PODCAST: Will Flu Season Be Bad?

DR. LONG: If we look back to 2020, at the start of the pandemic, thanks to numerous factors — including the lockdowns of schools and businesses that kept everyone staying at home, all the masking, all the social distancing — there was really no flu season to speak of in 2020. And then last year in 2021, as things started to return to normal and those measures had relaxed, we had a flu season of sorts, but it was fairly mild and wasn't really like typical flu seasons, let's say. And so, now, we are faced with the possibility of having a more severe flu season that's going to have an earlier start.

KATIE: And, so, what's making you and your colleagues and other flu experts worried about this flu season? Is there something you're seeing in particular? Is it what's coming out of Australia that's been the factor that's concerning?

DR. LONG: One of the reasons we're concerned is that, we can always look to the Southern Hemisphere as a predictor of what our flu season may be like. And that was true in 2020. They had no flu season to speak of, and we had no flu season to speak of. In 2021, flu returned to the Southern Hemisphere and we saw it return, although it was a mild season. Now in 2022, what we're seeing in the southern hemisphere, in places like Australia, was that the season started very, very early — so it started months earlier than usual. And then it was particularly severe, and they really saw cases as high, levels, they hadn't seen since five years prior — which was a pretty, pretty bad flu season five years ago. So, what we're seeing now is that in fact, yes, here in the U.S. we're seeing an early start to our flu season, especially in Houston. So, then the question becomes: Are we going to see a severe flu season?

KATIE: So, do we know yet — or is it too soon to know — why Australia's flu season was so bad, in terms of where vaccination rates low? Or were a couple strains circulating that are particularly severe? Do we know any of that yet?

DR. LONG: So, it's really a combination of factors. One of the things that likely contributes is because we've had two years of a lot of distancing, masking — really two years of having very mild to nonexistent flu seasons. We haven't had a lot of people who were naturally infected with flu. And then, since we haven't been seeing a lot of flu — although some people have been getting vaccinated, getting their flu shots — there's been such an emphasis on COVID, a lot of people sort of forgot about influenza and may think they don't need a flu shot because they haven't needed one in the past couple of years because flu hasn't been that big of an issue. So, it's probably a combination of both. People haven't been getting flu and then they haven't been getting vaccinated. And, so, there's a very large population of susceptible individuals who can be infected with flu. And, so, once flu moves into that population, it's able to spread very easily person to person because of the high number of susceptible individuals. And then you see an earlier start to the spread and higher peaks in terms of cases.

KATIE: And, so, you mentioned this — you're also part of a team that essentially examines respiratory pathogens as patients come into our hospitals and clinics, how much flu are we seeing and some other things — and I know we even have the flu tracker that we use that's looking at across the Houston Methodist hospitals how much flu we're seeing. So, are we seeing things already? I know you mentioned it does seem like the flu season is coming early. Even in our own data, are there any other trends we're seeing?

DR. LONG: So, the major thing we saw in September was that it really got off to a very early start. So, typically in September, we don't see very many cases of flu on a day-to-day basis. And really around the middle of September, we saw cases begin to spike and go up to the sorts of numbers we typically don't see until December. Often the flu season peaks in late December, January, February. So, we're seeing a very early start. And you can see that in our flu tracker at flu.houstonmethodist.org.

KATIE: We'll put the link for you guys in the show notes so you'll be able to take a look and actually follow along with the flu tracker if you would like to. With that data, are we seeing any people particularly vulnerable yet or anything like that? are kids particularly vulnerable? Does it seem to be mostly the elderly? Or is it kind of all across the board right now?

DR. LONG: So, we haven't really dug into the numbers yet on age ranges or, you know, who in particular is being affected. But one thing that's important to remember about influenza that’s very different than COVID is that influenza has the capability to make healthy young people and even children very, very severely ill. And even to cause mortality in those individuals. And, so, with COVID, we got very used to this concept that the people who were most at risk from COVID were people who had co-morbidities, people who were older, those sorts of things. All of that was true for COVID. It's simply not true for influenza. Influenza is capable of making very healthy young people with no comorbidities, very significantly ill, and even cause death in some of those individuals.

KATIE: That's a good segue into another question I had. For people that do end up getting the flu this season, do you have any tips for treating symptoms at home? But then also knowing, hey, this is getting bad enough, it's time for me to think about going to the ER, think about calling my doctor?

DR. LONG: So, similarly to COVID, if you're, you know, having difficulty breathing, if you're out of breath or things of those nature, it's always worth calling your doctor — perhaps going to seek care in those cases. It is important probably this season to get tested, to find out if you have flu or COVID, and then we have treatments for both of those viruses. So, there's oral medications to treat influenza. There's a variety of treatments available for COVID. But those treatments don't overlap. It's not…unfortunately, we don't have a single antiviral you can take for both. So, it's probably worth getting tested if you have symptoms. Getting tested and finding out if you have flu or COVID, and then seeking out the relevant treatments if you need to.

