With flu season fast approaching, and the Covid-19 pandemic raging on, hospitals and pharmacies across the country are stockpiling far more flu vaccines than normal, anticipating a surge in demand.

The drug store chain Rite Aid has purchased 40% more influenza vaccines than other years to meet an expected uptick in demand. Walgreens has also increased its flu vaccine stockpile this year, anticipating a 30% to 50% jump in customers who will want flu shots or other immunizations, the company’s chief medical officer told STAT. And Robert Redfield, the director of the Centers for Disease Control and Prevention, told lawmakers in a hearing this week that the agency had ordered an additional 9.3 million adult flu vaccines this year. Redfield said widespread flu vaccine coverage “could help our nation avert a very difficult fall.”

“Flu is a critical moment in time in the healthcare industry,” said Christopher Savarese, director of operations for Rite Aid. “This year is one of the most important — if not the most important — flu season in our generation.”

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Both flu and Covid-19 lead to respiratory symptoms, and a severe case of either can land someone in the hospital. Given how Covid-19 has already stretched resources at many hospitals, health experts say it will be crucial to achieve widespread flu vaccination to curb the added strain. But they’re also staring down significant challenges, from environmental disasters and prevalent vaccine misinformation to fears about in-person visits to health care facilities.

 

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Even in normal times, flu season has the potential to strain the health care system. Between 9 million and 45 million people are infected with the flu each year, and between 140,000 and 810,000 are hospitalized, according to CDC estimates. In 2018, the U.S. recorded its highest death toll from the flu in recent history, with 80,000 deaths.

Flu vaccines are designed to provide protection against three to four virus strains that scientists predict might circulate in the coming fall and winter, which means the effectiveness of this vaccine can vary from year to year. And even if it doesn’t prevent an infection, a flu shot can protect against severe disease, experts note. This year in particular, they say, getting a flu shot is a pressing precaution.

“It will not only help protect you from the flu,” said Glen Nowak, director of the Center for Health and Risk Communication at the University of Georgia, “but the more we can reduce transmission of influenza in the country, the less stressed our health care systems will be as Covid and flu viruses start circulating together.”

In part, experts are worried about the overlap in symptoms between flu and Covid-19, including a fever, muscle aches, and a cough, as well as about the potential impact of being infected with both a flu virus and the virus that causes Covid-19 at the same time. There are a handful of efforts to roll out tests that screen for both Covid-19 and flu, but being able to quickly distinguish between the two will have important implications for isolation and contact tracing efforts.

“I’m pretty hopeful that people are taking their responsibility to not just protect themselves but their friends, family, and co-workers very seriously this season,” said Kevin Ban, Walgreens’ chief medical officer.

The CDC recommends that the public get vaccinated in early fall, and ideally by the end of October to provide protection through the bulk of flu season. The CDC says getting vaccinated too soon — in July or August, for example — is associated with less protection later in flu season.

Still, some pharmacies and providers said they had patients coming in for flu shots as soon as they became available.

“We’ve seen patients come in since the end of August to get vaccinated,” said John Schirripa, regional medical director at Mount Sinai Doctors-Westchester in New York.

To mitigate potential risks around Covid-19 — or patient fears around them — his network of hospitals has set aside designated sites and days to operate flu clinics, where there is little overlap with other hospital patients and physicians treating them.

 

Other primary care facilities are taking similar precautions by providing drive-thru options or mobile clinics. Big Sur Health Center in California, for instance, is collaborating with local businesses to encourage employees to participate in a flu shot drive-thru this year in lieu of an on-site health fair held every October. “We’re adapting our ways so we can get as many people immunized” as possible, said Sharen Carey, executive director of the Big Sur Health Center.

In Oregon’s Washington and Yamhill counties, Virginia Garcia Memorial Health Center staff has historically used on-site Saturday flu drives in October and November to boost vaccination, with a focus on Hispanic-dominated farming communities. This year, though, they are using mobile clinics to provide Covid-19 and flu tests, as well as flu shots. Leaders said the mobile clinics are expected to operate nearly five days each week and vaccinate up to 20,000 people.

“We’re doing this in part to decrease risk and keep that interfacing with people outside our physical building,” said Sarah Deines, director of quality at the Virginia Garcia Memorial Health Center.

Still, health officials know there are a number of hurdles that may prevent parts of the public from getting a flu shot, including climate change-related crises.

“People are more concerned about their homes burning down than going in and getting the flu shot,” said Armand Dorian, chief medical officer at University of Southern California’s Verdugo Hills Hospital. “To get a flu shot may be a luxury for them.”

Dorian and other health care providers said they’re also concerned about vaccine misinformation, which Dorian said appears to have grown more politicized.

“I don’t know why and how this became such a polarizing topic,” Dorian said. “It’s falling in line with politics and I’m very scared about that.”

Experts said existing steps to curb the spread of Covid-19 — including social distancing, masks, and increased hand-washing — can also help keep flu transmission lower. But vaccinations will be a key part of that effort, they said.

“If we all get the flu shot, it will make a massive difference for us to get back into society,” Dorian said, “especially this flu season.”

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