Health experts stress importance of flu shot to avoid 'twindemic'

With the upcoming flu season on a collision course with the COVID-19 pandemic, there have been warnings of a potential “twindemic,” as health experts urged people to get their flu shot in the coming weeks.
“It has never been more important to get a flu vaccine because of COVID-19,” said Dr. Randy Bergen, who leads Kaiser Permanente’s flu vaccine program in Northern California and is also a pediatric infectious disease specialist at Kaiser in Walnut Creek. 

“During any winter season, people get multiple wintertime viruses either at the same time, or more commonly, one after the other,” Dr. Bergen explained. He said that as the body recovered from one illness, it’s in a more weakened state. “That is the concern about this ‘twindemic.’ Many healthcare providers are worried that if you get the flu, as you recover you would be at greater risk for a more severe case of COVID-19 or as you are recovering from COVID-19 you might be at greater risk for more severe flu symptoms.”

So failure to control coronavirus cases posed an even greater health threat moving into fall, when the flu season takes off and cooler temperatures bring more people to congregate indoors, making it easier to spread both the flu and the coronavirus.

"The indoor environment is really in almost every way much more the high threat environment because of the relatively reduced circulation of air and the fact that we do now appreciate SARS-CoV-2 and even the flu is likely spread by small particle aerosols which can be suspended for three to four hours in relatively still air indoors," explained  Dr. Dean Winslow, an infectious disease physician at Stanford Health Care and professor of medicine at Stanford University.

And with both infectious illnesses sharing many of the same symptoms, including fever, cough, sore throat, and body aches, health experts were bracing for emergency rooms and intensive care units to be flooded. 

FILE - Nurses care for a coronavirus COVID-19 patient in the intensive care unit (I.C.U.) at Regional Medical Center on May 21, 2020 in San Jose, California.

“With two serious respiratory viral illnesses happening at the same time there is no question that there will be more people who will get very sick,” according to Dr. Bergen who added, “There are limits to our healthcare system and when those limits reach the breaking point our ability to take care of patients can become more limited.” 


In an effort to help prevent stressing the health care system this flu season, the University of California last month took the rare step of issuing a systemwide executive order requiring UC faculty, staff and students to receive a flu shot before Nov. 1.

“The executive order is an important proactive measure to help protect members of the UC community — and the public at large — and to ameliorate the severe burdens on health care systems anticipated during the coming fall and winter from influenza and COVID-19 illnesses,” university officials said announcing the executive order. “In addition to protecting those on campuses and the surrounding communities, this requirement is designed to avoid a surge of flu cases at health care facilities across the state during the unprecedented public health crisis caused by the coronavirus pandemic.”

And to help ensure that a wider population of Americans got access to the flu vaccine this year, the Centers for Disease Control and Prevention has ordered an additional 9.3 million doses of vaccine for uninsured adults. That’s compared to roughly 500,000 doses in a typical year.

“There are many benefits from flu vaccination and preventing flu is always important,” CDC spokesman Jason McDonald told KTVU, “but in the context of the COVID-19 pandemic, it’s even more important to do everything possible to reduce illnesses and preserve scarce health care resources.”

Dr. Dean Winslow applauded the increased efforts by public health agencies to bring awareness about the importance of flu vaccination. “That may be one of the small, kind of unanticipated positive things that may come out of this terrible situation we’re in,” Winslow told KTVU. “The increased recognition of the severity of respiratory viral infections is really spurring Americans of all ages to get vaccinated.”

Winslow was also optimistic that the lifestyle changes brought on by the coronavirus, including wearing masks, social distancing, and reduced indoor dining, would be instrumental in stemming the spread of the flu.

“Again, that may be unanticipated benefits of the measures that we’re taking now to try to flatten the curve of coronavirus cases,” he said and emphasized the need to continue these practices. “I'm optimistically hoping that by us being careful for the next six months or a little longer, that it will also have a beneficial effect on reducing influenza transmission this season as well.” 

He said he expected a vaccine for COVID-19 to come out early next year, but in the meantime, “It’s really important for people to particularly protect themselves against the disease that we know that we have effective preventions for… which is by the way a very safe vaccine that’s been around for a long, long time.”

Winslow and other health experts said that the flu can show up in California as early as October and recommended that people got vaccinated by the end of September. They also noted that it’s important to take into account the roughly two weeks after getting the shot, for the body to build an immunity and develop protection against the flu. 

Dr. Winslow said currently at Stanford Health Care, flu shots were not yet available, he but expected vaccines to arrive in about a week. 

Kaiser was also preparing to roll out its flu vaccination program for the season. Bergen said every year the health system aimed to increase the number of members who get vaccinated, and in no way was this year different. 

For those who felt rushed to get their shot over concerns that an increase in demand might lead to a shortage? Dr. Bergen reassured the public not to worry. “People should not feel panicked about the flu vaccine supply,” he said. “We will be reminding people of the need for flu vaccine once all of our operations are in place. At that time people should come in and get a flu vaccine but they should not feel like they have to rush.” 

Even with the warnings of a possible “twindemic,” health experts acknowledged that there were those who continued to question the safety of the flu vaccine, as some have routinely avoided getting immunized, believing it actually made them sick with the flu. 

To those patients, Dr. Bergen stressed that that flu vaccine cannot cause flu illness, as the shot itself only contained a single protein from the influenza virus. And his message about the importance of getting vaccinated sounded exactly the same for why health experts urged people to wear masks and take other precautions in the face of the coronavirus: “It is not only good for yourself but also good for your loved ones, your coworkers and for the entire community.”