COVID-19 has dominated medical headlines for the past 20 months, often boxing out competing health concerns. Of course, other illnesses and viruses still exist, and the one that doctors caution should be on everyone’s minds at this time of the year is influenza.
The flu is a notorious shapeshifter, presenting slightly different challenges each year and requiring a yearly vaccine because there are several strains of the illness that can be dominant in any given year. But there are certain tenets that should guide every individual’s and every family’s approach to flu season, which, doctors say, is now upon us.
It is repeated every year but remains true — the best and most effective defense against contracting the flu is to get a flu shot. For those who become infected despite being vaccinated, the vaccine significantly reduces the severity of the illness.
Anyone over the age of 6 months is eligible to get the flu shot, and it is widely available in doctor’s offices, local pharmacies and grocery stores. Dr. Sharon Nachman is the chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. She explained why getting the shot annually is important and dispelled some common misconceptions.
“The reason we want people to get it every year is because the flu virus changes from year to year, so the vaccine from last year probably won’t protect you against the flu types circulating this year,” she said. The myth that healthy children will not suffer long-term or serious effects from having the flu is just that, a myth. Dr. Nachman said that of all children who die from the flu every year, only one-third had an underlying medical condition.
Like many other doctors and pharmacists, Dr. Nachman finds herself repeating each year the reassurance that the vaccine cannot give people the flu and does not contain anything that can make them sick or be otherwise harmful to their health or the health of their children.
“It’s not a live vaccine,” she said. “And there’s no preservative in it. People always wonder about thimerosal, or mercury, but it’s important to remind everyone that it’s a single-dose vaccine vial with no preservative.”
Dr. Charles Guida has been practicing in Southampton for 25 years, and specializes in treating geriatric patients, one of the most at-risk groups for death from influenza. He pointed out that the flu shot is also recommended by the CDC for women who are pregnant and breastfeeding, and spoke about how timing also matters when it comes to scheduling or going for a shot.
“Pharmacies will start promoting [the flu vaccine] in July or August, usually August, but that’s actually too early,” he said. “The CDC really recommends getting it at the end of October, so the protection lasts.”
For individuals over the age of 65, higher-dose vaccinations are available and are the preferable choice, he said. “It’s very important for the flu. We find the immune response [for people over 65] to the normal dose is not as good.”
He said it’s fine for individuals to get vaccinated at local pharmacies but they should ask specifically for the higher dose if they are over the age of 65, and while many pharmacies do carry that dose, they may need to go to their doctor’s office to assure they get the right dose.
When it comes to children, getting a flu vaccine is important for several reasons. Like older adults, children are at higher risk of developing severe illness from the flu, and with the pandemic still ongoing, there is extra incentive to stay out of the hospital.
“Babies and little kids get sicker from the flu, like the older population,” said pediatrician Dr. Nadia Persheff of Hampton Pediatrics. “Our health care system this winter will be stretched to the max. Getting routine health care will be harder for all illnesses.”
In a recent article for The New York Times, science-based parenting journalist Melinda Wenner Moyer (who publishes the popular parenting newsletter, “Is My Kid The A**hole?” on Substack) reported that certain children, particularly those between the ages of 6 and 8 who have never received a flu vaccine, as well as those who have only ever had one dose, should get two doses of the flu vaccine, at least four weeks apart. Dr. Persheff agreed that this is solid advice for parents of children who fall into that category.
Of course, parents of young children who are organizing their thoughts and plans around the flu vaccine for their kids have an added element to think about this year as Pfizer’s COVID-19 vaccine is on the cusp of emergency use authorization in children ages 5 through 11. On Tuesday, an FDA panel recommended offering the vaccine to that group, meaning shots could be going into their arms within the next two weeks. When it comes to vaccinating children against flu and COVID in close proximity, pediatricians say the science and research don’t provide any reason not to, and even added that it’s fine to give both shots on the same day — this is also true for adults, Dr. Guida said, adding there is no evidence that getting the COVID shot on the same day as the flu will cause any magnification of possible side effects. But Dr. Nachman pointed out that while there are no signs there would be any unique adverse effects from giving both vaccines on the same day, it’s probably not the best course of action right now for young children because it requires waiting.
