Will the flu season deliver a wallop as expected? What doctors need to know

By Alistair Gardiner
Published October 29, 2021

Key Takeaways

We’ve been hearing the warnings for months: This winter’s influenza season is going to hit with a vengeance. Health experts are anticipating an early arrival—and a severe impact.

But what makes this flu season different? And what should doctors be telling their patients? Here’s everything you need to know about the 2021-2022 flu season.

Why this year could be an anomaly  

For all intents and purposes, the 2020-2021 flu season didn’t happen, according to an article published by the Boston Herald

Flu cases and deaths last year were the lowest since 1997, which is the year influenza reporting began. The United States recorded roughly 700 flu deaths last year vs 22,000 deaths in 2019, which is a more typical figure. 

Health experts attribute this to COVID-19 restrictions, including social distancing, self-imposed isolation, and mask-wearing. As a result, doctors are worried about a drop in natural immunity levels, which may lead to a surge of influenza cases and a higher than average number of deaths. On top of this, there are concerns over a possible new wave of COVID-19 infections. 

According to an article published by Clinical Trials Arena, this combination is being referred to as the “Twindemic.” 

Patients who are co-infected with COVID-19 and influenza are reported to have higher mortality rates and disease severity compared to patients with just one of those infections. And, current flu vaccination coverage is estimated to sit at just 45.8% of the eligible population. All of this has prompted updated guidance from the CDC, urging people to get their flu shots.

The CDC states that while respiratory viruses like the flu weren’t spreading much last year, data from the National Respiratory and Enteric Surveillance System indicates that these viruses were highly active during the summer, which is outside of their usual seasonal increases. 

There’s still plenty we don’t know about how COVID-19 and the flu will interact since the former is still a relatively new illness. For example, it is still unknown whether a flu infection will affect an individual’s risk of getting COVID-19. That said, the CDC notes that we do know people can be infected with influenza and the virus that causes COVID-19 simultaneously. We also know that both COVID-19 and the flu can cause complications beyond the typical symptoms and effects.

Unusual and surprising flu complications

According to a study published in The Pediatric Infectious Disease Journal, it isn’t uncommon for patients who become hospitalized with influenza to develop neurologic complications. Researchers found that among 1,988 cases of the flu, 8.1% experienced neurologic problems. 

Other complications include muscle weakness and paralysis in cases where influenza infection leads to the development of Guillain-Barré syndrome (GBS), an autoimmune disorder. The causes of GBS remain unknown and cases are uncommon, but in some patients, the disorder can lead to permanent paralysis or death.

The flu can also result in health impacts like permanent hearing loss, blindness due to necrotizing encephalopathy secondary to flu infection, encephalitis (which can result in neurological complications like memory loss or seizures), or meningitis.

Patient populations at the greatest risk

According to CDC guidance, populations at a higher risk of flu-related medical complications include children aged 6-59 months; adults aged 50 years or older; individuals with chronic, pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic, or metabolic disorders; immunocompromised individuals; pregnant women; obese individuals; residents of long-term care facilities; American Indians/Alaska Natives; and young people who use aspirin- or salicylate-containing medications. 

Vaccinations can also improve flu mortality rates for patients with certain conditions. For example, one study found that in patients with heart failure, flu vaccination was associated with a 50% lower risk of death during flu season. 

Similarly, according to information provided by The National Kidney Foundation, patients with chronic kidney disease have weakened immune systems. Vaccination is particularly important for these patients to lower the risks of complications, hospitalization, or death.

However, the CDC advises that everyone 6 months or older should get an annual influenza vaccine. 

What your patients need to know

According to the CDC, all available flu vaccines for the upcoming season are quadrivalent, which means they can protect against the four influenza viruses that are anticipated to be most prominent. 

It’s important to inform your patients that they shouldn’t wait to get vaccinated. The CDC advises that everyone should have been jabbed by the end of October, even if flu activity is low in their community. The vaccine takes about 2 weeks to become effective, and cases could start rising at any time. 

If your patients are concerned about COVID-19, you should reassure them that there is no evidence that receiving a flu vaccine can increase your risk of getting coronavirus. However, if they suspect they have COVID-19, flu vaccination should be deferred—even if they’re asymptomatic.

For many patients, both COVID-19 and flu vaccines can be administered in one sitting. Physicians should encourage their unvaccinated patients to get both vaccines at the same time, as multiple trips to the clinic could increase the risk of exposure to the viruses.

Finally, as noted in an article published by UC Davis Health, it’s important to remind patients that COVID-19 is still a bigger health risk than the flu. As such, your patients should prioritize COVID-19 vaccination before influenza vaccination. 

Beyond that, your patients should avoid being around sick people, wash their hands regularly, and keep wearing a mask in public places as much as possible. 

See related reading on influenza and COVID-19 on MDLinx:

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