Every flu season is a guessing game: Flu shots have to be manufactured six months in advance, so health experts track flu throughout the world continuously and look to countries in the southern hemisphere, like Australia, for clues about which strains might be circulating in the United States by our fall and winter. There are never any guarantees that those strains will circulate here; we also can’t be certain how widely they’ll spread or how effective that year’s vaccine will be in fighting back.
But flu season 2020-2021? It’s even more of a guessing game than usual, though not because our understanding of the flu has changed. Our uncertainty about this year’s flu season exists because of one giant question mark: COVID-19.
“This is called the ‘novel coronavirus’ for a reason,” says David Cutler, MD, family medicine physician at Providence Saint John’s Health Center in California. “It didn’t even exist before last November and it’s hard to predict how it’s going to behave.”
Your best defense against the flu in the time of the coronavirus pandemic? Getting a flu shot! It’s important to get one every year, but this year it couldn’t be more important.
In some individuals, the flu can cause secondary infections like sinusitis, bronchitis, and pneumonia. Some of these infections can even be fatal; the Centers for Disease Control and Prevention (CDC) tracks flu activity and reports that in the 2019-2020 flu season there were up to 56 million flu cases between 24,000 and 62,000 deaths and anywhere from 410,000 to 740,000 hospitalizations.
Because the flu has such a widespread impact on Americans every year, the CDC recommends that everyone older than 6 months of age receive it, with few exceptions. Here’s everything you need to know about the upcoming flu season and the types of vaccines being offered, along with when and where you should get yours.
Flu season 2020-2021
A typical flu season in the U.S. runs from October to April, with infections peaking between December and February. The 2020 flu season isn’t expected to start any earlier this year just because COVID-19 is around, but it could be a more complicated flu season due to the simultaneous spread of the novel coronavirus.
It doesn’t have to be that way: According to Sandra Kesh, MD, deputy medical director and infectious disease specialist at Westmed Medical Group, the southern hemisphere has seen a more moderate flu season than usual—possibly because of all the preventative measures they’ve taken to reduce COVID-19 infections, like social distancing and mask-wearing.
That theory tracks with what we saw here in the U.S. this spring. In comparison to the past several flu seasons, the 2019/2020 flu season activity was downgraded from “widespread” to “sporadic” in many more states much earlier—in line with the time period that coronavirus was declared a pandemic and infection control measures really started revving up and states started shutting down.
The flu and COVID-19
The fact that COVID-19 is spreading doesn’t change much about the severity of the flu; it will make us as sick as it’s always made us, says Dr. Kesh, but the reason that’s more scary than before is because of the threat of co-infection.
“We have no idea what happens if you get both viruses at the same time…and you don’t want to be the person to find out,” Dr. Cutler warns.
Since there is a lot of symptom overlap between the flu virus, the common cold, and coronavirus, it will be hard to know what’s plaguing you if you get a fever, cough, or sore throat; if you’ve gotten a flu vaccine, though, your flu symptoms may be less severe (and your healthcare provider may recommend testing for COVID-19).
Without an available COVID-19 vaccine, the 2020 flu shot is the single best thing you can do to avoid the unpredictable one-two punch of coronavirus and influenza.
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When to get a flu shot
Flu vaccines usually start to become available in August, but there’s disagreement among physicians about the best time to receive one. Since the immune response only lasts four to six months, it can be tricky to time the vaccine: If it’s an early flu season, you want to be protected ASAP…but you also want that protection to last for the entirety of flu season, especially if the spread starts later in the fall.
This year, however, the concurrent spread of COVID-19 means you don’t want to risk missing your chance for flu protection.
“What I’m telling people is that it’s better for a normal-risk person to get it as soon as it becomes available,” Dr. Kesh advises. “For higher-risk categories, we want the protection to last longer, so for them I would aim for October.”
