The flu season always hits hard, but this year is different. There is a looming threat of a “twindemic,” which is the combination of a severe flu season and the current pandemic. Even a mild flu season can disrupt hospitals that have already been stretched by the surge of COVID-19 cases. While there is no vaccine yet for COVID-19, there is one for influenza and doctors are urging people to get the flu shot to reduce the risk of widespread outbreaks.

What doctors wish patients knew

Keep patients up-to-date on how to safely navigate the pandemic with insights from physician colleagues in this special edition of AMA Moving Medicine.

Kate Kirley, MD, a family physician and director of chronic disease prevention at the AMA, took time to discuss what doctors wish patients knew about the influenza vaccine to help clear up any misinformation.

While the flu shot is made of pieces of the virus, “the nasal spray is a whole virus, but it’s an inactivated form of the virus, so neither kind can actually give you the flu,” said Dr. Kirley. “It’s not uncommon for people to have a low-grade fever or feel a little run down for a couple of days after they get their vaccine. That’s just their immune system responding to the vaccine and doing exactly what we want it to do.”

Patients will sometimes coincidentally come down with the flu shortly after receiving the vaccination, but that’s just a quirk of timing, Dr. Kirley explained.

“It takes the vaccine a couple of weeks to generate a full immune response, so you don’t have your full protection until a couple of weeks after you get your shot,” she noted.

Learn more about six reasons patients avoid flu vaccination.

“People have not necessarily been getting their preventive medical services that we all should continue getting” during the pandemic, said Dr. Kirley. “We really want to highlight the importance of continuing to get preventive services in general, and the flu vaccine is a great example of that.

“Every year, influenza causes hundreds of thousands of hospitalizations and tens of thousands of deaths in the United States,” she said. “We're very concerned about it compounding the hospital capacity problems that we may see if we get more surges in the numbers of patients with COVID.”

Additionally, it is “possible to get influenza and COVID at the same time, and then you really have that double whammy in terms of two significant respiratory illnesses,” said Dr. Kirley, adding that the vaccine is ”really to get the protection against that scenario.”

Read this JAMA clinical update on influenza in the COVID-19 era.

“We typically don't know the effectiveness of the vaccine until we really get into flu season and we can see what types of viruses actually end up circulating in the population,” said Dr. Kirley, adding that every year, the flu vaccine is adjusted to align with what is predicted to be the most likely strains circulating.

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“It typically falls somewhere between 40% and 60% effectiveness,” she said. “In recent years, I have typically seen them reporting closer to 60% for common flu strains, which is great.”

Learn about nine questions your patients may have about the flu vaccine.

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices is “generally recommending what they would recommend every year, which is shoot for September or October to get your flu vaccine,” said Dr. Kirley. “You can start to get your vaccine, ideally before the end of October, but if you don’t squeeze it in, go get it any time.”

“Ideally before January is what’s best. But we’ll tell people all throughout flu season, if you haven’t gotten the vaccine yet, it’s still OK to get it and you’re likely to benefit,” she said.

Learn how to get patients on board with immunization.

“There are a couple reasons why someone might not be able to get the flu vaccine—that’s relatively rare,” said Dr. Kirley. “A real allergy to it might be the most common reason, but generally speaking, if you are older than six months old, you should definitely get the flu vaccine.”

“Our seniors, for sure, are a higher-risk population. They have slightly different vaccine options that are designed to protect them a little bit more,” she said. “Because they are also clearly one of those high-risk populations for COVID, it is even more important for them to protect themselves against the flu as well.”

“The sprays are only approved for ages 2 through 49,” said Dr. Kirley. “There are some medical conditions or reasons why you may not be able to get the spray, or it may not be the best choice for you, but most people can take that option of getting the nasal spray if they really are anxious about getting the shot.

“We will definitely say, ‘If it means you end up getting a flu vaccine and you'd rather choose a nasal spray, get that nasal spray,’” she added. “It is typically pretty comparable to the shot in terms of effectiveness.”

“There are benefits to us as individuals: We're less likely to get the flu. Even if we do develop the flu, we're less likely to need to be hospitalized and it tends to be less severe if you get the vaccine,” said Dr. Kirley. “It is also about protecting others—your family, friends, community members.”

Related coverage

9 questions your patients may have about the flu vaccine

“The flu vaccine is most effective for all of us when more of us get it, so we can get closer to achieving—at least for flu season—that herd immunity,” she said. “Getting the flu shot is not just doing something for yourself, but it definitely is a way you can contribute to good health in your community.”

Learn more about how teamwork and an empathic approach helped a clinic double their vaccination rate.

“You have a lot of options in terms of where you can receive the flu shot. We usually suggest that people reach out to their primary care doctor's office first,” said Dr. Kirley. “Primary care physician offices usually have lots of options for how you can come in and get your flu shot, but there are other places as well.”

“This year, we're going to see a real decline in employers offering the flu shot with so many people working from home. That’s definitely a concern for me,” she said. “There's going to be a big awareness push to help people find where they can get their flu shots.”

Read about the Centers for Disease Control and Prevention’s push to vaccinate 65% of Americans against the flu.

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