Claire Wolters is a Philly-based reporter covering health news for Verywell.
Heather Mercer is native to Northwest Ohio (go Walleye!) and graduated from Loma Linda University with two doctorate degrees (psychology and public health). She is currently a professor at Owens Community College, as well as a fact-checker for Verywell Health. She has gained experience in a variety of settings, ranging from corporate wellness and preventive medicine, to mental health, chronic disease, and end-of-life care.
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Flu season is right around the corner. Or is it here already?
The United States flu season typically peaks around February. But as of mid-September, influenza has already crept into some states. Moderate case numbers are spreading through Texas, New Mexico, and North Mariana Islands, and a few cases have been reported in almost every other state, according to the Centers for Disease Control and Prevention (CDC).
The flu's early appearance is causing some experts to worry about the virus’s 2022-2023 trajectory–and trends from countries like Australia are exacerbating concerns, too.
When it comes to predicting the severity of the U.S. flu season, experts typically look to previous trends from countries in the Southern Hemisphere, like Australia. Australia’s winter occurs during the U.S. summer, and the country experiences its flu season during this time as well.
This Australian winter yielded a pretty severe flu season, with higher-than-usual numbers of cases and hospitalizations from the disease.
According to Australia health department data, the country reported more than 200,000 laboratory-confirmed cases of influenza in 2022, along with 1,763 hospital admissions and 295 related deaths. That's well above the country's 5-year average of 141,635 annual cases.
Australia's flu season began earlier than usual; mid-April instead of June. It peaked earlier than usual, too, only tapering off at the end of July.
The tricky thing with flu is that despite the wealth of information from Australia, experts still don’t know exactly when the U.S.'s season will peak, or how severe it will be.
“It’s always dangerous trying to predict flu,” William Schaffner, MD, a professor of medicine in the division of infectious diseases at the Vanderbilt University Medical Center, told Verywell. “Our crystal balls are always cloudy, because flu is so variable. I actually like to say, flu is very fickle. But with the exception of the last two years, U.S. flu seasons typically peaks in February, diminishes in March, and dribbles into April.”
Even without his crystal ball, Schaffner said he is concerned about the premature arrival and possible higher numbers of flu this fall and winter.
"We’re in September—and that's early. This is beginning to look a little bit like what happened in Australia," he said. "If you detect a certain amount of unease or anxiety in my voice, it's there."
In an email to Verywell, Jeffrey Klausner, MD, MPH, an infectious disease specialist at the Keck school of medicine, University of Southern California, said that the 2022-2023 flu season will likely be “much worse than more recent seasons.”
In a typical flu season, the U.S. already experiences hundreds of thousands of hospitalizations and tens of thousands of deaths, he added. According to the CDC, flu has resulted in anywhere from 140,000 to 710,000 hospitalizations and 12,000 to 52,000 deaths each year between 2010 and 2020.
In 2020-2021, the flu season was abnormally mild and short. For the most part, experts credit the dulled-down seasons to COVID-19-based restrictions like wearing masks and city shutdowns that enforced social distancing.
By default, these restrictions protected people against the flu as well. In fact, more than a hundred years before COVID-19’s appearance, these measures were designed to target the flu.
“Mitigation efforts like masks, social distancing, and quarantining were all designed during the 1918 influenza pandemic, and happen to work for COVID,” Gregg Sylvester, MD, MPH, chief health officer of influenza vaccine company CSL Seqirus, told Verywell. “That’s why we saw such a low level [of flu] in the past.”
Now that so many COVID-19 restrictions are lifted or ignored, flu may be back with a vengeance.
"If you look at the number of [2022 Australia] cases, they were also higher than what we saw pre-pandemic," Sylvester said. "My guess is that [the U.S.] will have a robust flu season, and we'll have to wait and see how it plays out. A lot of that will have to do with how many people get vaccinated."
Australia saw high numbers of flu in children and teenagers, putting younger people in an unexpected at-risk group. According to the country’s health department, children and adolescents below the age of 19 had the highest rates of flu.
"If anything, [Australia’s situation] should make us aware that flu can do this," Schaffner said. "We ought to do everything we can to prevent the impact of influenza on our population."
As a first line of defense against the flu, the CDC recommends that everyone 6 months old and up gets a flu shot before the end of October if possible. This year, people over the age of 65 are encouraged to get high-dose versions of the flu shot.
Some people may be less vigilant about flu protections because they are focused on COVID-19. Others may be more worried about both viruses, and the chances they can get sick with both at the same time.
According to Sylvester, the good news is the chance of co-infection appears relatively low. The bad news is that the chance of getting at least one virus appears significant, and the magnitude of hospitalizations may be high.
"There are two separate diseases," Sylvester said. "We’re still having 400 deaths per day of COVID–that's still a problem, and we still need to get a hold of that."
Following trends from the Southern Hemisphere, experts believe the U.S. flu season could come earlier and hit harder than usual. Getting vaccinated ideally before the end of October, is key to protecting yourself from a severe case of the flu this year.
Centers for Disease Control and Prevention. Weekly US map: Influenza summary update.
Australian Government Department of Health and Aged Care. Australian Influenza Surveillance Report – No 12 – fortnight ending 11 September 2022.
Australian Government Department of Health. Report of the National Influenza Surveillance Scheme, 2011 to 2018. Commun Dis Intell (2018). 2022;46. doi:10.33321/cdi.2022.46.12
Australian Government Department of Health and Aged Care. Australian influenza surveillance report and activity updates.
Centers for Disease Control and Prevention. Disease burden of the flu.
Centers for Disease Control and Prevention. FluView Summary ending on October 2, 2021. Weekly U.S. influenza surveillance report.
Grohskopf LA, Blanton LH, Ferdinands JM, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2022–23 influenza season. MMWR Recomm Rep 2022;71(No. RR-1):1–28. doi:10.15585/mmwr.rr7101a1
Centers for Disease Control and Prevention. Flu and people 65 years and older.
Centers for Disease Control and Prevention. COVID data tracker.
Claire Wolters is a Philly-based reporter covering health news for Verywell. She is most passionate about stories that cover real issues and spark change.
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