end up sending their children to child care even with they’re sick. “This is very common and unfortunately what it does is it promotes more spread of the virus in the community,” Dr. Gounder said. “We’re all getting sicker.”
Her advice to parents and children?
“If you’re sick, stay home if you can afford to. That’s definitely one of the most important things. If somebody else in your child’s play group, for example, is sick, you might want to be cancelling some of those play dates,” she said.
The pandemic has also introduced a new tool for preventing the spread of illnesses: face masks.
“I think we would benefit [from wearing them.] Whether people are willing to do it, I don’t know,” Dr. Gounder said.
And everyone who is eligible should get vaccinated against the flu and COVID-19, she added.
“That’s a really good solution to prevent some of these [illnesses], is to get your kid vaccinated for the flu, for COVID. You can at least prevent those two if not RSV,” Dr. Gounder said.
As hospitals and emergency rooms fill up amid a surge of flu cases, doctors are warning people to get vaccinated for that and COVID-19, especially ahead of the holiday season. The flu is already hitting hard, with 22 states and Washington, D.C., reporting high levels of activity, according to the Centers for Disease Control and Prevention.
The CDC also said the hospitalization rate for flu is at the highest for this early in the season in a decade.
Dr. Daniel Guzman, of Cook Children’s Medical Center in Fort Worth, said the one-two punch of RSV — a respiratory illness common in children — and flu cases has filled up his emergency room. He added that the rate of cases in the hospital nearly doubled in the last week from 172 to almost 338 flu patients.
It’s why doctors are urging people to get vaccinated. Andrew Talbot, a Massachusetts teacher, said he got his COVID-19 booster before he travels to see his immunocompromised mother for the holidays.
“I’m aware of the fact that there is, you know, COVID that comes and goes in waves,” he told CBS News. “And especially with her being on immunosuppression drugs, I didn’t want to risk bringing anything home.”
But, only 10% of people age 5 and older have received the updated COVID-19 vaccine and just 21% of adults say they’ve been vaccinated against the flu, according to the CDC.
“You’re protecting your entire bubble of your family members,” Guzman said about getting vaccinated. “You know, those that are really old to those that are really young. And so it’s really important that we do as much as we can to help protect them.”
To stay safe this holiday season, experts advise to get vaccinated, consider a “mini-quarantine” the week before traveling, testing before gathering and staying home if you feel sick.
“Never too late to get a flu shot,” Guzman said. “I think we have to stress it’s an important thing to help protect yourself as well as everyone around you, that everyone goes out and get a flu shot.”
Sometime in the spring of 2020, after centuries, perhaps millennia, of tumultuous coexistence with humans, influenza abruptly went dark. Around the globe, documented cases of the viral infection completely cratered as the world tried to counteract SARS-CoV-2. This time last year, American experts began to fret that the flu’s unprecedented sabbatical was too bizarre to last: Perhaps the group of viruses that cause the disease would be poised for an epic comeback, slamming us with “a little more punch” than usual, Richard Webby, an influenza expert at St. Jude Children’s Research Hospital, in Tennessee, told me at the time.
But those fears did not not come to pass. Flu’s winter 2021 season in the Southern Hemisphere was once again eerily silent; in the north, cases sneaked up in December—only to peter out before a lackluster reprise in the spring.
Now, as the weather once again chills in this hemisphere and the winter holidays loom, experts are nervously looking ahead. After skipping two seasons in the Southern Hemisphere, flu spent 2022 hopping across the planet’s lower half with more fervor than it’s had since the COVID crisis began. And of the three years of the pandemic that have played out so far, this one is previewing the strongest signs yet of a rough flu season ahead.
It’s still very possible that the flu will fizzle into mildness for the third year in a row, making experts’ gloomier suspicions welcomingly wrong. Then again, this year is, virologically, nothing like the last. Australia recently wrapped an unusually early and “very significant” season with flu viruses, says Kanta Subbarao, the director of the WHO Collaborating Centre for Reference and Research on Influenza at the Doherty Institute. By sheer confirmed case counts, this season was one of the country’s worst in several years. In South Africa, “it’s been a very typical flu season” by pre-pandemic standards, which is still enough to be of note, according to Cheryl Cohen, a co-head of the country’s Centre for Respiratory Disease and Meningitis at the National Institute for Communicable Diseases. After a long, long hiatus, Subbarao told me, flu in the Southern Hemisphere “is certainly back.”
That does not bode terribly well for those of us up north. The same viruses that seed outbreaks in the south tend to be the ones that sprout epidemics here as the seasons do their annual flip. “I take the south as an indicator,” says Seema Lakdawala, a flu-transmission expert at Emory University. And should flu return here, too, with a vengeance, it will collide with a population that hasn’t seen its likes in years, and is already trying to marshal responses to severaldangerous pathogens at once.
