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Surge in Flu Cases Brews ‘Perfect Storm’ for Holidays

Older adults bear brunt of influenza in December as RSV and COVID add to toll

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Drazen Zigic

Flu hospitalizations as of early December are at the highest level seen in a decade, public health officials say, and the majority of the 78,000 patients hospitalized so far have been 50 and older, federal data shows.

The Centers for Disease Control and Prevention (CDC) estimates that 8.7 million Americans have been sick with the flu this season and 4,500 have died from the illness — and no region of the country is being spared by the outbreak.

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Nearly all U.S. states are reporting high or very high levels of flu-like illness, which includes people going to the doctor with a fever and a cough or sore throat, CDC Director Rochelle Walensky, M.D., said in a Dec. 5 media briefing. Just four states (New Hampshire, Vermont, Michigan and Alaska) are experiencing low levels.

“Flu is here,” said Sandra Fryhofer, M.D., board chair of the American Medical Association and an Atlanta-based internal medicine physician. “It started early, and with COVID and RSV also circulating, it’s a perfect storm for a terrible holiday season.”

In fact, COVID-19 hospitalizations are climbing after a fall lull, which Walensky says is “especially worrisome as we move into the winter months when more people are assembling indoors with less ventilation.” Cases of RSV — or respiratory syncytial virus, which like flu can be especially dangerous for older adults — remain high across the country, Walensky said. Even in areas where RSV is declining, “our hospital systems continue to be stretched with high numbers of patients with other respiratory illnesses,” Walensky added.

Vaccines can help to blunt the impact 

The best way to prevent the worst outcomes of both flu and COVID-19 is to get vaccinated, public health authorities stressed. (There is no vaccine for RSV, but scientists are working on one.)

Uptake for the flu shot, however, is behind last year’s pace for some groups, including pregnant women and children, Walensky said in the briefing. CDC data shows that about a quarter (26 percent) of U.S. adults received the flu shot by the end of October; and just under half of older adults (45 percent) rolled up their sleeves.

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Fryhofer says there’s likely a “sense of complacency” after two “almost nonexistent” flu seasons, largely due to social distancing, masking and other pandemic precautions put in place to keep germs from spreading. “We’ve forgotten how bad flu can be, but this year’s season is a shout-out that it can get really bad. And it’s here, so people need to get vaccinated,” she said.

It’s recommended that adults 65 and older get what’s known as a high-dose flu shot for even greater protection. There are three different options to choose from, “but if one of those is not available, don’t wait. It’s better to get any flu shot than no flu shot at all,” Fryhofer said.

If you’ve already had the flu this fall, you should still get vaccinated, Fryhofer said. “Different flu strains can circulate within the same flu season, and the only thing worse than getting flu once in the season is getting it again,” she said. This year’s vaccine targets two stains of influenza A and two strains of influenza B and appears to be a “good match” for what’s circulating, Walensky added. 

When it comes to COVID-19 vaccines, just over 12 percent of eligible individuals have received the latest version of the shot that targets the most current coronavirus variants. About one-third of fully vaccinated adults age 65 and older have gone back for the updated booster, which first became available in September. Older adults, meanwhile, continue to have the highest mortality rates from COVID-19.

“If you’ve received your primary COVID vaccine series only, you are considered fully vaccinated but you are not considered fully protected,” Walensky said. A recent CDC study found that the updated booster provides “significant additional protection” against symptomatic COVID-19. Previous research has found that adults who are up-to-date on their COVID-19 vaccines are much less likely to wind up in the hospital or die from the disease.

“We all have booster fatigue. But understand you could get really, really sick this year and ruin your holiday celebrations if you don’t get vaccinated,” Fryhofer said.

COVID-19 precautions work for other respiratory illnesses 

In addition to getting vaccinated, there are a few other things you can do to protect yourself from the respiratory bugs that are blanketing the U.S. Stay home when you are not feeling well, wash your hands often, and avoid poorly ventilated spaces, health officials said.

“We also encourage you to wear a high-quality, well-fitting mask to prevent the spread of respiratory illnesses, most especially for those in the 5 percent of the population currently living in counties with high COVID-19 community levels,” Walensky said. (These levels take into account COVID-19 case numbers and hospitalizations.)

Walensky added that the CDC continues to recommend masking on planes, trains, buses and other forms of public transportation, “or for anyone who may be immunocompromised or at increased risk of severe disease” from a coronavirus infection.

If you do get sick and experience symptoms of COVID-19 or flu — a few common overlapping symptoms are fever, sore throat and cough — it’s important to get tested so you can be treated. “It is going to be a confusing respiratory infection season, and figuring out what’s making people sick is going to be a conundrum,” Fryhofer said. You can test yourself for COVID-19 at home; a health care provider can perform a flu test.

There are prescription antiviral treatments for both flu and COVID-19 that can help to keep symptoms from progressing. In both instances, these medications need to be started soon after symptoms begin for them to be effective.

“As we approach the holiday season, togetherness, family, community and connection are truly now more important than ever to achieve all of those things in good health. It’s critical we all take the steps to protect both ourselves and our loved ones,” Walensky said. 

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