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This year, the possibility of a flu and COVID-19 outbreak in the fall worries health care professionals because of the stress it could place on hospitals.
“If you get sick and you're the one that needs an ICU bed, we want to make sure that you've got one,” said Emily Cheshire, doctor of nursing practice at the University of Colorado College of Nursing at Anschutz Medical Campus.
In the 2017-2018 flu season, 61,000 people died from the flu and more than 810,000 people ended up in the hospital, the worst flu year since the 2009 pandemic. About 37 percent of the U.S. had gotten the flu shot that year, which is estimated to have prevented 8,000 deaths.
Had more of the population been vaccinated, even more deaths and hospitalizations could have been avoided.
Vaccination rates for the flu in the U.S. are low. Last year, 45.3 percent of adults got a flu vaccine. Black and Hispanic vaccination rates were even lower at 39 and 37 percent respectively. Just as COVID-19 disproportionately impacts communities of color, so does the flu.
Readers asked lots of questions about the flu this year, so here's what you need to know:
If so many people are wearing masks for COVID-19, is the flu still expected to be bad this year? Seems like we'll be spreading fewer germs, not more.
Experts aren’t quite sure whether the flu will be bad or not. They are certain that if it is a bad flu year, that could spell disaster for hospitals and patients. Doctors and public health experts tend to look to the Southern Hemisphere to make predictions for the flu season in the U.S.
Australia is one place health practitioners look for clues because their earlier flu season provides a snapshot of what flu might look like. This flu season was mild for Australia. They’ve had 21,119 laboratory-confirmed cases in 2020, compared to 272,146 at the same time the year before.
But the reasons why may not translate to the United States. Australia had a record 18 million flu vaccines available compared to 13.2 million vaccines in 2019, and took a more aggressive approach to social distancing. Experts say that measures like mask wearing, hand washing and social distancing will help, but they don’t replace a vaccine.
“If we look at Australia, they're doing those things, but they also delivered 2 million more vaccines,” said Cheshire. “Their borders are closed, their schools are closed, they've got a lot more going on than we do.”
When should I get a flu shot?
Today. OK, but really, experts like Cheshire say to get your flu shot by Oct. 31.
Your body takes about two weeks to mount an immune response and create antibodies to protect you from the flu. It’s important to have full immunity before the flu season, which starts in October, peaks in December through February, and can last into May.
That doesn’t mean if you don’t get it by the end of October that you can skip it. It just means the sooner the better.
Everyone, 6 months or older, should get a flu shot every year, according to the Centers for Disease Control and Prevention. There are a few exceptions for those who’ve had an allergic reaction in the past or certain health problems. Talk to your health care provider if you’re concerned about getting a flu shot.
I'm old and have lots of underlying conditions, so I've been fastidious about isolating. I need a flu shot, but I don't want to wade into a doctor's office or pharmacy building to get one. Are there drive-up or outdoor flu shot locations?
You aren’t the only one, Joseph! Drive-up flu clinics are a good choice for people who are looking to avoid contact as much as possible. There are a few hospitals and health systems offering drive-up flu shots.
The University of Colorado’s Belleview Point Clinic in Aurora offers a drive-up service by appointment only for anyone on Sept. 23 and Oct. 7. However, they do not accept Kaiser or Denver Health Medicaid insurance. Those patients can pay out of pocket: $30 for those 64 and younger and $50 for ages 65 and older.
Kaiser Permanente facilities are offering drive-up flu shots for members through September by appointment only. You can find locations and hours here.
Safeway and Albertsons are offering drive-up flu shots at locations in Denver, Colorado Springs, Pueblo and Fort Collins. No appointments are necessary, but be sure to check the dates and times for each location. (Special thanks to Lynne for the tip!)
Banner Health has locations in Weld and Larimer counties offering drive-up flu shots. Flu shots cost $35 and can be paid for with cash, credit card or Medicare Part B. Call 970-810-6633 for more information. (Special thanks to Serena for the tip!)
Know of another drive-up option? Tell us at email@example.com.
I am age 71 and have read that the CDC recommends those over age 65 receive the 'high-dose' flu vaccine. Any comments or suggestions?
As people age, their immune systems are less effective at mounting an immune response. Until 2010, there was only the standard dose flu shot available. People who are 65 and older account for 70 to 85 percent of flu-related deaths and 50 to 70 percent of hospitalizations. Then came the high-dose vaccine, which has been shown to be 24 percent more effective in preventing flu in adults over age 65.
“The amount of antigen that's delivered is more, therefore your body creates more antibodies,” Cheshire said. “The antibodies are what mounts your immune response, so that when flu comes along in the community and you're exposed to the flu, that's not the first time your body's seen it.”
The Fluzone High-Dose Quadrivalent vaccine contains four times the antigen, which is the part of the vaccine that helps your body build up protection against flu viruses, than a standard dose vaccine.
There are two different types of high-dose flu vaccines, Fluzone and FLUAD. The Fluzone contains that higher antigen amount, while the FLUAD pairs the standard dose vaccine with an adjuvant, which is an immune stimulant that causes the immune system to have a higher response to the vaccine. The CDC does not recommend one over the other.
Why are they charging older people more for a flu shot?!?!
“To have a stronger vaccine and to have something added to it that's highly purified – it makes the vaccine more expensive,” Cheshire said.
Medicare Part B and most Medicare Advantage plans cover the cost of the high-dose flu vaccine. Some places offer free vaccines to uninsured people.
Where else can I get a flu shot?
Your doctor’s office, local pharmacy, urgent care or community health center all likely offer flu shots. This year, all pharmacies, clinics and doctor’s offices have implemented social distancing guidelines, which may mean you need to make an appointment. Places like Walgreens and Target pharmacies offer walk-in appointments. Flu shots cost you nothing under most health insurance and are covered under the Affordable Care Act.
