The Flu Is Back –– How Seniors, Families And Caregivers Can Prepare For A Possible “Twindemic”

Remember the flu?

Thanks to remote working and learning, social distancing and wearing masks, the flu season all but vanished over the last two years. And after a global pandemic, doesn’t the flu seem almost…harmless?

It’s not.

We sometimes forget that the flu has a long and deadly record.

According to estimates from the Centers for Disease Control and Prevention (CDC), every year between 2010 and 2020, the flu was to blame for nine million to 41 million illnesses; 140 thousand to 710 thousand hospitalizations; and 12 thousand to 52 thousand deaths.

Those are significant numbers.


An Early Warning Signal to Seniors –– and All Ages

The flu has returned. And, after studying what’s happening in the southern hemisphere right now (more on that in a minute), health experts are issuing this early warning to all ages:

Prepare for a possible “Twindemic” –– a simultaneous, double punch of COVID’s winter revival and what could be the earliest, longest and worst flu seasons in years.

The flu is dangerous to everyone, especially pregnant women, teens and young children. In mid-October there were three new infant fatalities, bringing the 2021-2022 flu season total to 43 pediatric deaths. Often the flu strikes children first then rapidly spreads to older groups.

But as with COVID, no age group is more at risk of getting the flu and suffering serious consequences, than seniors. The CDC estimates that in every flu season, about 85 percent of the flu-related hospitalizations and deaths occur in our older populations.

So right now, it’s the perfect time to suit up in defense.

In this blog we’ll share what makes this flu season so worrisome, the symptoms, new vaccines available (and why so few people are getting them), the possibility of a Twindemic and the best way to protect yourself and loved ones living in senior care facilities.


Clues on the Flu From the “Land Down Under”

Let’s begin by hopping an imaginary flight to the southern hemisphere. Home to the Great Barrier Reef, Great White Sharks ––– and right now, the Great Flu. Look at some of the news headlines during the height of Australia’s flu season, in August:

“Brisbane Schools Shut Down Due To Extraordinary Flu Outbreak”

“Flu Cases Soar”

“Governments Push Back Free Flu Jab Deadline As Cases Rise”

Because the flu season arrives early in Australia, health experts have always looked there to see what might happen in the US. Here’s a snapshot of what they’re finding:

  • Australia is just emerging from what is the worst flu season in five years –– arriving earlier, lasting longer and affecting more people.
  • Australia has had more than 30 thousand cases a week, thousands of hospitalizations and hundreds of deaths.
  • Australians know the best way to avoid the flu is to get vaccinated but according to the country’s National Center for Immunization Research and Surveillance (NCIRS), less than 35 percent of Australians are getting the flu shot.

Is the flu vaccine participation any better in the US?

The National Foundation for Infectious Diseases (NFID) found that like Australians, most of us – in fact nearly 70 percent surveyed – believe the annual and widely available flu shot is the best protection against the flu.

And yet…

The study found that only 49 percent say they plan to get the vaccine this year and into 2023; and 41 percent say they are either unsure or do not plan to get vaccinated.


Can You Relate to Their Reasons Why?

That same NFID study reveals why so few people are getting the flu shot this year. Do any of them resonate with you?

I don’t think flu shots are effective. (This is the top reason.)

I’m tired of hearing about vaccines.

I’m concerned about potential side effects.

I never get the flu.

I’m afraid the flu vaccine will give me the flu.

The flu isn’t a serious illness. I’m not at all concerned.

I’ll protect myself from the flu by wearing masks and avoiding large crowds.


Scientists Say Here’s Why We Should Get the Flu Vaccine –– Now

  • Based on Australia’s flu season, we may be headed into an early, long and difficult flu season.
  • We haven’t been as exposed to the flu the last few years, so our immunities aren’t strong enough to protect us.
  • Fewer people getting the flu shot leaves more people exposed.
  • Hospitals are still understaffed.
  • Schools and job sites are the biggest sources for flu outbreaks. Children bring the flu home and parents can inadvertently bring the flu to senior living communities, one of the most vulnerable age groups for the flu and COVID.
  • COVID, with its highly contagious Omicron variety, is expected to make a winter resurgence possibly creating that Twindemic of the flu and COVID.

To help you make a decision on the flu shot this year and keep your loved ones safe, let’s talk with Terri Fagan,  board member of the American Society of Consultant Pharmacists, a senior care pharmacist and Director of Clinical Services for Consonus Pharmacy. She’s a recognized expert on vaccines, helping Consonus Pharmacy lead the nation in completing its CDC approved COVID vaccination program early and with the highest rate of staff and resident participation.


Q: Terri, where is this early flu season popping up in the US and what are we learning?

A: The CDC just sent out its first weekly influenza surveillance report and as expected, we’re seeing early and abnormally high increases in influenza-like illnesses in the southeast and south central states. By influenza-like illnesses, I mean sore throat, cough and fever.

Those cases will be evaluated later, with other data, to determine how many are indeed influenza. But when you have that many illnesses, it’s a good bet many of them are cases of the flu.

So, with those numbers and the timing, I believe the flu season is here, it’s early and it could be rough season.


Q: Who should get the flu shot and when?  

