Health officials are urging Americans to get their flu shots, warning the flu season that didn't materialize when most of society was shut down last year could come roaring back and strain hospitals in the months ahead.
Survey data released Thursday found slightly more than half of American adults plan to be vaccinated against influenza. That's not much of a change from pre-pandemic surveys conducted by the National Foundation for Infectious Diseases, but health authorities are alarmed because some evidence points to a potentially more severe flu season.
Experts say Americans have built up less natural immunity against influenza because so few were infected in 2020.
"This low flu activity was likely due to the widespread implementation of covid-19 preventive measures like masks, physical distancing and staying home," Centers for Disease Control and Prevention Director Rochelle Walensky said in a Thursday briefing announcing flu vaccination efforts.
"Because of so little disease last year, population immunity is likely lower, putting us all at risk of increased disease this year," she added.
The United States already saw a similar pattern with the spring and summer resurgence of common viruses including respiratory syncytial virus, known as RSV. Hospitals reported surprisingly high numbers of toddlers coming in with severe cases, likely because they were not exposed as infants in the early months of lockdown.
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Flu viruses may also roar back with more opportunities to spread this fall and winter in reopened schools, workplaces and businesses, especially where masks are not mandated. Hospitals already battling simultaneous pediatric spikes in covid-19 and respiratory syncytial virus fear oxygen and staffing will be stretched thin if flu and coronavirus admissions surge together in the months ahead.
The fears are especially acute after hospital systems, especially in the South, struggled to manage the summer wave of covid-19 admissions, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. She noted some hospitals, including in Florida and California, were running out of oxygen because of the heavy demand from covid-19 patients struggling to breathe.
Hospital leaders also fear burnout among doctors, nurses and respiratory therapists who have been on the front lines of the pandemic and have been growing frustrated as they confront coronavirus surges that robust vaccinations would have prevented.
"The same specialists who would care for covid patients are among those who would be caring for flu patients as well," Foster said last week. "We don't want those individuals to be so overworked they cannot appropriately care for you, regardless of what brought you into the hospital."
The Cedars-Sinai health care system in Southern California, which battled a devastating coronavirus surge in the winter but had zero flu cases, is among the hospitals urging people to get coronavirus vaccinations and flu shots to prevent spikes of both.
"It would be worst-case scenario," said Soniya Gandhi, an infectious disease physician and vice president for medical affairs. "There are several hospitals operating at full capacity. And that's now. So going into the winter, the best way to protect and preserve that hospital capacity is for individuals to be vaccinated as much as possible."
Flu seasons are notoriously difficult to predict.
While experts agree another nonexistent season is unlikely, other evidence suggests the upcoming one could be typical or milder than normal. Some experts say the remnants of coronavirus-containing measures, from school mask mandates to office reopenings delayed until next year, could block the virus from circulating as it would in a normal year.
"None of us can predict whether it will be mild, moderate or severe flu season, but we are certain that there will be flu activity," said William Schaffner, medical director of the National Foundation for Infectious Diseases. "We certainly don't want a 'twindemic,' both covid and influenza."
The Children's Hospital of Atlanta, one of many hospitals throughout the southeast reporting a spike in pediatric respiratory syncytial virus cases over the summer, is preparing for the possibility of a similar surge in pediatric flu cases after the Thanksgiving and Christmas holidays.
"One of the challenges we face is because we thankfully did not have a very active flu season last year, some parents feel flu is not a concern," said Andi Shane, the hospital's medical director of infectious disease. "I think it's important we understand what happened last year was great in the sense we didn't have a lot of transmission ... but we may have less immunity."