What if I don’t have insurance?
You still have options. One way is to head to your local pharmacy and pay out of pocket for the flu shot. That can run you anywhere from $19.99 to $69.99, depending on the flu shot you get.
Costco pharmacies offer the flu shot for $19.99. You don't have to be a member to get your flu shot at Costco. You can reserve a time or walk-in.
CVS Pharmacy has the seasonal flu vaccine for $39.99 and a high–dose vaccine for $69.99. High-dose vaccines are typically for people 65 and older to better protect them against the flu. You make an appointment or walk-in to a CVS pharmacy location.
There are also places that offer free flu shots to folks without insurance. Denver Public Health’s Immunization Clinic is one such place. Just call ahead and make an appointment. You can also search for a provider using the Colorado Department of Public Health and Environment’s find-a-free-vaccine-provider tool.
I’m still skeptical. In the past, I’ve gotten a flu shot, and then I got sick anyway. Does it even work?
First, it’s important to know that the flu vaccine does not cause the flu. There is no live virus in the vaccine that could make you sick. But there are a few ways you may have gotten the flu anyway.
Remember that two-week period for immunity? That means that right around the time you get the flu shot, you’re still susceptible to the flu. So if you’re exposed right before or right after you get the shot, you could still get the flu.
You’re also still susceptible to other viruses like the common cold or COVID-19 that have similar symptoms. The only way to know for sure if you have the flu is to get tested. You may have had another virus after getting the flu shot.
Now, say you got the flu shot yesterday or the day before and now you’re feeling a little rundown and tired, and are running a low-grade fever. That must mean the flu shot made you sick, right? Not really.
“That's your immune system ramping up saying, Oh, there's something I need to be fighting here. Let me get ramped up,” Cheshire said. Your body is reacting to the foreign material, and creating the defenses it could eventually use to fight the flu. “So that piece should actually make us feel pretty good, right? Like, oh, my immune system is working.”
The flu vaccine is a safe and effective way to prevent the flu. But, like any medication, it can cause complications in some people.
You may also have gotten sick from a strain not protected by the vaccine. More on that below.
How reliable is the flu shot? Am I definitely protected if I get it?
It depends on the year and other factors. There are four types of flu: influenza A and B, responsible for most seasonal flu viruses in the U.S., influenza C, which isn’t thought to cause severe illness, and influenza D, which is found in cattle. Those four types all contain different strains, making the creation of a flu vaccine a difficult task. Plus, these strains are known to mutate quickly which can make a vaccine less effective.
Every year, scientists and health experts look to the Southern Hemisphere and other data to pick which flu strains will be in the vaccine – typically three or four. They don’t always predict correctly, and sometimes a flu strain spreads in the U.S. that isn’t in the vaccine.
When you get a flu shot it contains deactivated versions of the virus. They can’t make you sick, but they do allow your body’s immune system to create antibodies that will fight the live virus if you come into contact with it.
No vaccine is 100 percent effective. That’s due to a host of reasons, including the fact that people’s bodies respond differently to vaccines, and that viral strains change over time, making the antibodies you have less effective.
For the upcoming flu season, manufacturers estimate they will provide between 194 and 198 million doses of the flu vaccine, breaking last year's record of more than 175 million doses.
How long is this year's flu vaccine effective?
The flu vaccine is most effective in the first three months after getting the shot, but it lasts for about six months, Cheshire said. Over time, antibody levels decline and changes in the flu strain from year to year mean the antibodies you do have are less effective against new strains.
How does the flu spread?
The flu, a respiratory virus, is spread in much the same way as the novel coronavirus, through droplets from a person's mouth or nose. You can also contract the flu by touching droplets and transferring them to your mouth or nose.
If I get the flu, or a rhinovirus or common cold, how do I know I don’t have COVID-19? When should I go see a provider?
Short answer: you’re not going to know if it’s COVID-19, the flu or a common cold without a test. Plus, this year’s wildfires have only made symptoms more confusing. The flu and COVID-19 look especially similar, but the wide variety of symptoms for any of the three means you have to get tested to know for sure.
Cheshire said her first question to patients reporting COVID-19 or flu-like symptoms is, “Did you get a flu shot?” It will help her to determine the best course of action for care.
Can I have flu and COVID-19 at the same time?
Yes. Scientists are still studying how common an infection with both viruses might be, but it’s possible to have the flu, other respiratory viruses or COVID-19 at the same time. One study of about 1,200 people in northern California found that one in five people diagnosed with COVID-19 were coinfected with another respiratory virus. The pathogens attach to different receptors on our cells to gain access to our bodies, which means the SARS-CoV-2 virus and a flu virus could enter separately and coexist – all the more reason to protect yourself from the flu and get a flu shot.
Will any flu vaccination this fall interact negatively with any potential COVID-19 vaccine this coming winter or spring?
“We can't answer that question a hundred percent from a scientific standpoint right now. And that's because there's no COVID vaccine currently,” Cheshire said. “Flu vaccines can be given safely and effectively and are recommended by the CDC to be given simultaneously with the long list of other vaccines.”
Once a COVID-19 vaccine is widely available, we should figure this out quickly. But, it’s important to keep in mind that most Americans may not see a COVID-19 vaccine until late spring or early summer 2021.
Just remember: a flu vaccine will not protect you from COVID-19 – mask wearing, hand hygiene and social distancing are still the best ways to prevent the spread of the coronavirus.
Do you have questions about the flu and the flu vaccine that weren’t answered here? Email us at firstname.lastname@example.org! We'll continue to update this story with answers to your questions.