A: The flu affects all age groups, not just seniors. So, everyone six months and older should get the flu shot by the end of October. But if for some reason you don’t get vaccinated, and it’s January 2023, you still want to go and get immunized.

You’ll not only protect yourself, but you’ll also safeguard senior members of your family and the larger community.


Q: Who should not get the flu shot?

A: People with severe, life-threatening allergies to any ingredient in a flu vaccine, other than egg proteins, or people who have had a severe allergic reaction to a dose of influenza.

If you have a history of Guillain-Barré Syndrome (GBS), which is a rare, autoimmune paralyzing disorder, you should talk to your healthcare provider before getting the flu vaccine.


Q: What’s different about the flu vaccines this year and how effective are they?

A: Every year the composition of the flu vaccine, basically the recipe, is updated. The goal is to match the new flu strains floating around out there and provide you with a robust dose of protection.

All flu vaccines this year are engineered to protect you against four different flu viruses. The different vaccines available are approved for different age groups.

This year the Advisory Committee on Immunization Practices for the CDC are highly recommending older adults get one of the three flu vaccines for people 65 years and older. These are Fluzone High-Dose, Flublok recombinant and Fluad adjuvanted.

Are the vaccines working? It’s too early in the season to tell, but we’re hopeful.


Q: What are common flu symptoms and when should you seek medical help?

A:  If you get the flu, you may experience any or all of the following symptoms: a fever, runny nose, stuffed-up nose, cough, sore throat, aches and pains, fatigue, diarrhea and vomiting.

If you have trouble breathing, shortness of breath, severe fatigue, muscle pain, confusion or dizziness, call your doctor.

A silver lining from our experience with COVID, is the ease and accessibility of virtual care from your doctor, nurse or pharmacist. Use those services!


Q: Terri, those flu symptoms sound just like COVID symptoms. How do we tell the difference?

A: You’re right. They do sound alike. The only unique COVID symptom is a possible change in taste and smell. It’s so easy to test yourself. COVID tests are readily available at your grocery store pharmacy, doctor’s office and online.

Regardless, the red flag symptoms for both – trouble breathing, shortness of breath, severe fatigue, muscle pain, confusion or dizziness – are warnings you should call your doctor.


Q: What’s all this talk about a possible Twindemic?  Are you concerned?

A: Yes, I am. As we discussed, the early indicators say it’s going to be severe flu season and we know COVID is still circulating. As we head into winter and we’re inside in closer proximity to each other, I think we’re going to see the numbers for COVID and flu jump at the same time.

Here’s something else that has me concerned. We’re not seeing an uptick in the number of people opting to get the latest COVID booster. That vaccine is called the Bivalent booster, meaning it has the original protection from COVID, plus the very latest variant protection. It’s the booster to get now.


Q: What’s the most important question we should be asking our health care providers to prepare for a Twindemic?

A: Good question! To make all this super simple, when you go to get your flu vaccine, ask your provider, “Are my vaccines all up to date?” “Do I have the latest COVID booster?” “Am I eligible for the vaccines protecting me against shingles or pneumonia?”


Q: Will there be one shot for both COVID and the flu?

A: Not yet. Right now, they’re two separate shots, but the good news is you can get them at the same time, if the timing coincides. I’m doing that this week!


Q: If we’re up to date on our COVID vaccines, will they protect us from the flu?

A: I think the jury is out on this, as studies are ongoing. For now, I would continue to encourage being up to date with both vaccinations for those eligible.

We know that COVID may cause significant lung inflammation, which may make one more susceptible to other respiratory illnesses.

So, it’s logical that if our lungs are healthy, we could be better protected from infections.


Q: One of the more interesting facts to come out of the NFID study is that the global pandemic did not create any urgency for people to get the flu shot. Why is that?

A: I’m not sure. Perhaps it’s because people think, well I’ve been masking up for so long, I should be fine. To that I say, just look around when you go to the grocery store or mall. Are people wearing masks like they used to? Will people do that again when the flu hits?

We’ll see.


Q: How are senior living communities protecting their staff and residents?

A: Let me begin with questions you should ask if you live in a senior community or have a family member who does.

What are your infection protection practices?

Are you using masks?

Have you had outbreaks?

Have they been contained and how?

What is your rate of immunization for flu and COVID for both residents and staff? (The higher the better!)

For instance, at Marquis, 92 percent of our residents have received the primary series of COVID-19 vaccines and 78 percent have had the boosters. Among our employees, 90 percent are vaccinated with the primary series and 64 percent have had their boosters. We’re always working to improve those numbers.

We have high primary series vaccination rates in part because of our stringent, foundational practices like wearing masks, hand hygiene, surface cleaning, routine screening and testing, monitoring any new case, containing spread and recommending approved antiviral medications.


Q: Finally, Terri, are there any other ways we can protect loved ones living in a senior community?

A: I know it’s difficult, but if you’re not feeling well, stay home.

If your senior family member is reluctant to get the flu shot, gently talk with him or her about the advantages and protections the vaccines provide. Also, get vaccinated yourself to protect the most vulnerable around you.


Thank you for reading the Marquis Blog! It’s our passion and hope you find our fact-based information helpful in keeping you healthy and vibrant –– whatever your age!

You can find other Marquis Blog health care topics here.