Flu threatens early surge. Doctors urge vaccinations now.

This year’s flu season is expected to be a doozy as the state and nation head into the first winter in two years without masks, social distancing and other COVID-19 mitigation measures, which slowed the spread of coronavirus along with influenza in 2020 and 2021.

Already, parts of the U.S. are seeing big increases in flu activity, with high levels of transmission reported in New York state, Tennessee, Georgia, South Carolina, Texas, and the District of Columbia, according to the U.S. Centers for Disease Control and Prevention.

“With the COVID precautions — people wearing masks and socially distancing and not traveling as much — we basically had no flu at all” in the first two years of the pandemic, said Dr. Thomas Veverka, president of the Michigan State Medical Society and a trauma and general surgeon at MyMichigan Health in Midland.

More:Story of survival: Runner, 26, lived after his heart stopped during half-marathon

More:Black Michiganders got 60% of monkeypox cases, only 17% of vaccines

“Part of our resistance to flu is natural immunity from getting exposed to flu. For the last two years, we have not had any exposure to flu, so we haven't had a chance to build up any natural immunity. That may make us more susceptible to the flu in this coming year.”

Warning flare from Down Under

Scientists often look to the Southern Hemisphere, which has its flu season during our summer months, for indications of what might be headed our way for the winter.

Australia reported its worst flu season in five years in 2022, with 308 flu-related deaths. The bulk of infections were caused by influenza A.

“There's an indication that we're headed for the same kind of experience,” Veverka said.

Although Michigan isn’t yet seeing the high level of flu activity affecting some parts of the country, the virus already is having an impact on the state’s hospitals, said Dr. John Dery, an emergency medicine physician at MyMichigan Health Gratiot who also serves on the board of the American College of Osteopathic Emergency Physicians.

In a single 24-hour period last week, Dery said he personally saw three cases of flu — two were identified as influenza A strains; the third was flu B.

“The emergency departments are overrun right now,” Dery said, noting that it’s not just because of people with the flu. There also has been a swell of children with respiratory syncytial virus, better known as RSV, along with people who have COVID-19 and those who need care for other illnesses.

After more than two years of the pandemic, “now everybody and his brother is coming back,” Dery said. “Everybody is having all their surgeries that were put off for a year or two. Everybody has to have testing. So our ERs are overwhelmed with the volume of patients. We're grossly understaffed on a nationwide level with nursing and ancillary staff, and then we have a lot of people that are coming in for nasal swab testing.”

State's top doc: 'Have a plan' for flu, COVID this year

Dr. Natasha Bagdasarian, the state’s chief medical executive, told the Free Press this week that Michiganders ought to prepare now for what’s likely to be a difficult respiratory virus season.

“Have a plan,” she said. “No. 1, we want the public to make sure that they are vaccinated and boosted. So find out: Are you eligible for one of the new COVID bivalent boosters? Have you had a flu shot this year?

“No. 2, make sure that you've got a supply of well-fitting masks at home. If you are unwell, you should stay home, but if you can't avoid being around other people and you are symptomatic, wearing a mask is one really good way to protect those around you.”

More:Where to get your COVID-19 bivalent booster vaccine in Michigan

More:Am I fully vaccinated for polio? How to check your Michigan immunization record.

She also recommended stocking up on rapid, at-home coronavirus tests.

“Keeping a supply of over-the-counter COVID-19 tests at home can also allow you to at least rule out one of those viruses so you can see if you have COVID-19,” Bagdasarian said. “But I do want to preface that by saying if you test negative for COVID, that doesn't mean you can just go about your day. We really don't want people who are ill and who are symptomatic to go out into public spaces.”

How to know whether you've got influenza or COVID-19

It’s very difficult to tell the difference between COVID-19 symptoms and flu symptoms without testing, Dery said.

“They present the same: cough, congestion, upper respiratory tract symptoms, minor fevers and chills,” he said. “We're not going to know … if it's COVID or it's flu. … You have to be tested."

If your at-home rapid coronavirus test is negative, Dery said it doesn’t necessarily mean you don’t have COVID-19. It could be that you didn’t get a good enough sample on the swab to trigger a positive result. It could also be that you tested before there was high enough viral load in your nose to be detected on the test. You also might be infected with a strain of the virus that isn’t as easy for your rapid test to identify, he said.

Dery suggests making an appointment at a local pharmacy for a coronavirus PCR test, which is more likely to be accurate, along with a flu test. Other places to seek testing include an urgent care center or through your primary care physician.

“Going to the ER is not the best bet … to get those tests,” Dery said. That's because going to the hospital for COVID-19 and flu testing jams up crowded waiting rooms and keeps people who truly need emergency care from getting treatment as quickly.

Why you should seek testing

Getting tested is especially important if you are at high risk for severe disease from COVID or the flu so doctors can treat you with antiviral medications or monocolonal antibody therapy that can keep you from needing hospital care.

“We have really effective therapeutics for COVID-19,” Bagdasarian said. “We've got medications like Paxlovid and remdesivir, and we also have medications like Tamiflu for influenza.

“So talking to your doctor to find out if you are a candidate for one of those medications if you do get sick ahead of time is one way to make things a little bit smoother this respiratory season.

More:Henry Ford doctor, Trump White House tried to pressure FDA into hydroxychloroquine use

“We have to really think about this holistically. We want to keep people out of the hospital. We want to keep people from spreading disease and from having schools closed down because of outbreaks. The best way to do that is just to take all of these precautions for viral respiratory season in general.”

State goal: Administer 4 million flu shots

Th state’s goal is to immunize 4 million Michiganders against the flu this year, Veverka said. State data shows that nearly 1 million had been vaccinated against the virus as of Oct. 8, which is the most recent date for which data was available.

This year’s flu quadrivalent vaccine appears to be well-matched for the dominant strain circulating now in the U.S., the H3N2 form of influenza A. The vaccine is recommended for people ages 6 months and older. The CDC urges people ages 65 and older to ask for the high-dose version.

“Last year, there were 3.3 million vaccinated and the goal is to get 4 million this year,” Veverka said. “Hopefully, that will be the number that could keep the influenza surge down. But unfortunately, a survey of U.S. adults … (suggests) we're at some risk for not meeting those numbers.”

Veverka said he’s concerned that anti-vaccine sentiment that bubbled up around COVID-19 will affect people’s willingness to take flu vaccines, too.

“There's this vaccine hesitancy that now is leading to the resurgence of other preventable infections and diseases,” he said. “And, unfortunately, that could affect us with influenza coming up as well.”

Getting vaccinated before the end of October will ensure protection through the holiday season, which is when the spread of the virus typically ramps up.

“With all of these diseases, our goal is not necessarily to stop every single infection, but we want to save lives,” Bagdasarian said. “We want to keep health care capacity open, and we want to keep our vital infrastructure open. By using the tools, we will be able to get through this respiratory viral season.”

Contact Kristen Jordan Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus. Subscribe to the Free Press.

This article originally appeared on Detroit Free Press: Flu season in Michigan: What to know about shot, symptoms