Boston beginning to see flu cases rise

BOSTON -- Just a couple of weeks into autumn and already it is upon us.

“What we’re seeing right now, at least in Boston, pediatric influenza seems to be up,” said Paul Sax, MD, Clinical Director of the Division of Infectious Diseases at Brigham and Women’s Hospital. “So far, in adults, we haven’t seen that yet. But usually what happens in children is followed by what happens in adults.”

While Sax said it is impossible to predict the severity of a flu season, it’s hard to see how this year won’t be worse than the last two.

“Two years ago in the winter, we had a very bad COVID surge, so a lot of people were just completely isolating and we barely saw any respiratory virus infections,” Sax said.

Then, last year, flu largely got squeezed out of the picture by the Omicron variant, which infected millions beginning in late November.

What both those winters had in common -- besides COVID -- were COVID precautions. Mask mandates and, to a lesser extent, social distancing protocols, were still in place.

This year, precautions are out the window. And that’s led to fears this could be a memorable flu season -- and not in a good way. And then there’s the data from down under, where flu season is wrapping up.

“There’ve been several years where a bad flu season in the Southern Hemisphere, particularly Australia, has portended a bad flu season in the Northern Hemisphere and in the United States,” Sax said.

And the Australian Department of Health and Aged Care report it’s been a pretty bad flu season, so far, with some 225,000 lab-confirmed cases of influenza and more than 300 deaths. That’s compared with 550 cases and no deaths last year. Flu cases and deaths in 2020, the first year of the pandemic, came in 90% lower than they are now.

Of course, Australia’s case and death numbers the last two years were heavily influenced by the COVID precautions that had been in place. In 2019, months before COVID began its worldwide spread, the country recorded nearly 300,000 flu cases.

If Australia’s experience becomes ours this flu season, one of the best strategies to keep from getting sick is to get a flu shot -- flawed as those vaccines may be, Sax said.

“It’s hard to recommend something that you acknowledge is not a great vaccine,” Sax said. “In a good year, it’s about 40 to 50 percent protective. In a not-so-good year it’s about 10 to 20 percent effective. There is some evidence, though, that even if you do get a breakthrough case of influenza, if you had the flu vaccine it makes the flu less severe.”

Sax said it’s perfectly okay to get a COVID booster and the flu vaccine at the same time -- if you don’t mind dealing with two sore arms at once.

He also recommends, with all the potentially infectious agents circulating during flu season, it’s important not to assume a diagnosis.

“Certainly the symptoms of COVID and the common cold overlap tremendously,” Sax said. “One of the most common things we hear from patients is, it can’t be Covid. It feels just like a cold.”

That feeling might get reinforced if testing turns up negative for SARS-CoV-2 -- as it sometimes does in the first days of an infection. Regardless, Sax said if you feel sick, you should stay home.

“We have to stop what is commonly called presenteeism,” he said. “Which is showing up at work, going to school with respiratory viral infections. You don’t want to spread these respiratory viruses around. They’re annoying, they’re disruptive -- and in some very rare cases, they’re severe.”

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