Where to get a flu shot
Flu vaccinations have always been and will continue to be available through medical practices like primary care providers and pediatrician offices. Recently, more and more local pharmacies (and big box stores, like Walmart and Target) have been offering flu shots, too—and you can expect to see more of that this year.
“The government is trying to push out vaccines through pharmacies more this year to avoid overcrowding at doctors’ offices,” says Dr. Kesh, which means it should be easier than ever to get a flu vaccine while running errands.
Most pharmacy chains—from Rite Aid to CVS to Walgreens—are ramping up their flu shot promotion campaigns already with extra COVID precautions in mind. Major pharmacy chains are implementing patient temperature checks and wearing face shields while vaccinating for patient safety. And where young children could previously receive a flu shot only at a medical visit with their pediatrician, the U.S. Department of Health & Human Services (HHS) recently changed that policy, authorizing pharmacists to administer childhood vaccinations, including the flu shot, in an effort to make protection from the flu easier to come by.
Dr. Kesh adds that most vaccine manufacturers are increasing their production to respond to what the CDC hopes will be an elevated demand for vaccines: “In other countries, more people are getting vaccinated this year than normal—in past years, maybe 50% of Americans got it, and this year the CDC is hoping for 65%.”
The hope is that the more people that get vaccinated, the less flu cases we will see—easing an already burdened healthcare system during this pandemic.
What to expect from the 2020-2021 flu vaccine
There are nine different vaccines in production, says Dr. Cutler, but they will all provide protection against the same strains of the flu. (Different manufacturers produce different vaccines to ensure that there are enough to go around.)
“Most practices will choose one of the three types of those nine vaccines: the nasal spray, the standard injectable, and the recombinant vaccine,” he says.
|Types of flu vaccine||Brand name(s)||Who can get it||Get coupon|
|Nasal spray (live attenuated influenza vaccine)||Flumist||People aged 2 to 49 who are not pregnant, not immunocompromised, have never had an allergic reaction to a flu shot, and who do not have asthma or several other medical conditions||Get Rx card|
|Standard injectable||Afluria, Fluarix, Fluzone, FluLaval||Anyone over the age of 6 months||Get Afluria coupon Get Fluarix coupon|
|Fluad, Fluzone High-Dose||Anyone over the age of 65||Get Fluad coupon|
|Recombinant (egg-free)||Flublok||People over the age of 18 with egg allergies; vegans||Get Flublok coupon|
|Flucelvax||People over the age of 4 with egg allergies; vegans||Get Flucelvax coupon|
The two main kinds of flu to infect humans are A and B, and each have their own strain variations in circulation every year. Flu vaccines are now usually quadrivalent, meaning they target four strains in total—two A and two B. The common influenza A strains, H1N1 and H3N2, change frequently from one year to the next, but influenza B strains are less variable, says Dr. Kesh, who adds that this year’s A strains are different from last year but the B viruses are more consistent with what has been used in the past.
Even though the new flu vaccines have been modified to better target the strains experts think will circulate this year, the effectiveness of the vaccines remains the same: about 40% to 60%.
“Because they have to be made six months in advance, we never get 100% effectiveness,” Dr. Kesh says. The fact that only half the population gets a flu shot at all also lowers the overall effectiveness, since lower vaccination rates increase community spread. The herd immunity threshold against the influenza virus is 33% to 44%.
The bottom line
In all honesty, no one knows how bad flu season 2020 will be. Although we know which strains have been circulating in the southern hemisphere, we don’t know which ones will spread widely here—and some of the responsibility for that spread rests on us.
If we continue wearing face masks in public, social distancing, washing our hands, and staying home when we’re sick, we may be able to keep our flu numbers down. And, of course, the other piece of puzzle in reducing spread is the flu vaccine.
“The spray and the shot are equally effective—the most important thing is getting the vaccine into you,” says Dr. Kesh. “Nothing is risk-free, but your risk of getting the flu and having serious side effects is much higher than any risk of getting the vaccine.”