When Should You Get The Flu Shot? How Does Covid-19 Coronavirus Affect This? – Forbes

A sign says, "get your flu shot today." So should you or should you wait until later, given the ... [+] Covid-19 coronavirus pandemic? (Photo by: Jeffrey Greenberg/Education Images/Universal Images Group via Getty Images)

You may have heard of concerns about a twindemic happening this Fall. This is not referring to an epidemic of twins, which could be either adorable or horrifying if they keep repeating, Come play with us, forever and ever and ever," as they did in the movie The Shining. No, the twins here would be the continuing Covid-19 coronavirus pandemic plus a seasonal influenza epidemic hitting our population simultaneously. Thats why public health experts are urging you to get the flu shot, which makes sense.

Ah, but the question that you may be asking is when. For example, Ellie J. Murray, ScD, Assistant Professor of Epidemiology at the Boston University School of Public Health, posed the following query to the Twittersphere or at least to the people-who-understand-vaccines-and-are-not-anti-vaccination-bots portion of the Twittersphere:

A timely question indeed from Dr. Murray.

First, the easier part of the answer: unless you have a medical reason not to get the flu shot, its a good idea to get vaccinated against influenza each and every year. Medical reasons include being younger than six months of age or having a severe, life-threatening allergy to the vaccine. (If you are younger than six months of age and reading this, wow.) Typically, the seasonal flu virus is not as deadly as the Covid-19 coronavirus or a novel strain of the influenza virus. Nevertheless, it can cause serious harm and even kill, especially if youve got a weaker immune system. Plus, few people will say the word cool after saying, Ive got the flu. Getting the flu is like the exact opposite of eating avocado toast.

In a typical flu season, the common advice is to get the flu shot sometime in mid-to-late-October. Thats because after you get the flu shot, it takes about one to two weeks for your immune system to mount enough of a response for you to have some protection. Then once you have a reasonable level of protection, this protection tends to last on average for six months. Therefore, getting vaccinated in October would get your protected by the time November rolls around and take you into April when the flu virus may still be around.

In a response to Dr. Murray, Nahid Bhadelia, MD, MA, an infectious diseases physician and the medical director of Special Pathogens Unit at Boston University School of Medicine, shared a tweet thread that she had first tweeted back in August:

Now, protection from the flu shot isnt like renting a suit of knights armor or a full body condom. (By the way, dont rent condoms. Buy them new instead.) Its not as if one day youve got protection and the next day its completely gone. Instead, your immune response will wane over time, gradually getting weaker and weaker. Moreover, duration of protection may vary from person to person and year to year.

Using the six month timeline, vaccination now would on average keep you reasonably protected through early March. According to the Centers for Disease Control and Prevention (CDC), in the United States, flu activity usually peaks sometime between December and February but can continue in some seasons into May.On its web site, the CDC has a histogram that shows how often each month has been the peak of the flu season since this has been measured. February has been the most common month for the peak, checking in at 15 times, followed by December at seven times, January and March at six apiece, and then October and November at one apiece.

Keep in mind these were the months when flu activity was at its highest. There is continuing flu activity well before and after the season peaks. Thus, when the flu season peaks in February or March, which is quite common, expect flu activity to continue into April and even May. So in most years, trying to stay protected through April aint a bad idea.

So, does this mean that you should wait until mid-to-late October? Not necessarily.

Thats because, spoiler alert, 2020 is not your typical year. The History Channel is cancelling its series Vikings after six seasons. Poland accidentally invaded the Czech Republic in a minor misunderstanding, as Colin Dwyer reported for NPR. And gee what else? Whats different about 2020 compared to previous year? Oh, thats right, theres this thing called the Covid-19 coronavirus pandemic.

Even though the flu is not the same thing as Covid-19 (repeat, the flu is not the same as Covid-19), some of their earlier symptoms may be similar. This can make it even more freaking confusing to tell whether you have Covid-19 or the flu or something else. Getting vaccinated against the flu could at least reduce the probability that you have the flu.

Will social distancing and face mask use also lead to a milder flu season? (Photo by Roy ... [+] Rochlin/Getty Images)

Additionally, the flu and Covid-19 make for terrible twins. You dont want to play with either of them, let alone both of them at once. Catching the flu could make you more susceptible to Covid-19 coronavirus badness and vice-versa. Infection from one virus could tax your immune system, making it easier for other invaders to enter and cause more havoc. Your respiratory tract is not like a parking space or a fitting room for respiratory viruses. Just because one type of virus is there, doesnt mean that other types cant jump in as well. You cant say to viruses, er, pardon me, but the Covid-19 coronavirus is reproducing like heck in me, so youll have to wait.

As described in a research letter to JAMA, a team at the Stanford University School of Medicine ( David Kim, MD, PhD, James Quinn, MD, MS, Benjamin Pinsky, MD, PhD, Nigam H. Shah, MBBS, PhD, and Ian Brown, MD, MS) found that 20.7% of respiratory specimens that were positive for SARS-CoV-2 were also positive for at least one other respiratory pathogens. A publication in the Journal of Investigative Medicine: High Impact Case Reports had, guess what, case reports of three patients who were co-infected with both the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) and the influenza virus with one of the patients not surviving.

Moreover, it is difficult to predict what will happen in the coming months with the pandemic and resulting effects on health care services. What would happen if an October surge in SARS-CoV2 cases occurs, overtaxing the health care system and leading to shut downs of businesses? After all, the health care system has already been running like a well-oiled cinder block wrapped in a paper bag filled with potato chips. What if you cant go to or find a place to get vaccinated?

Furthermore, there is no guarantee that enough of the flu vaccine will in stock in October to meet the demand. Assuming that flu vaccines will always be available is a bit like assuming that toilet paper will always be around. And you saw how that went back in March. During this pandemic, supply chains for many products in the U.S. have deserved a C-minus grade for come on or maybe even a D for doggone it, I just want some yeast or why did you send me a fish tank when I wanted watermelon?

If this season were to have flu vaccine shortages, it certainly wouldnt be a first. Just look at what happened in 2003 or during the 2009 H1N1 influenza pandemic:

In fact, just last year, when there was no pandemic to blame, vaccine shortages were a problem as this WTHR 13 news report showed:

Unless you think things this year are somehow being run so much more efficiently and effectively than they have in the past, prepare yourself for possible vaccine delivery delays and shortages. Add the current focus on the Covid-19 coronavirus vaccine as another reason why seasonal flu vaccine production and distribution may have disruptions. Therefore, it may be better to get the vaccine while you can.

So, how about getting the flu vaccine twice: once now and a second time four months later in January? Well, the jury is still out on the effects of doing this. As the CDC website describes, in adults, studies have not shown a benefit from getting more than one dose of vaccine during the same influenza season, even among elderly persons with weakened immune systems. The exception is children getting their first ever flu vaccination. So check to see if you are a child first. Regardless, this may not be a great thing for everyone to try to do because there may not be enough vaccines around.

Theres one other reason to get the flu vaccine now rather than later: herd immunity. If you havent heard of herd immunity, I described it previously for Forbes. Basically, the greater the proportion of the population that has been vaccinated, the harder it is for a virus to find someone to infect. If enough people get vaccinated early before the flu virus has had a chance to spread, it could alter and suppress the spread of the flu virus. Couple this with more social distancing than usual because of the Covid-19 coronavirus, and the flu virus could have a tougher go at it this season. This could make for a more mild flu season in general, which would be good news in a year that hasnt exactly been brimming with good news.

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When Should You Get The Flu Shot? How Does Covid-19 Coronavirus Affect This? - Forbes