KATIE: That's a really interesting point I hadn't considered. I've never been tested for the flu. Obviously have been tested for COVID quite a bit because I was kind of paranoid the whole pandemic. But yeah, it's a good reminder that it’s always better safe than sorry and to figure out which one you may or may not have. And, speaking of COVID, that hasn't gone away. It’s still here. So, this flu season is kind of already ramping up and your team also closely surveils COVID spread, the cases that we see come in and out of the hospital. What are we seeing right now? And I guess my reason for asking is: Do we think this is the year we finally get the “twindemic” of flu and COVID kind of spiking at the same time?

DR. LONG: So, it's a really good question. And, I think to some extent, we have to wait and see. We did see last year…really what happened in 2021, which was somewhat interesting, was that flu numbers had started to go up in November and, then, when omicron came into the country, [it] just really crushed flu. So, flu went down to almost nothing when Omicron spiked in December. And then when the omicron wave came down in sort of January, February, then we had some flu cases come back — but it was still a pretty mild season. So, it's a little bit interesting to see if we do see a sort of a phenomenon where, I think what we're likely to see right now — as COVID numbers are going down, continuing to go down, we haven't yet seen any new variants that are wildly different than the original variant. So, we haven't seen another variant like omicron, which was really very different than Delta, which was one of the reasons it had such a meteoric rise. I think what we're likely to see this season is, probably the trend in COVID is going to continue and we're going to have an early flu season, and then we'll have to see how that plays out over the next few months. In terms of, you know, the flu season may peak and start to be coming down by December, January. But then the question is, will we have a COVID wave at that point, thanks to waning immunity or a new variant.

KATIE: Going back to the silent flu season almost that we had in 2020 during the COVID pandemic, you know, this year, we're finally getting to a place where masks are mostly off, I would say. Do we think it's time to embrace some of those COVID precautions during flu season, or is flu just never going to be as bad as COVID and so it's okay for us to kind of like get our shot, stay home if we're sick, and that's enough?

DR. LONG: I think, first and foremost, the most important thing to do to protect yourself from flu — just as it is to protect yourself from COVID — is to get vaccinated. If you get the flu vaccine, it's going to do a very good job of preventing severe disease and preventing hospitalization and preventing death. So, you want to get that flu vaccine to protect yourself. Same thing with the new bivalent COVID vaccines. We know that our immunity to COVID wanes over time, and so if you haven't had that booster yet, you really ought to get the bivalent booster. It's more tailored towards the strains that are circulating now. It's going to help protect you from COVID, protect you from severe disease, hospitalization and death. Now, certainly, again, one of the reasons we saw this, you know, nonexistent season in 2020 was things like masking, distancing, lockdowns. And we're in a much different world now. So, flu is going to be out there. it's going to be circulating in the community. The vaccine is the best thing to do to protect yourself. And then I think everyone has to, you know, think about their own risks, the risks of their family members or household members and make decisions about if they want to take additional measures, like masking or distancing or avoiding indoor crowds, things like that. Those are certainly things that individuals can choose to do to help lower their risk of getting influenza and getting COVID. But I think it just has to be everybody's personal decision really to think about are they themselves at risk to their lives with someone who's high risk. The interesting thing about influenza, though, again, is that being able to sort of identify who's high risk for influenza, severe disease from influenza is a little bit more difficult because again, influenza has this capability and characteristic of causing such severe disease, sometimes in younger, healthy people. So, it's not as easy to sort of stratify the risk. Again, because you could be in your early twenties and think, “I'm in my early twenties, I'm perfectly healthy, I don't need to get the flu shot.” And there, you know, unfortunately, every year there are cases of individuals who get severely ill and some of whom die from influenza. So, it's really important to get the vaccines to be your primary method of protection.

KATIE: And, on the topic of vaccines — maybe just a couple quick questions that I think people probably have. When, ideally, and especially in a year where we're having an earlier flu season, when ideally do you want people to be getting vaccinated by?

DR. LONG: So, I think it's important for people to get vaccinated now because of the numbers that we're already seeing. There's a lot of common knowledge or a lot of wisdom that's been passed around the past few years and pre-COVID where people would say, “Wait to get your flu shot until October or November so that it helps protect you longer into the spring.” Since, typically, it would peak in January or February. And, so, there was a lot of that sort of armchair wisdom that was being thrown around before the pandemic. Well, now the problem with that is, since we're already seeing numbers like we typically see in December, there's already transmission occurring. So, you want to get vaccinated now because you need to be protected now against influenza because it's going to peak so much earlier. If you wait until November…we could be peaking in November. So, again, the whole reason people used to recommend waiting was because it would peak months from now and cases really didn't start going up typically until November or December.

