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Flu shots during the COVID pandemic: everything you need to know

It’s more important than ever to get vaccinated because flu symptoms are similar to those of coronavirus and can put you at greater risk.

The CDC says everyone 6 months old and older should get the flu vaccine every year.
The CDC says everyone 6 months old and older should get the flu vaccine every year.
Sherry Young -

The message to vaccinate hasn’t been lost on Americans already calling their doctors and pharmacists to schedule a flu shot appointment before the start of the 2020-2021 influenza season.

Experts say it’s especially important this year, amid the coronavirus pandemic, to get vaccinated against the flu, whose symptoms can be similar.

It’s hard to predict how COVID-19 will mix with this year’s flu season. Will mask-wearing and social distancing help limit flu transmission as it’s meant to do with SARS-CoV-2? Or will both viruses simultaneously wreak havoc on the nation even as some schools reopen for in-person learning?

“This fall, nothing can be more important than to try to increase the American public’s decision to embrace the flu vaccine with confidence,” says Dr. Robert R. Redfield, director of the Centers for Disease Control and Prevention. ”This is a critical year for us to try to take flu as much off the table as we can.”

Here’s what doctors say everyone should know about the flu vaccine as we approach the start of this year’s season:

Who should get a flu shot?

The CDC recommends everyone who’s 6 months old or older should be vaccinated against influenza every year.

“It is more important now than ever to get a flu vaccine because flu symptoms are very similar to those of COVID-19, and preventing the flu will save lives and preserve health care resources,” says Dr. Larry Madoff, medical director of the Bureau of Infectious Disease and Laboratory Sciences for the Massachusetts Department of Public Health.

When should I get my flu shot?

Dr. Susan Rehm of the Cleveland Clinic’s Department of Infectious Diseases says it’s important to get the influenza vaccine as soon as possible.

CVS stores already had flu vaccine in stock, and it became available Monday at Walgreens. And Chicago-area Jewel-Osco pharmacies also are administering flu shots on a walk-in basis.

Some doctors are recommending people wait to get a flu shot until late September or early October so the protection can last throughout the flu season, which typically ends around March or April. The vaccine lasts about six months.

The CDC recommends people get a flu shot no later than the end of October. It takes a few weeks for it to become fully protective. But even if you don’t get it by then, the CDC says it’s better to get vaccinated late rather than not at all.

Healthy people can get vaccinated as soon as it’s available, but experts recommend older people and those who are immune-compromised wait until mid-fall to get their shots so it lasts the entire flu season.

What is the high-dose flu shot for seniors?

People over 65 should get Fluzone High-Dose or FLUAD. It provides better protection against flu viruses.

Fluzone High-Dose contains four times the antigen that’s in a standard dose, making it a stronger version of the regular flu shot. FLUAD pairs the regular vaccine with an adjuvant — an immune stimulant — to cause the immune system to have a higher response to the vaccine.

Research indicates that such high-dose flu vaccines offer improved protection against the flu. A peer-reviewed study published in The New England Journal of Medicine and sponsored by Sanofi, the company behind Fluzone High-Dose, found the high-dose vaccine is about 24% more effective than the standard shot.

An observational study in 2013 found FLUAD to be 51% effective in preventing flu-related hospitalizations for people 65 and older. No studies have done a comparative analysis between the two vaccines.

Is the flu vaccine safe?

According to the CDC, hundreds of millions of Americans have safely received flu vaccine over the past 50 years.

Common side effects for the flu vaccine include soreness at the injection spot, headache, fever, nausea and muscle aches.

Dr. William Schaffner, professor of infectious diseases at the Vanderbilt Medical Center in Nashville, Tennessee, says these symptoms aren’t the flu. The vaccine can’t cause influenza.

Not only is the flu vaccine safe, but the pharmacies, doctor’s offices and hospitals administering it are also safe.
Not only is the flu vaccine safe, but the pharmacies, doctor’s offices and hospitals administering it are also safe.

“That’s just your body working on the vaccine and your immune response responding to the vaccine,” he says. “That’s a small price to pay to keep you out of the emergency room. Believe me.”