The worst-case scenario won’t necessarily pan out. What goes on below the equator is never a perfect predictor for what will occur above it: Even during peacetime, “we’re pretty bad in terms of predicting what a flu season is going to look like,” Webby, of St. Jude, told me. COVID, and the world’s responses to it, have put experts’ few forecasting tools further on the fritz. But the south’s experiences can still be telling. In South Africa and Australia, for instance, many COVID-mitigation measures, such as universal masking recommendations and post-travel quarantines, lifted as winter arrived, allowing a glut of respiratory viruses to percolate through the population. The flu flood also began after two essentially flu-less years—which is a good thing at face value, but also represents many months of missed opportunities to refresh people’s anti-flu defenses, leaving them more vulnerable at the season’s start.
Some of the same factors are working against those of us north of the equator, perhaps to an even greater degree. Here, too, the population is starting at a lower defensive baseline against flu—especially young children, many of whom have never tussled with the viruses. It’s “very, very likely” that kids may end up disproportionately hit, Webby said, as they appear to have been in Australia—though Subbarao notes that this trend may have been driven by more cautious behaviors among older populations, skewing illness younger.
Interest in inoculations has also dropped during the pandemic: After more than a year of calls for booster after booster, “people have a lot of fatigue,” says Helen Chu, a physician and flu expert at the University of Washington, and that exhaustion may be driving already low interest in flu shots even further down. (During good years, flu-shot uptake in the U.S. peaks around 50 percent.) And the few protections against viruses that were still in place last winter have now almost entirely vanished. In particular, schools—a fixture of flu transmission—have loosened up enormously since last year. There’s also just “much more flu around,” all over the global map, Webby said. With international travel back in full swing, the viruses will get that many more chances to hopscotch across borders and ignite an outbreak. And should such an epidemic emerge, with its health infrastructure already under strain from simultaneous outbreaks of COVID, monkeypox, and polio, America may not handle another addition well. “Overall,” Chu told me, “we are not well prepared.”
At the same time, though, countries around the world have taken such different approaches to COVID mitigation that the pandemic may have further uncoupled their flu-season fate. Australia’s experience with the flu, for instance, started, peaked, and ended early this year; the new arrival of more relaxed travel policies likely played a role in the outbreak’s beginning, before a mid-year BA.5 surge potentially hastened the sudden drop. It’s also very unclear whether the U.S. may be better or worse off because its last flu season was wimpy, weirdly shaped, and unusually late. South Africa saw an atypical summer bump in flu activity as well; those infections may have left behind a fresh dusting of immunity and blunted the severity of the following season, Cohen told me. But it’s always hard to tell. “I was quite strong in saying that I really believed that South Africa was going to have a severe season,” she said. “And it seems that I was wrong.” The long summer tail of the Northern Hemisphere’s most recent flu season could also exacerbate the intensity of the coming winter season, says John McCauley, the director of the Worldwide Influenza Centre at the Francis Crick Institute, in London. Kept going in their off-season, the viruses may have an easier vantage point from which to reemerge this winter.
COVID’s crush has shifted flu dynamics on the whole as well. The pandemic “squeezed out” a lot of diversity from the influenza-virus population, Webby told me; some lineages may have even entirely blipped out. But others could also still be stewing and mutating, potentially in animals or unmonitored pockets of the world. That these strains—which harbor especially large pandemic potential—could emerge into the general population is “my bigger concern,” Lakdawala, of Emory, told me. And although the particular strains of flu that are circulating most avidly seem reasonably well matched to this year’s vaccines, the dominant strains that attack the north could yet shift, says Florian Krammer, a flu virologist at Mount Sinai’s Icahn School of Medicine. Viruses also tend to wobble and hop when they return from long vacations; it may take a season or two before the flu finds its usual rhythm.
Another epic SARS-CoV-2 variant could also quash a would-be influenza peak. Flu cases rose at the end of 2021, and the dreaded “twindemic” loomed. But then, Omicron hit—and flu “basically disappeared for one and a half months,” Krammer told me, only tiptoeing back onto the scene after COVID cases dropped. Some experts suspect that the immune system may have played a role in this tag-team act: Although co-infections or sequential infections of SARS-CoV-2 and flu viruses are possible, the aggressive spread of a new coronavirus variant may have set people’s defenses on high alert, making it that much harder for another pathogen to gain a foothold.
No matter the odds we enter flu season with, human behavior can still alter winter’s course. One of the main reasons that flu viruses have been so absent the past few years is because mitigation measures have kept them at bay. “People understand transmission more than they ever did before,” Lakdawala told me. Subbarao thinks COVID wisdom is what helped keep Australian flu deaths down, despite the gargantuan swell in cases: Older people took note of the actions that thwarted the coronavirus and applied those same lessons to flu. Perhaps populations across the Northern Hemisphere will act in similar ways. “I would hope that we’ve actually learned how to deal with infectious disease more seriously,” McCauley told me.
But Webby isn’t sure that he’s optimistic. “People have had enough hearing about viruses in general,” he told me. Flu, unfortunately, does not feel similarly about us.
