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The flu is hitting the U.S. unusually early and hard, leading to the most hospitalizations at this point in the season in more than a decade and underscoring the potential for a dangerous respiratory virus winter, according to federal health data released Friday.
Although the flu season is usually between October and May, with a peak in December and January, it has arrived about six weeks early this year with an unusually high number of illnesses. There have already been at least 880,000 cases of flu-like illness, 6,900 hospitalizations and 360 flu-related deaths nationwide, including one child, according to estimates released Friday by the Centers for Disease Control and Prevention.
Not since the 2009 H1N1 swine flu pandemic has there been such a high flu burden, a metric the CDC uses to estimate the severity of a season based on laboratory-confirmed cases, doctor visits, hospitalizations and deaths .
“It’s unusual, but we’re coming out of an unusual covid pandemic that has really affected influenza and other circulating respiratory viruses,” said Lynnette Brammer, an epidemiologist who leads the CDC’s domestic influenza surveillance team.
Activity is high in the southern and southeastern US, and is beginning to move up the Atlantic coast.
The CDC uses a variety of measures to track the flu, including estimating the percentage of doctor visits for flu-like illnesses. But given the similar symptoms that might include people seeking care for covid-19 or RSV, another respiratory virus with similar symptoms, the lab data leaves no room for doubt.
“The data is ominous,” said William Schaffner. medical director of the nonprofit National Infectious Disease Foundation and professor of infectious diseases at Vanderbilt University School of Medicine. “Not only is the flu early, but it also looks very serious. This is not just a preview of upcoming attractions. We are already starting to see this movie. I would call it a scary movie.”
Adding to his concern, he said, is that flu vaccine uptake is lagging behind what it usually is at this point in the season. “That worries me doubly,” he said. The high flu burden “certainly looks like the start of what could be the worst flu season in 13 years.”
The number of flu cases this season is already one-eighth of last season’s total estimate of 8 to 13 million cases.
So far, flu vaccination rates in the United States are lower than they have been at this point in the season in recent years. About 128 million flu vaccine doses have been distributed so far, compared with 139 million at this time last year and 154 million the year before, according to the CDC.
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The latest flu data comes as the country’s strained public health system is grappling with multiple virus threats. Cases of the coronavirus are expected to rise as the country moves into colder weather and more people gather indoors. New covid-19 subvariants with a greater ability to evade immune defenses now account for 27 percent of cases, up from 17 percent a week ago. Children’s hospitals are being overwhelmed by record numbers of children infected with RSV.
The flu vaccine’s effectiveness in preventing a doctor visit, hospitalization, or death is uneven from year to year, and in past years has ranged from 40 to 60 percent , according to the CDC. But Brammer and others say this season’s vaccine is well-adapted to circulating strains. That offers a “little ray of sunshine” for what could be a bleak winter, Schaffner said.
Nationally, the predominant virus, a particularly nasty strain, H3N2, causes the worst outbreaks of the two. types of influenza A virus and two influenza B viruses that circulate among people. Seasons where H3N2 is prevalent tend to cause the most complications, especially for the very young, the elderly and people with certain chronic health conditions, experts say.
What many people don’t realize is that even after someone recovers from the flu, the inflammatory response generated by the virus continues to wreak havoc for another four to six weeks in middle-aged and older people, increasing the rate of ‘heart attacks. and bangs, Schaffner said.
The flu has not been a serious problem in the past two years, experts and health officials said, because of masks, social distancing and other measures people took to protect themselves from covid-19.
The omicron variant of covid-19 has evolved into dozens of sub-variants that evade the immune system. The Post’s Frances Sellers explains the threat of these new strains. (Video: Jackson Barton, Sarah Parnass/The Washington Post)
Health officials tend to consider a flu season officially underway after consecutive weeks of flu activity by various surveillance systems, including a significant percentage of doctor’s office visits for flu-like illnesses. Those doctor visits have increased for three straight weeks since Oct. 22, more than a month earlier than in previous seasons, the CDC’s Brammer said.
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The flu is notoriously difficult to predict. It’s hard to know how long the season will last, how severe it might be, and whether different parts of the country will experience different levels of respiratory illness at different times. Last season, flu activity peaked in January, “then dropped like a rock, then smoked just below the epidemic threshold beyond March through April, May and June” , Schaffner said. That “long smoking tail was very unusual.”
“An early start doesn’t always mean serious,” Brammer said.
In the southern hemisphere, the flu season has also been very different, Brammer said. In Australia, there was a “very strong, very rapid uptake and then a very rapid decline”, he said. In Argentina, the peak of flu activity occurred in what would have been the summer of that country.
“Things have not returned to a normal pattern,” Brammer said.
Chile got ahead of its bad flu season, which started months earlier than a typical season, by quickly vaccinating 88 percent of its high-risk population before peak flu activity, according to a report by the CDC this week. The flu vaccine used in Chile, which included a match with the dominant H3N2 virus, was about 50 percent effective in preventing hospitalization. The vaccine used in the Northern Hemisphere includes the same viral makeup as the vaccine in the Southern Hemisphere, so experts expect the formulation to be equally effective in preventing serious flu illness.
The latest CDC data shows overall respiratory disease activity is “very high” in South Carolina and Washington, DC, and “high” in 11 states: Alabama, Georgia, Louisiana, Maryland, Mississippi, New Jersey, New York, North Carolina, Tennessee. , Texas and Virginia.
Texas was one of the first states to see flu activity in late September. At Houston Methodist Hospital System, lab-confirmed flu cases have risen to 975 as of Oct. 20, up from 561 the previous week, officials said.
Officials had been bracing for a more robust flu season this fall and winter because many people have abandoned protective measures against covid and are reluctant to get vaccinated.
“This was something we expected because we are a hub and a lot of people travel here,” said Cesar Arias, the hospital system’s chief of infectious diseases. “I didn’t expect to see so much [flu] so soon.”
Arias said the flu vaccine talks have been tied to the hesitancy over the coronavirus vaccines. The conversations in Texas, “as you can imagine, [are] stronger and at least more vocal,” he said. “We’re struggling with that, trying to get the message out to vaccinate.”
People must get a new flu shot each year to be protected, and it takes up to two weeks for protection to kick in and for the vaccine to work. The flu is contagious before symptoms start. The CDC recommends that everyone 6 months of age and older get a flu shot, ideally by the end of October.