KATIE: Since you also mentioned the bivalent COVID booster, can people get both at the same time? Let's say I make an appointment at my local pharmacy. Can I just say, “Hey, also, can you do my flu shot today?” Or do people need to be worried and split them apart?

DR. LONG: So, you can absolutely get both flu and COVID vaccines on the same day. They'll typically put one in each arm. You can absolutely get them on the same day. So, if you're having difficulty getting time away from work or finding the time to go get vaccinated, there's no reason to have to separate those two shots out. You can get them both on the same day. So that's the good news.

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ZACH: Think you can just wait to get your flu shot until you notice your friends and family are starting to get sick? Think again. It takes about two weeks for the flu vaccine to fully prepare your body to ward off the flu. In these two weeks, the flu vaccine is encouraging your body to create the antibodies needed to help you fight the flu virus should you become infected. Dr. Long has mentioned that flu season is unpredictable, so consider planning ahead and getting your flu shot as soon as possible. You can get one at your primary care physician's office, a pharmacy, urgent care clinic, or even a flu vaccine drive.

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KATIE: You might have heard that the flu shot can give you the flu. When we get back from the break, Dr. Long separates fact from fiction.

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KATIE: Back to our conversation with Dr. Long.

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KATIE: Another question that I think I have heard a lot, and I'm sure you have too, can you get the flu from the flu shot?

DR. LONG: You absolutely cannot get influenza from the flu vaccine. I think it's a very common misconception. People will say, “I got the flu shot and I feel sick or I felt sick or I got sick.” So, hopefully, now that people have been getting their COVID boosters — experiences it differently — but some people get that immune response after the vaccine where maybe you feel a little crummy the next day, maybe even a day or two, but it's generally short lived. And that's just your body, you know, recognizing the vaccine and building an immune response against the pathogen. The flu vaccine is, you know, recombinant. Very much like the COVID vaccine, it's just a couple of parts of the influenza virus. It's not a complete virus. There's no virus there. It can't make you sick. The other compounding factor is that people are usually getting vaccinated during respiratory virus season. So, right now, even with the early start to flu, we're still seeing a lot of rhinovirus, enterovirus — these common cold viruses. And, so, it's also entirely possible that someone gets vaccinated against influenza and contracts a different respiratory virus at the same time and then feels ill, you know, at some point that week afterwards. It's not that you've gotten the flu from the vaccine. That's absolutely impossible. It could just be that you picked up a different virus in the community. And, usually, influenza feels different than the common cold. Usually it comes on very suddenly, very high fever, muscle aches. It's very, very distinctive from common colds and other things. So, again, don't be worried that the influenza vaccine is going to give you the flu. It's technically impossible. It can't happen.

KATIE: Also, another good plug for the flu tracker. It's not just a flu tracker. It also tracks other respiratory pathogens. So, you can see what else is out there circulating that might be contributing to symptoms you're having if you get vaccinated and maybe don't feel so great the next day. So, what are some things that you would like our listeners to take away from today about whether a flu season or a flu shot?

DR. LONG: So, the first thing I'll say is that if you are 65 or older, you need to be getting the high-dose flu vaccination. Most people giving vaccinations, should recognize that and give you that. But you want to make sure and ask — make sure you're getting the high dose. I know we talked a lot about how younger people are at risk for severe outcomes from influenza. That's true. But, also, people with co-morbidities and chronic conditions, pregnant women, all those individuals are at heightened risk for severe disease from influenza. So, it's very important that they get vaccinated.

KATIE: Got it.

DR. LONG: Someone was asking me, too, if you can get COVID and influenza at the same time, and you actually can. So that's something that we saw very early in the pandemic when both were circulating. And, generally, having both at the same time is really not good — especially early in the pandemic when we didn't have treatments. Now, we have treatments for both. But still you want to get vaccinated for both so you can avoid getting both because you can actually be actively infected with both viruses or with influenza and another respiratory virus — because there are other respiratory viruses that circulate in the winter like RSV, rhinovirus, enterovirus. So, you want to be getting vaccinated against the respiratory viruses you can to protect yourself to try to avoid being infected or being double infected.

KATIE: Got it. Yeah, that makes a lot of sense. Well, thanks so much for being with us today, Dr. Long. This is a lot of great advice that I think will get our listeners prepared and ready for flu season. Also, a great reminder for everybody to get their flu shot.