What to Expect This Flu Season
Hint: It’s already here.
By Catherine Roberts
For the past two years, the flu season has been unusually quiet.
During the 2020-2021 flu season, coinciding with the first full winter of the COVID-19 pandemic, many people were still wearing a mask, staying home, and canceling travel plans. Flu all but disappeared: There was so little flu that season that the Centers for Disease Control and Prevention didn’t even release an estimate of total cases. The following flu season, with some (though fewer) mitigation measures still in place, the flu circulated—with about 9 million cases—but that was still only about a quarter of the estimated number of cases in the 2019-2020 season, before COVID-19 hit.
This flu season, however, with COVID-19 measures largely abandoned in most settings, experts say our break from the flu is officially over. “One of the things that we should all expect is that we are going to have more flu than we had last year,” says Alicia Fry, MD, chief of the CDC’s Epidemiology and Prevention Branch.
And in some parts of the U.S., particularly the Southeast, flu season is already in full swing. The CDC estimates that 1.6 million people have already caught the flu so far, a sharp rise from the 880,000 case count estimated in the third week of October. Still, “it’s not unusual when flu season begins, particularly on a local level, for activity to increase pretty rapidly,” said Lynnette Brammer, MPH, who leads the CDC’s domestic flu surveillance team, in a news conference on Nov. 4.
Gathering Clues About This Flu Season
The flu is notoriously difficult to predict. Still, scientists often look to the Southern Hemisphere—where the flu season typically occurs between April and October—for clues about how it might play out in the Northern Hemisphere.
During the most recent flu season in Australia, for example, the number of cases was the highest it has been in the past five years. Its season began earlier than usual, peaked quickly, and then fizzled out early as well. The highest proportions of cases were in children. Still, the Australian government’s Department of Health and Aged Care said that because of the relatively small numbers of hospitalizations and deaths overall, it classified the season severity as low.
Fry notes that South Africa also had what looked like a typical flu season, while other countries like Chile and Peru had slightly unusual ones, with considerable flu activity during months that aren’t usually considered flu season.
It’s difficult to say what all of this will mean for the U.S. “We look at the Southern Hemisphere just hoping for a clue,” Fry says. “But it’s not a perfect predictor at all.”
Still, one aspect of the Southern Hemisphere’s flu season appears to be playing out in the U.S. already. Pedro A. Piedra, MD, a pediatric infectious disease specialist and professor in the department of molecular virology and microbiology at Baylor College of Medicine, notes that the dominant strain of influenza that circulates in the Southern Hemisphere often indicates what will circulate in the North, too. So far in the U.S., the influenza type A strain H3N2 has been most common, the same one that dominated in Australia and other Southern Hemisphere countries.
An H3N2 season generally means the flu could be especially severe for older people, Piedra says, because it “causes the greatest mortality in older adults compared to any other influenza strain.” Vaccine effectiveness against H3N2 also tends to be lower than for other strains of flu.
Plus, there are reasons to think this season could be particularly hard on children, too, as it was in Australia. In addition to being a problem for older adults, H3N2 can also be especially severe for young children. And with two years in a row of low flu activity, many of them have probably had less exposure to flu viruses. That means they could be more susceptible to the illness this year, Fry says. A few seasons without flu will affect adults less because they have many years of exposure under their belts, which taught their immune systems how to fight the virus.
Overall, it’s wise to be prepared for a difficult season, Piedra says. Flu cases have already spiked in some areas much earlier than in a typical flu season. “What we’re seeing definitely is an early flu season, and I expect that generally when things come early, they tend to come in hard,” Piedra says.
How to Prepare for Flu Season
Get a flu shot if you haven’t yet. “It’s the best tool we have to prevent flu,” Fry says. “It prevents outpatient illness; it can reduce the chance of getting hospitalized. If you do get sick with the flu, it can make your illness less severe.”
Almost everyone 6 months and older is eligible. The vaccine takes about two weeks to fully kick in, so the sooner you get your shot, the better. You should also get a flu shot even if you already caught an early case of flu to protect against the other strains of flu circulating.
Get your other vaccines, too. It’s possible to contract flu and COVID-19 or other respiratory viruses at the same time. And while there are no vaccines to protect against RSV and many of the viruses that cause colds, you should still be protected from as many of these illnesses as you can.
If you haven’t had your bivalent COVID-19 booster yet, get that as soon as possible. You can get it and the flu shot at the same time. And if you’re eligible for a pneumococcal vaccine, it’s wise to get that shot, too.
Employ other mitigation measures. As with COVID-19, masks can help protect against the flu. If you’re at higher risk or if you’re around people with risk factors that make them susceptible to severe disease, wearing a mask in higher-risk situations can reduce the likelihood of flu transmission. The same goes for avoiding large crowds or parties and staying home when you’re sick.
Know your treatment options. Home tests aren’t yet widely available for the flu the way they are for COVID-19. If you get sick, taking a rapid COVID-19 test (or series of tests, if the first is negative) is wise to rule out a case of COVID—or confirm one, so that you can get treated with antivirals if you’re eligible.
It’s important to note, though, that the CDC currently advises that doctors not wait for any test results (for COVID-19 or the flu) if they suspect that a person has the flu and he or she is at high risk for flu complications. The CDC has a full list of conditions that put you at high risk.
If you’re at high risk and develop flu-like symptoms, the agency says you should call a healthcare provider as soon as possible so you can receive antiviral medication like oseltamivir (Tamiflu and generic). These antivirals can shorten the amount of time that you’re sick, but they must be started within the first 48 hours after you first develop symptoms in order to be effective. You may want to take advantage of any telehealth services your doctor offers so that you don’t have to drag yourself into a clinic.
Another option that Piedra suggests if you’re at high risk is to consider contacting your physician as soon as possible before you get sick. Ask whether he or she would advise you to fill a prescription for flu medication now. That way you can get started on medication sooner if you do get sick.
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