Some studies have found a small association of the flu vaccine with Guillain-Barré syndrome.

But Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, says there’s a one-in-a-million chance of that.

Not only is the flu vaccine safe, but the pharmacies, doctor’s offices and hospitals administering it are also safe.

Horovitz and Schaffner say hospitals are taking all necessary precautions to make sure patients are protected against COVID-19. Some hospitals send staff out to patients’ cars for inoculation; others allow patients to bypass the waiting room. All offices require masks, social distancing and are routinely disinfected.

Will it help prevent COVID?

While experts speculate that any vaccine hypothetically could provide some protection against a virus, there’s little data that suggests the flu vaccine can protect against the coronavirus, SARS-CoV-2, which causes COVID-19.

“We don’t want to confuse people of that,” Schaffner says, “because there’s simply no data. Flu vaccine prevents flu. We’re working on a coronavirus vaccine. They’re separate.”

Still, experts say it’s important to get the flu shot this year to lessen the burden on hospitals overwhelmed by COVID-19 patients.

A 2018 study found the flu vaccine lowers the risk of severe illness, reducing the risk of being admitted to intensive care with flu by 82%, according to the CDC.

“People perhaps forget that influenza is something that we see every year,” Rehm says. “Tens of thousands of people die of influenza ever year, including people who are very healthy, and hundreds of thousands of people are hospitalized every year.”

Doctors say it will be even more hectic this year, as some flu and COVID-19 symptoms overlap, delaying diagnosis and possibly care.

What can we expect from this year’s flu season and vaccine?

“Even before COVID, what we say about the flu is that it’s predictably unpredictable,” Rehm says. “There are some years that it’s a light year and some years that it’s horrible.”

Flu experts say they sometimes look at Australia’s flu season to get a sense of the strain and how it spreads as winter in the Southern Hemisphere started a few months ago.

According to that country’s Department of Health surveillance report, influenza has virtually disappeared, with only 85 cases reported in the last two weeks of June — compared to more than 20,000 confirmed cases at that point last year.

“Australia has had a modest season, but they were very good at implementing COVID containment measures, and, of course, we’re not,” Schaffner says. “So we’re anticipating that we’re going to have a flu season that’s substantial.”

The CDC says two types of flu vaccines are available for the 2020-2021 season: the trivalent and the quadrivalent.

Trivalents contain two flu A strains and one flu B strain and are solely available as high-dose vaccines.

Quadrivalents contain those three strains plus an additional flu B strain and can be both high-dose and standard-dose vaccines.

While some doctors might have both vaccines, others might only have one, depending on their supply chain. But people should get whichever vaccine is available to them.

Horovitz says vaccine production and distribution has been on schedule this year despite international focus on coronavirus vaccine development.

Producers are boosting supplies of the flu vaccine this year to meet what they expect will be higher demand. Vaccine maker Sanofi said Monday it will produce 15% more vaccine than in a normal year.

Redfield told the Journal of the American Medical Association the CDC arranged for an additional 9.3 million doses of low-cost flu vaccine for uninsured adults this year, up from 500,000. The agency also is expanding plans to reach out to minority communities.

What about nasal spray instead of the shot?

After the 2009 swine flu pandemic, several studies showed the nasal spray flu vaccine was less effective against H1N1 viruses, leading the CDC and the Advisory Committee on Immunization Practices to recommend against it.

But since the 2017-2018 season, ACIP and the CDC voted to resume the recommendation for its use after the manufacturer used new H1N1 vaccine viruses in production.

While these agencies and advisory committees don’t recommend one vaccine over the other, some pediatricians prefer the nasal spray because it’s easier to administer to children than a shot.

Other doctors prefer the flu shot because some of the nasal spray’s side effects mimic respiratory symptoms. Those include wheezing, coughing and a runny nose, according to the CDC. Horovitz says anything that presents cold symptoms should probably be avoided, especially among children, who are known vectors of respiratory diseases.

“Giving them something that gives them cold [symptoms] for two or three days may expel more virus if they’re asymptomatic with COVID,” he says.