Editor’s Note: This story and its headline have been edited to remove inaccurate information regarding the prevalence of flu compared to COVID-19. Read the full correction below and a follow-up story at https://www.staradvertiser.com/2021/10/14/hawaii-news/hawaii-flu-pneumonia-report-includes-hundreds-of-covid-fatalities/
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With the new flu season just underway, health officials are urging the public to get their annual shots, which can be administered at the same time as COVID-19 vaccinations. 

Public health experts nationwide warned in 2020 of a possible “twindemic” of flu and COVID-19 that never materialized. The threat remains, but the same health and safety measures aimed at keeping the coronavirus in check — mask wearing, hand washing, social distancing and limits on gatherings — so far have proved effective in curtailing the spread of influenza viruses. 

State Department of Health influenza surveillance data through all but the final week of the 2020-2021 flu season, which ended Sept. 26, shows that only 0.8% of outpatient visits to “sentinel” health care providers involved patients with influenza-like illness. 

That compares with 2.1% of outpatient visits during the 2019-2020 flu season and 2.4% in the “moderate” 2018-2019 season, before COVID-19 hit the islands. 

The DOH has separately reported only a single death from influenza during the 2020-2021 flu season compared to 29 the previous season. 

But the just-announced easing of restrictions as COVID-19 cases and hospitalizations have declined in recent weeks could open the door to more widespread flu infections, according to Ron Balajadia, chief of the DOH Immunization Branch. 

“COVID is definitely the big elephant in the room, but with things opening up, with things relaxing as far as people interacting, there is always that potentiality of flu spreading,” Balajadia said. “So the best way to minimize that is, No. 1, to get vaccinated, but then also all the mitigation factors that we’ve used for COVID do come into play. So wearing masks, washing hands constantly, social distancing — all of those play an important part in minimizing flu spread as it does with COVID spread.” 

Influenza viruses circulate year-round in Hawaii but are most prevalent in the fall and winter months. The annual flu season generally starts in late September. 

The 2019-2020 flu season peaked in mid-February 2020, before the first coronavirus infections were detected in the islands. Doctor visits for influenza-like illness plummeted in March after the counties issued stay-at-home orders. From there the percentage of outpatient visits related to the flu hovered around 1% for the remainder of the season and through most of 2021. 

Another indicator of how COVID-19 restrictions have kept a tamper on flu spread: The DOH reported 33 influenza clusters during the 2018-2019 season and only nine in 2020-2021.   

“The disease does what it does year to year, which is make people sick and also hospitalized, and, sadly, people die from it,” Balajadia said. “So it doesn’t diminish the fact that we may not be seeing as many cases, but it’s still a disease that can do all those things.” 

Due to the constantly evolving nature of influenza viruses, vaccines are retooled each year to protect against the four viruses that research indicates will be most common during the upcoming flu season, according to the U.S. Centers for Disease Control and Prevention. That’s why health officials insist the most effective way to prevent getting sick or suffering severe complications is to get vaccinated annually. 

While vaccine effectiveness can vary, the CDC says recent studies show that flu vaccination reduces the risk of flu illness by 40% to 60% “when most circulating flu viruses are well-matched to those used to make flu vaccines.” Additionally, the agency reported that a 2021 study showed that among adults, flu vaccination was associated with a 26% lower risk of ICU admission and a 31% lower risk of death from flu, compared with those who were unvaccinated. 

Although both are respiratory diseases, flu vaccines offer no protection against the coronavirus. 

Balajadia said it’s too early to say whether some of the stubborn resistance to COVID-19 vaccines will carry over to flu immunizations, but it’s something health officials will be keeping an eye on. 

And unlike with the initial release of the first COVID-19 vaccines, Balajadia said there doesn’t appear to be a shortage of doses, and there’s no rationing of who can get the widely available flu shots, which the CDC recommends for just about everyone, starting with 6-month-old babies. 

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People at high risk of flu complications, including young children, older people, pregnant women and people with certain chronic health conditions, are especially encouraged to get the vaccine yearly. 

Different flu vaccines are approved for use in different groups of people, the CDC says, and depending on the individual, vaccines can administered by injection or nasal spray. 

Balajadia stressed that people who still need a COVID-19 vaccination — either first shots or a booster dose — can get one at the same time as a flu shot. He advised calling pharmacies and other providers ahead of time to make sure both are offered. 

The DOH did not have information on influenza vaccination rates in Hawaii, but Balajadia said the state’s older population, which has the highest rate of COVID-19 immunization, has made it an annual ritual to get flu shots early in the season. 

The department’s influenza surveillance reports show that the overwhelming percentage of patients seeing doctors for flu-like illness are infants, children and young adults. The lowest-percentage group is patients age 65 and older. 

“We have a very faithful elderly population that really sees the value of making sure they don’t get sick from flu,” Balajadia said. 

Because COVID-19 safety measures inadvertently reduced flu spread in the past two seasons, Balajadia said that “we really can’t predict how bad a flu year this will be. We won’t know until we get into the season and see how that is affected by people’s actions with COVID and how that is going to impact flu.” 

“The other part to this is really that our medical infrastructure is already fragile as it is, and it’s strained to the point that if we have influenza sickness and individuals that need to be hospitalized, that is actually going to make our medical infrastructure even worse.” 

FACTS ABOUT THE FLU 

>> The flu is a contagious respiratory illness caused by influenza viruses that spread from person to person in droplets from coughing or sneezing. It also can be picked up from contaminated surfaces and then touching the eyes, nose or mouth. 

>> Unlike a cold, the flu comes on abruptly and might include fever, headache, tiredness, cough, sore throat, runny or stuffy nose, body aches, diarrhea and vomiting. Complications include pneumonia, dehydration, worsening of chronic medical problems, inflammation of the heart and brain, multiorgan failure and death. 

>> Most cases of the flu can be treated with plenty of rest and drinking lots of liquid. Antiviral drugs are available to lessen symptoms, shorten the course of the illness by one to two days, prevent serious complications and reduce spreading the virus to others. They are most effective when administered within 48 hours of the onset of symptoms. 

>> To prevent getting sick or spreading the flu, cover your mouth and nose when coughing or sneezing, stay away from people who are sick, wash hands frequently with soap and water, and avoid touching eyes, nose or mouth. 

>> The best way to prevent flu is get a flu shot each fall. Common side effects from the vaccine include a sore arm, a low fever or achiness. These side effects, if experienced, are mild and short-lived. 

>> For more information, visit the CDC’s website at cdc.gov/flu.