Idaho’s COVID crisis persists, and it’s flu season. What’s that mean for health care?

After more than a month with crisis standards of care activated statewide, the number of COVID-19 patients at Idaho hospitals has begun, slowly, to fall. But many hospitals are still quite full, and with colder weather and winter approaching, the coronavirus isn’t the only virus that has public health leaders concerned.

Public health leaders fear that the flu season will be resurgent this year after an unusually mild 2020-21 season, when many more people were social distancing, wearing masks, and working or doing schoolwork remotely.

Though most people who come down with the flu do not require hospitalization, some do, especially those with underlying conditions or those who are elderly or very young, according to the Idaho Department of Health and Welfare. Since 2010, the flu has hospitalized between 140,000 and 710,000 Americans each year and killed between 12,000 and 52,000 Americans annually, according to estimates from the Centers for Disease Control and Prevention.

“We are very concerned that an influx of influenza hospitalizations will put an increased strain on hospitals, just as we are starting to see some improvement in hospitalization rates due to COVID-19, potentially prolonging the need for crisis standards of care,” Dr. Christine Hahn, Idaho’s state epidemiologist, said in an email to the Idaho Statesman.

Crisis standards were activated statewide on Sept. 16 at the request of St. Luke’s Health System, the state’s largest health care provider. Since then, St. Luke’s hospitals — as well as others in Idaho — have been stretching nursing ratios and stopping nonemergency surgeries to make room for the high numbers of patients.

“The concern that we have within the hospital system about flu season is, ‘How bad could it be?’” Dr. Joshua Kern, chief medical officer for St. Luke’s hospitals in the Magic Valley, Wood River Valley and Jerome, told the Statesman. “Because our resources are already strained.”

Kern said St. Luke’s is operating at about 130% of normal capacity.

“If we go into a bad flu season, that would really strain us to the point of continuing to have difficulty taking care of all the patients.”

He also noted that studies have shown that coming down with a dual infection — having both COVID-19 and influenza at the same time — puts people at higher risk of severe illness. Kern said he has already heard about hospitals in the state seeing patients with co-infections.

In the U.S., flu season typically begins in the fall and ends in the spring, with peak infections occurring between December and February, according to the CDC.

Historically, Idaho has one of the lowest rates of flu vaccination in the country. Among children 6 months to 17 years, just 47.3% received a flu vaccination last year, which was the sixth-lowest of any state. Among adults, Idaho had the 10th-lowest rate of flu vaccination.

This year has seen effective COVID-19 vaccines become a somewhat partisan political issue, and Kern said he’s concerned that an increase in anti-vaccine sentiment could extend to the influenza shot.

“I think there’s reason to be concerned that it will have spillover,” he said, even though inoculations have been commonplace for a long time in the U.S. The flu vaccine was first licensed for use in the general population in 1945, according to the CDC.

When should you get your flu shot?

According to the CDC, most Americans should aim to be vaccinated by the end of October. Kern said he’s heard from some patients who wait longer out of a concern that the immunization might wear off before the end of flu season.

He said they shouldn’t worry.

“There really is no reason to wait,” he said. “The flu shot does give you good immunity ... well into next year.”

Kern also addressed something he says he hears a lot from people, which is, “I get the flu every year and it’s no big deal.”

“The reality is that influenza makes people really doggone sick,” he said, noting that many probably just had a cold but think they had the flu.

“Nobody gets the actual influenza (virus) and says, ‘That was no big deal,’” he said.

Kern added that “the safety of our vaccines, both COVID and influenza, is way higher than the safety of getting the viruses.”