This year’s flu season may start earlier and be more active

CEDAR RAPIDS — After two years of mild flu seasons due to COVID-19 mitigation efforts like mask wearing and social distancing, local health experts are bracing for cases of influenza to increase this year.

For the past couple of years, experts have warned of twin pandemics with COVID-19 and influenza. So far, that hasn’t happened.

That may change this year. Some countries in the southern hemisphere — particularly Australia — are experiencing their most severe flu season in five years. The flu season Down Under can be an indicator of what’s to come in the northern hemisphere, and it can help inform which vaccines to use.

Australia’s flu case count has surpassed pre-COVID-19 numbers.

Dr. Tony Myers, vice president of system quality, risk and medical affairs at Mercy Medical Center in Cedar Rapids, said another point of concern is that Australia’s flu season started six to eight weeks earlier than it typically does. The Australian flu season usually lasts from June to September, but this year it started in April.

An earlier start usually means a more severe season.

So far this year, Australia has seen 216,725 cases and more than 270 deaths due to influenza, according to Australia's Department of Health and Aging. In 2021, the country had around 500 reported cases and zero reported deaths. More than 80 percent of Australia’s reported cases have been influenza A.

Since April, Australian sentinel hospital sites have reported 1,666 flu-related admissions with more than 6 percent being admitted directly to ICU.

“If it’s going to start earlier than it usually does here, that will be soon,” Myers said. “We will see cases increase very soon in the next few weeks if that happens.”

Typically, the U.S. flu season runs from mid- to late-fall through the winter, with the peak happening between December and February.

Last year’s season in the U.S. was exceptionally mild, according to data from the Centers for Disease Control and Prevention. The CDC estimates that from Oct. 1, 2021, through June 11, 2022, between 8 million and 13 million people caught the flu, and around 5,000 to 14,000 individuals died in the U.S.

In comparison, from 2010 to 2020, the U.S. recorded between 9 million and 41 million cases of the flu each year, resulting in 12,000 to 52,000 deaths annually, according to the CDC.

“Last year with flu season, I think it's important to remember we had a lot of mitigation factors in place that would be beneficial for any respiratory illness,” said Linn County Public Health Clinical Branch Supervisor Heather Meador. “We had a lot of masks and social distancing, people really thinking about their health and how they felt. People were better about staying home. Schools and workplaces were set up with distance between people to help reduce the spread.”

Local experts are encouraging residents to get vaccinated early this year. In the last week, pharmacies at Hy-Vee and CVS have started offering flu vaccinations by appointment or walk-in.

Only about half of the U.S. population got the shot during the 2020-21 season, the CDC reported. And only around one-third of Iowans received the flu vaccine last year, according to Iowa Department of Public Health data. Cases in Iowa were considered “minimal” by IDPH and the CDC.

“A lot of my concern goes toward how people are feeling about vaccinations at this time,” Meador said. “The vaccine is not going to protect you from getting the flu, but it will protect you from severe complications. The goal is to keep you out of the hospital and from dying. You never know if it will be your year to get really sick until it happens.

“I do have concerns we will not see the numbers getting shots that we want to see,” Meador said.

Increased flu hospitalizations in the country, in Iowa and in the Linn County area would put a strain on the already-struggling health care system, which has been stretched thin since the COVID-19 pandemic began.

“We’re all stretched from a staffing standpoint,” Myers said. “All hospitals are. You may think it’s just a few extra admissions but unfortunately, we have limited ability to absorb additional people. We will. We will get it done. But it adds more pressure to the staff.”

In Australia, children and teenagers have made up the majority of flu cases. One reason for that may be that young children haven’t been as exposed to the flu virus due to the abnormally inactive flu years during the COVID-19 pandemic, according to the country’s health department.

“All the kids are back to school and it’s anticipation, on the flu side, that a lot of kids were not exposed at all, so there may be an increase in kids with flu. That certainly won't put pressure on hospitals, but outpatient care, too,” Myers said.

While there’s an expectation that flu cases will be up this year, an increase in COVID-19 cases is possible as well as people move back indoors during the winter months and have indoor gatherings during the holiday season.

“Come fall and winter, with a decrease of mitigation efforts, we’re going to be inside and closer contact and I anticipate we will see more COVID cases circulating, but we’re also in a much better place now and even though we have high transmission rates, the vaccinations are effective and not at prevention but protecting from severe complications,” Meador said.

“We expect a COVID surge, but nobody has a reliable prediction of that,” Myers added. “The population should've been exposed to Omicron now, so unless there's a new variant, I don't expect a huge surge like the last two years.”

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