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During the 2019-20 flu season, 15 children died from seasonal influenza in Texas, with thousands more hospitalized from the disease, according to the state health department.
But last year, there was almost no seasonal flu to speak of, in Texas or elsewhere in the state.
Now, as the COVID-19 pandemic approaches its second flu season within the U.S., experts say it’s unclear what the 2020-21 flu season will bring.
“It is very difficult to predict the timing of when influenza will arrive,” said Dr. Pedro Piedra, professor of molecular virology and microbiology at the Baylor College of Medicine.
Last year’s unusually quiet flu season was due, in part, to safety steps the public took because of the COVID-19 pandemic, like wearing masks and avoiding large crowds and big events. But because almost all requirements regarding masking and occupancy limits are no longer in effect in Texas, those same protections won’t be in place to slow the spread of the flu this season.
“I don’t think that will happen to the same extent this year,” Piedra said.
In the last season, flu activity was the lowest it’s been in the U.S. since 1997, when the CDC began tracking flu activity in its current reporting form. The COVID-19 pandemic also disrupted the typical respiratory syncytial virus, or RSV, season. Like the flu, RSV usually peaks during the winter months. But there was almost no RSV season last year. Instead, parts of the U.S., including Fort Worth, experienced an unexpected surge in RSV cases this summer.
The disruptions to the RSV season are evidence that the COVID-19 pandemic could have still unforeseen effects on seasonal influenza.
The best protection against both COVID-19 and seasonal influenza is to get the vaccines that protect against both diseases, Piedra said.
Flu shots are recommended annually for everyone over the age of six months, according to the U.S. Centers for Disease Control and Prevention. In a typical flu season, flu activity peaks between October and February. Based on that calendar, the CDC recommends that people be vaccinated during September and October.
“We need to always understand that the best way to prevent the serious complications of these respiratory viruses, whether they be COVID or influenza, is through the use of vaccines,” Piedra said. “Vaccines are the safest, and also least expensive way to really reduce the chances of a bad outcome”
But in a typical year, only about half of American adults actually get a flu shot. In Texas, a survey in 2017 estimated that only about 32% of adults between the ages of 18 and 64 got the annual flu shot, and fewer than one in four uninsured adults get their annual flu shot, according to the state health department.
Low flu uptake levels among people without insurance is part of the reason why researchers have concluded that adults who live in poorer neighborhoods are more likely to become severely ill with the flu, said Dr. James Hadler, a professor of epidemiology and public health at the Yale School of Public Health. Hader and his colleagues have studied the characteristics of people who became severely ill and were hospitalized with seasonal influenza, and found that higher rates of flu hospitalization were linked to higher rates of census tract poverty.
“People who live in poorer areas and neighborhoods with more crowded housing have two to three times the rate of hospitalization from flu that people who live in wealthier neighborhoods,” Hadler said.
The higher hospitalization rates could be caused by a number of factors, Hadler said, including that people living poorer neighborhoods are more likely to live in crowded housing and to be exposed while working, but also because neighborhoods with higher risk also tend to have lower vaccination rates against the flu, Hadler said.
“There’s an access issue” when it comes to the annual flu shot, Hadler said, both because of a lack of health insurance, a lack of physical locations to get a flu shot, and limited outreach in poorer neighborhoods during flu season.
“With COVID, there’s been a lot of outreach in many states, including door-to-door knocking and offering to bring the vaccine to them rather them having to come to a clinic,” Hadler said. “Despite that there’s still some gaps. But the gaps aren’t as big as what we’ve observed for influenza. That suggests that there is an access component to it.”
Where to get a flu shot
If you have health insurance, flu shots should be available for free at your doctor’s office, local clinics, and pharmacies. If you don’t have health insurance, some providers offer low-cost or free flu shots. To locate a flu shot provider, visit 211Texas.org.