“What I tell parents is that the flu vaccine is here and it’s available right now,” Dr. Nachman said. “It makes sense to get it before we see large numbers of flu circulating. Once flu gets a toehold in the community, it spreads like wildfire. So waiting puts you at risk for missing an opportunity to prevent the flu. You absolutely can get both vaccines at the same time, in different arms, but it’s still an unknown when the COVID vaccine will be approved for kids. It could be a month from now, and flu season is here now.”
For people who may have been lulled into a false sense of security because last year’s flu season was basically nonexistent, doctors spoke of the importance of staying vigilant. Dr. Guida said he would be surprised if there wasn’t a “serious uptick” in the number of flu cases this season, and Dr. Nachman added that medical professionals are concerned about the potential for a much more potent season this year.
“Everyone is worried,” she said. “Last year we had very low rates of flu because people were adhering to social distancing and using masks, and that was quite effective. This year, there is quite less of that, and people are back to school and back to work, so the potential for a big flu explosion is there. It could happen, or it could not happen. It’s hard to predict.”
Dr. Guida pointed out that people should not get too hung up on trying to decipher whether or not this year’s flu vaccine will have high rates of efficacy against the dominant strains.
He pointed out that while the drop in flu cases last year was clearly good news from a public health perspective, it had the negative effect of providing less data to inform decisions about developing this year’s vaccine. But in the bigger picture, that isn’t an argument for opting out of a shot.
“The strains don’t change that much,” he said. “There are four strains in the vaccine, two type A and two type B, and it doesn’t have to be an exact match to be effective.”
The start of last year’s flu season was marked by fears of a “twindemic,” with health professionals expressing fears about the potentially devastating effects of high rates of hospitalization for both flu and COVID, how that would overwhelm the already taxed health care system, and how dangerous it could be for individuals to contract both illnesses at the same time. That nightmare scenario never materialized, and COVID numbers are currently on a downswing, but the potential for contracting both illnesses at once still exists, especially for individuals who are choosing not to get vaccinated, and for children who are not yet eligible for the COVID vaccine.
Because the symptoms of both illnesses are similar — with the exception that, unlike the flu, COVID can lead to a loss of taste and/or smell — getting the flu vaccine means you “limit the diagnostic possibilities” if you do get sick, Dr. Guida said. He also pointed out that getting both illnesses simultaneously would be a “total disaster,” and dispelled the idea that a COVID shot will provide protection against the flu.
Dr. Nachman spoke about the negative ripple effects contracting both COVID and flu at the same time would have.
“If you have more than one respiratory virus at the same time, it’s possible that you’ll get more than twice as sick, or pass twice as much illness to family and friends when you’re sneezing and coughing,” she said. “Both viruses cause pneumonia, and having two different pneumonia-causing viruses at the same time is worrisome, because it means the lungs are taking a double hit.”
When it comes to vaccine hesitancy broadly speaking, Dr. Guida said he has not seen any carry-over effect from the highly politicized vaccine hesitancy surrounding COVID when it comes to the flu vaccine. If anything, he’s seen an encouraging opposite effect, with people seeming to be more vigilant about getting their flu vaccine, perhaps because the specter of contracting COVID is still at the front of their minds. In broaching the topic of vaccine hesitancy with parents, Dr. Nachman takes a simple approach.
“I want to remind families that your child’s doctor is the expert in your child’s medical care,” she said. “You should discuss concerns with them openly, and listen to what they’re saying.
“Don’t listen to the echo chamber,” she added. “Talk to the expert and ask appropriate questions. Don’t sit there and say, ‘I read it, I read it’. Just because you read it doesn’t mean it’s true.”