Health authorities are urging Canadians to get a flu shot this year to avoid the spectre of a “twindemic,” where the health-care system is overwhelmed by COVID-19 and influenza, but there are concerns about how to safely deliver flu shots to more people.
Canadians are about to face yet another challenge in the COVID-19 pandemic: the arrival of flu season.
Hoping to avoid what some have termed a “twindemic” — an influx of people becoming ill as influenza and the new coronavirus circulate at the same time — health experts say it’s more important than ever to get the flu shot.
“If you haven’t received the vaccine in previous years, this is the year to get it,” said Dr. Danuta Skowronski, an infectious disease expert specializing in influenza and emerging respiratory illnesses at the B.C. Centre for Disease Control.
Anticipating an increased demand for the flu shot, the provinces and territories have collectively ordered 22 per cent more doses of the vaccine (13.7 million) compared to the amount ordered by the same time last year (11.2 million), according to the Public Health Agency of Canada.
“This is the highest order ever placed in Canada for seasonal influenza vaccine,” the agency said in an email to CBC News.
Here, experts weigh in on some questions you may have about getting a flu shot during the pandemic.
Why is it so important to get the flu shot this year? Will it protect me from COVID-19?
No, the flu shot won’t protect you from COVID-19. But it’s important to protect yourself from influenza for several reasons, experts say.
Flu often takes an enormous toll on the health-care system, so it’s vital that people do what they can to reduce their chances of getting it. Otherwise, hospitals and health-care facilities could become overwhelmed if they need to treat both flu and COVID-19 patients.
There is an “overlap” in the people who are at especially high risk of critical illness from influenza and from COVID-19, Skowronski said, including seniors and people with underlying health conditions.
“It is particularly important this year that those with high-risk conditions receive the influenza vaccine so that we are not utilizing critical hospital beds for influenza that could be used for those with COVID, [where] there is currently no vaccine,” she said.
Getting a flu vaccine could also help reduce “unnecessary testing” for COVID-19, Skowronski said, because several symptoms of both illnesses are similar.
In addition, it’s not known whether people will become co-infected with both flu and COVID-19 at the same time — and what the consequences of that combination could be, said Dr. Jacob Rosenberg, a pediatrician in Woodbridge, Ont.
At this point, children don’t appear to be highly susceptible to COVID-19, Rosenberg said, but they’re at high risk for flu. It’s not clear what would happen if they contracted both.
“It is super important for every child over six months of age to get the flu vaccine,” he said.
Pediatric immunization against influenza will not only help protect the child, but also protect others who are vulnerable, Rosenberg said, because unlike with COVID-19, children are often “super-spreaders” of the flu.
When can I get my flu shot?
The flu vaccine is expected to be available at its usual time in Canada this year, starting in mid-September with most deliveries completed by the end of October, the Public Health Agency of Canada said in an email.
But it’s already available in some parts of the U.S. Shouldn’t it be available in Canada sooner if the demand is high?
Rosenberg used to practise in New York, where the flu vaccine was available in early September and sometimes even late August.
In Ontario, his clinic usually receives the vaccine in early October, he said. Normally that’s OK — but this year he and his colleagues are worrying about how they will vaccinate all their patients before the flu season picks up, with the combination of increased demand and the inability to give the shot to as many patients each day due to the COVID-19 physical distancing requirements that have put an end to crowded waiting rooms.
CBC News asked the Public Health Agency of Canada why the U.S. gets its vaccine supply before Canada, but the agency was unable to provide an answer before deadline.
Skowronski said it’s partly because the U.S. has to vaccinate many more people, given their population is so much larger than Canada’s.
But she’s confident that Canadians will get their flu vaccinations in time, noting that in the past, “we have deliberately gone … with an end of October, beginning of November-type rollout because we want to ensure that the protection is optimal when we expect influenza to be circulating and in particular when it’s peaking.”
That peak normally happens around January, Skowronski said, and health-care providers want to ensure the protective antibodies from the flu vaccine last right through to the end of influenza season in the spring.
In many jurisdictions, high-risk groups, including people in long-term care homes, hospitals and seniors will be prioritized to get the earliest available flu vaccine doses.
