PHILADELPHIA -- The flu is poised for a comeback this year after two seasons in the shadows of the COVID-19 pandemic.
Influenza circulates year-round in the United States but the virus is most active in the winter. Cases usually start climbing in October or November, peaking around January or February, and declining through May. In a regular season, the flu leads to as many as 710,000 hospitalizations and 52,000 deaths including up to 200 children, according to the Centers for Disease Control and Prevention.
Then came COVID-19.
People stayed home, wore masks, and kept a safe distance from one another. The result was record-low flu activity in 2020-2021.
“All these things that stop the spread of coronavirus also stop the spread of influenza,” said Scott Hensley, a professor of Microbiology at the Perelman School of Medicine at the University of Pennsylvania who studies the virus.
Fewer flu cases meant that fewer people developed immunity. Those, like Hensley, who closely follow influenza were worried that after the 2021 winter, flu would come back with a vengeance. And that’s how last year’s flu season started, Hensely says. But right before flu was expected to peak, the COVID-19 omicron variant emerged and the flu decreased. Influenza peaked again for an unusual second wave in the spring.
“The verdict is out,“ Hensley said. “We don’t know what will happen this year.”
One thing that will determine the severity of this year’s flu season is how many people get vaccinated. The Inquirer spoke to physicians and researchers to answer your questions about the flu shot.
Q. Should I get the flu shot?
A. Yes.
Because there was little flu activity in the past two years many people don’t have antibodies, which makes them more vulnerable, said David Cennimo, an infectious disease specialist at Rutgers University. It’s called “immune debt,” he said. His fear is that this season people will pay back that debt with more severe disease.
“Vaccination has been shown to dramatically decrease the risk of hospitalized influenza, really sick, severe influenza,” Cennimo said.
He says that everyone over age six months should get the flu shot — not just those who are at higher risk for severe illness, such as the elderly and people with compromised immune systems.
Q. Can I get the flu from the flu shot?
A. No.
Flu vaccines contain either inactivated virus (meaning the virus is no longer infectious) or particles made to look like the virus to the immune system.
“It’s a very safe vaccine,” Cennimo said. “You cannot catch flu from it.”
Q. What are the side effects for the shot?
A. Most side effects are mild.
Every year, Cennimo plans on getting the shot before the weekend because he knows he will feel achy and tired the day after. Common side effects include soreness in the location of the shot and cold-like symptoms, according to the CDC.
The side effects are the result of the body developing antibodies, says Renell Dupree, a family medicine physician and the co-medical director of the Ala Stanford Center for Health Equity. “[It’s] our immune system doing exactly what we are asking it to do,” she said.
Dupree also noted that side effects of the vaccine usually last one or two days, while you’ll be out of commission much longer — and with more severe symptoms — if you catch the virus.
Q. Can I get the flu shot and a COVID-19 booster at the same time?
A. Yes.
The CDC initially recommended waiting 14 days between getting the COVID-19 and flu vaccines. But more recent data suggest that it is safe to get the two vaccines at the same time, Dupree said. Some studies found that getting the two shots at once does increase the likelihood of mild side effects such as fatigue and headaches.
In a press briefing early last month, White House coronavirus response coordinator Ashish Jha said: “I really believe this is why God gave us two arms — one for the flu shot and the other one for the COVID shot.”
Q. Which flu shot should I get?
A. What matters more than which shot is that you get it.
That was the advice physicians and researchers told The Inquirer. There are multiple vaccines on the market and most offer the coverage people need.
People over 65 should ideally get a high-dose vaccine for extra protection, said Dupree. There are three approved formulations specifically for people over 65 — Fluzone high dose quadrivalent, Flublok quadrivalent, and FLUAD quadrivalent — and Depuree recommends any to her older patients.
Q. When should I get the flu vaccine?
A. Now-ish.
The best time to get the vaccine is before the flu begins spreading in your community, said Alicia Fry, who leads the influenza epidemiology and prevention team at the CDC.
“Ideally, everyone should be vaccinated by the end of October,” she said in an email.
But the vaccine is still worth it even later in the season, she added. Cases usually peak around February and continue through May.
Q. Does the flu vaccine cost money?
A. It shouldn’t.
Medicare, all health insurance marketplace plans, and most private insurance plans will pay for the influenza vaccine without charging a copay, so long as you go to an in-network provider. Medicaid programs in Pennsylvania and New Jersey cover all or some versions of the flu vaccine, though Medicaid coverage varies in other states.
The federally funded Vaccines for Children program provides free flu vaccines for children who are 18 years old or younger, eligible for Medicaid, or are American Indian or Alaska Native. Children who are underinsured, meaning they have health insurance but it doesn’t cover vaccines or has cost restrictions, can get vaccinated for free under the VFC program at a Federally Qualified Health Centers or Rural Health Clinics.
There are many places to get the flu shot for free regardless of insurance.
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