Why Is Flu Season So Bad This Year?

Why is the flu season so bad this year? It peaked early; then, everyone just kept getting sick with one thing after another. People have been miserable with fevers and even pneumonia. What is going on? Is the flu worse this year? What health tips might boost immunity for the next few months of winter?

It feels like everyone around us is sick. This is fairly typical for the post-holiday weeks, but with a new endemic virus, SARS-CoV-2, in the mix, it is hard to know what pathogen is driving all the illness. In fact, the 2022-23 flu season started eight weeks earlier than normal and had already peaked by the time a typical flu season ramps up, commonly just after Thanksgiving.

This flu season vs typical flu seasons

Hospitalization rates have been higher this year than a typical year, although 2014-15 and 2017-18 were also difficult. The Centers for Disease Control and Prevention (CDC) reports hospitalization rates per 100,000 population. During a typical year, the influenza hospitalization rate might peak at six per 100,000 across all ages, but this year it peaked at approximately eight per 100,000. Other years have been worse, though. In 2017-18, the rate was 10 per 100,000.

The highest risk group, those 65 years and older, experienced a hospitalization rate of 27.2 per 100,000 at the peak of the flu season. The next highest risk group was babies ages 0 to 4 years, peaking at 11.7 per 100,000. We have already reached a typical cumulative flu season hospitalization rate of approximately 60 per 100,000, but with cases trending down, perhaps the worst is behind us.

Is the new COVID-19 variant surging?

One of the reasons that this flu season feels particularly rough is because a new SARS-CoV-2 variant, XBB.1.5, debuted just as the flu season began an early retreat. The so-called “Kraken” variant was already predominant in the Northeast by mid-January, accounting for more than 70% of cases.

The symptoms of the XBB.1.5 variant are similar to prior COVID-19 variants, although you may experience flu-like symptoms. Some people have only a mild cold, while others may notice a slight cough and then about 12 hours later experience fever, chills, headache, muscle aches, and congestion. The range of symptoms is very similar to the flu. In fact, unless you tested for both influenza and COVID-19, you might presume you had the flu.

Other viruses are currently circulating

The CDC tracks other respiratory viruses nationally and regionally. What we know is that human metapneumovirus is currently surging, adenovirus is in steady state circulation, and respiratory syncytial virus (RSV) peaked at the same time the flu did and is now on the decline. Human metapneumovirus is in the same family as RSV, causing upper and lower respiratory tract infections. These infections may seem like the common cold for most people, but may cause more serious diseases in infants, older adults, and those with weakened immune systems.

The four seasonal coronaviruses, which have been endemic long before SARS-CoV-2, are also trending up at the moment throughout the US. These common cold viruses can cause complications for very young infants and the elderly.

The CDC also tracks enteric viruses (those that affect the gastrointestinal tract, causing nausea and vomiting). Results show that rotavirus and norovirus are both trending up.

Should I get tested for flu and COVID?

Getting to a clinic or pharmacy for testing can be very difficult if you are feeling ill. However, if you have any risk factors for serious influenza or COVID-19 illness, then early testing can help you get started on the right course of medication, if appropriate. It would be wise to have a plan for testing, such as a drive-through pharmacy or urgent care clinic, should you develop symptoms.

Medications for treating the flu or COVID

Viruses cause these respiratory illnesses, so no medication can kill the pathogen like an antibiotic can for bacteria. It is always a good idea to call your nurse practitioner or doctor if you have any health concerns as you rest and recover, such as a fever that lasts more than two or three days, pressure in the chest, difficulty breathing, confusion, or loss of balance.

People at higher risk for complications of viral respiratory infections are urged to consider an antiviral. These medications create an environment making it difficult for the virus to replicate. Examples include Tamiflu (for influenza) and Paxlovid (for COVID-19), but these must be started early, within the first few days of illness, to be effective.

Note that all drugs have side effects, such as nausea and vomiting with Tamiflu, and the decision to take an antiviral is one you should discuss with your doctor. Your trusted healthcare professional can weigh the potential risks and benefits with you and help you make a decision that is best for your unique circumstances. The best advice is often to rest, hydrate, and manage your pain and fever with medication.

How long does the illness typically last?

Most upper respiratory infections will last about 4–5 days; then, you will start feeling better. In some cases, the fever is the worst part. Fever can make us feel truly horrible and despondent that normalcy will not return. While a fever is the body's response to invasion by a pathogen, there is a time and place for toughing it out. Getting enough rest is also important.

One strategy for managing a fever is to allow the body to fight the infection during the day if you can distract yourself. Save fever-reducing medication for bedtime, when it is vital that you or your child get some sleep.

The liver must process all medications to become “bioavailable” in the bloodstream. This is why there are daily dosage limits for anti-inflammatories. However, you can alternate between two types of anti-inflammatory medications, such as ibuprofen and acetaminophen, to avoid exceeding the daily limit.

Help others stay well

The most important thing you can do to avoid spreading illness in your community is to stay home while you are sick. If you test positive for COVID-19, the CDC guidelines recommend five days of home isolation. After the fifth day, or as soon after as you have no symptoms, you can end isolation.

If you have COVID-19 symptoms, but your temperature stays below 100.4℉ without medication for 24 hours, and your symptoms are improving, it is safe to leave home after five days. However, the CDC recommends you continue masking outside the home for five additional days.

You can help avoid spreading infection by wiping down high-use surfaces after you touch them, such as faucets, the coffee pot, stove and refrigerator door handles, and other items. Avoid sharing utensils with your children, and help them keep their hands clean. If you must travel by car, you can circulate air by opening opposite windows just a crack.

Precautions for caring for sick children

The viruses in circulation are common seasonal viruses that all children were exposed to prior to the pandemic. For new parents, though, the constant siege of illness in the house can be exhausting. Add to this stress media headlines about group A strep, and new parents can be overwhelmed.

For children with a fever, it is always a good idea to keep a close eye on trends by checking with a thermometer before dosing the child with medication. Children often spike fevers at the beginning of a cold, but if the temperature hits 104℉, it is time to check in with the child's pediatrician.

If a fever spikes several days into the cold, it might be a sign of a secondary infection, such as bacteria in addition to the virus. This is also a good time to check in with the child's doctor.

Parents can monitor the child's symptoms and rest assured that for healthy children, the process of building immunity is often done the hard way: by getting sick and then returning to health. Often, one cold can be followed by another. However, it is important to keep an eye out for worsening or unusual symptoms, such as those identified in the CDC's table of “Emergency Warning Signs of Flu” for children:

• Difficulty breathing or very rapid respiratory rate.
• Lips or face turning bluish.
• Sucking in under ribs with each breath.
• Chest pain.
• Muscle pain causing an inability or refusal to walk.
• Dehydration (no wet diaper for 8 hours, dry mouth, no tears when crying).
• Distant, not alert even when awake.
• Seizures.
• Fever above 104F that is not brought down by medication.
• Any fever in an infant younger than 12 weeks.
• Worsening fever or cough.
• Other medical conditions that worsen.

The warning signs for adults are very similar to those for children, except for a specific fever. Rest assured that colds and flu usually last about four to five days, and up to about two weeks for lingering symptoms to continue. It might help ease your anxiety to make an appointment with your medical professional for a few days out, just in case you need some reassurance that you are trending in the right direction. This may help you rest easier knowing that you have an appointment already set aside should you require it. (Just remember to cancel if you are on the mend quickly.)