Will COVID-19 change how I get the flu shot this year?
Yes. In previous years, you may have gone to a crowded doctor’s office or walked into your local pharmacy to get a flu shot on the spot.
This year, physicians, nurses and pharmacists will be wearing personal protective equipment, spacing out when patients arrive to ensure physical distancing, and requiring them to wear a mask while they get their flu shot. Patients will also be screened for COVID-19 symptoms or exposure and should stay home and reschedule their appointment if they don’t feel well.
About 35 per cent of flu vaccinations in Canada are given by pharmacists each year, said Shelita Dattani, director of practice development with the Canadian Pharmacists Association. She’s expecting that as some family practice clinics have cut down on in-person appointments during COVID-19, pharmacists may be giving many more flu shots this year — and they’ve been preparing for months, she said.
“For sure, we are going to be having to do things differently this year,” Dattani said.
You may need to make an appointment instead of just walking in, she said, noting that some pharmacies have already been taking reservations for flu vaccinations.
Other safety measures may include having people wait outside instead of “sitting in the pharmacy or browsing through the greeting card aisle.”
For the first time this year, pharmacists in some jurisdictions, including Ontario, will be able to administer the high-dose influenza vaccine for seniors.
Public health agencies are also suggesting that primary care providers set up drive-through flu vaccination clinics or outdoor clinics when possible. Community centres with a lot of space where physical distancing is possible have also been suggested.
Will the flu shot put me at greater risk of getting COVID-19?
No. That’s misinformation that has been refuted multiple times, said Skowronski, the infectious disease expert.
“Receiving the seasonal influenza vaccine will not affect your risk of COVID-19. It will neither protect you from COVID-19, nor will it increase your risk of COVID-19 infection,” she said.
Skowronski has reviewed many studies and conducted research in this area herself after people expressed this fear about the influenza vaccine in relation to other respiratory illnesses in years past. That research included a series of randomized placebo-controlled trials involving thousands of children and elderly participants.
When people started raising the question again after COVID-19 emerged, she and her colleagues did another analysis last spring, looking for any association between influenza vaccinations and increased risk of infection with other coronaviruses and found none.
“Vaccines are specific in their effects. If that were not the case, we would have a universal vaccine against all respiratory infections, and we don’t,” she said.
Would the flu shot have an impact of the effectiveness of a COVID-19 vaccine, should one be developed soon?
No — the same logic applies, Skowronski said.
The flu vaccine has a specific effect on stimulating immunity against influenza strains, while an effective COVID-19 vaccine would provide protection against that coronavirus.
How long does it take the flu vaccine to work?
Antibodies begin building right away, Skowronski said, but it takes two weeks to reach the full level of protection.
How many people got the flu shot last year?
In the 2019-20 influenza season, 42 per cent of Canadian adults got the flu shot, according to the Public Health Agency of Canada. The number was much higher — 70 per cent — among seniors 65 years of age and older.
What do we know about how effective this year’s flu vaccine will be?
The effectiveness will depend on how close a match there is between the influenza strains this year’s flu vaccine protects against, and which strains end up circulating in Canada’s flu season.
As usual, the World Health Organization made its recommendations in February on which strains of Influenza A and B vaccine-makers should prepare for.
But as for which strains will circulate, it’s too early to tell, both public health and infectious disease experts say, because normally predictions are made based on flu infections in Australia, which has its peak influenza period during Canada’s summer. But this year, the number of flu cases were so low that it’s difficult to collect data.
That’s largely because the same precautions for COVID-19 — physical distancing, handwashing, staying home when sick and wearing a mask — also help prevent the spread of other respiratory illnesses such as the flu, Skowronski said.
In addition, she said, her global counterparts reported an increase in the number of people who got the flu shot — so the combination may have contributed to “exceptionally low influenza activity” in the southern hemisphere.
She’s optimistic because the World Health Organization changed some of the influenza strains in this year’s vaccine to better match what was actually circulating last flu season.
Plus, Skowronski said, the low influenza activity in the southern hemisphere means the virus may be less likely to have mutated by the time it reaches the northern hemisphere, because it wasn’t pressured to adapt to people’s immune systems as much as usual. That could also make this year’s vaccine more effective, she said.