Dr. Jennifer Shuford, infectious disease medical officer for the Texas Department of State Health Services, spoke with Community Impact Newspaper in late September about influenza and the public health agency's work this season. This interview has been edited for length and clarity.
How does the DSHS typically prepare for flu season?
The one thing that we know about flu seasons is that every one is unpredictable. So we don't know when they're going to start, when they're going to end or when they're going to be at their worst. And we've seen some patterns over the years about usually we see the peak of flu season sometime between December and March, but it can even be outside of those times. And so there's a big element of the unknown when it comes to flu season.
One of the things that DSHS tries to do is, early in the fall, start sending out messages that getting the flu shot is the single most important thing that a person can do to prevent themselves from getting the flu or from severe flu and its complications. ... Our recommendations are always that every Texan age six months and older should get their flu vaccine for every flu season unless they've got a medical reason not to. And we recommend that take place before the end of October so their body has time to build up those antibodies, to build up that immunity after they get the vaccine, before the flu activity in Texas really ramps up.
We also do a lot of surveillance surrounding flu so that we have an accurate idea of how much flu activity is occurring in different parts of the state, and that helps us respond to health care systems that might become overwhelmed or pharmacies that might be experiencing decreases in their flu medication stock.
Have preparations changed this year?
The operations themselves have stayed a lot the same. It's a process that we do every year and try to improve on every year because every flu season could be the worst flu season we've ever seen. And so we really do focus on that. This year, though, we have tried to increase the messaging even more. We are working with multiple different communications groups at DSHS to make sure that every part of our agency really amplifies that message for Texans across our state to prepare for flu season. ... Another thing that's changed is that [the] CDC typically supplies us with a lot of those vaccines for our Texas Vaccines for Children Program, but this year, they're also giving us additional vaccines for adults because [the] CDC knows, just like [the] DSHS [does], that this yea,r it's particularly important that people protect themselves from influenza ,both for their individual health and for the function of our whole health care system.
What is the department expecting from this flu season in Texas?
We are hoping for the best but preparing for the worst. We have seen the experience of other southern hemisphere countries and that some of those prevention methods that they're using for COVID-19 has probably decreased their flu activity over their last flu season. And so we are hoping that that holds true for Texas as well—that as long as people continue to do things like wear their masks and stay 6 feet apart from people who are outside of their household—that we, too, will be low-activity through flu season. But we can't count on that, obviously. So we are ... trying to get that message out about flu shots but also [to maintain] awareness of our hospital and our health care infrastructure just to make sure that no part of it starts to get overwhelmed during flu season, knowing that flu season by itself can in some seasons overwhelm our health care system. And this year, we've also seen that happen with just COVID-19 alone.
Is there any concern that hospitals in Texas could have capacity issues with both flu and COVID-19 patients?
We did see a lot of COVID-19 activity over the summer, and over the last month, we have seen decreases in the COVID-19 case counts, and that has been encouraging. ... What we're seeing is that our hospitals are able to cope with the amount of COVID-19 that’s in our hospitals right now but that they are at a level where if we start seeing increased COVID-19 in the community—that our health care system could become incredibly stressed again. And so we don't feel like we're out of the woods. We feel like our health care system is safe at this moment in time but that any addition of flu in our communities or COVID-19 in our communities really could start to impact and stress our health care system.
Has the focus on COVID-19 this year benefited the state’s preparedness for flu season?
We're certainly hoping for increased rates of flu vaccination across our state this year, but it's a little early to tell if that's actually happening. I think with the focus on really washing your hands and staying home if you're sick and distancing yourself from other people, that is going to help with COVID-19 and with flu. ... People have, whether they wanted to hear it or not, had to listen to that message now for months. And so I think that everybody is aware of those really good practices to help prevent the spread not only of COVID-19 but also influenza.
How can people differentiate between COVID-19 and influenza symptoms?
The symptoms for flu and the symptoms for COVID-19 overlap a lot. It is going to be hard for people, individuals, to tell the difference, and it's going to be hard for health care providers to tell the difference between those two illnesses in any given person. ... If people fall within a high risk group for either one of those things and they start to develop symptoms, they need to call their health care provider. So for flu, we'd be talking about people who are older, especially 65 years and older, pregnant women, young kids, especially those under the age 2 and people who have chronic underlying medical conditions. And then, for COVID-19, we'd be talking about, again, those older age groups, like 65 and older, and people who have chronic underlying medical conditions, including things like heart disease or diabetes or obesity. ... For those populations that are at risk for more severe disease, it's important for their health care provider to know how symptomatic they are, whether they've been tested and if a medication would be right for that person.
Even though a lot of the symptoms of flu and COVID-19 overlap, there's one that's a lot more common for COVID-19, and that's a loss of taste or smell. And so that would be one indication that it’s COVID-19 rather than influenza. But otherwise, they look so much the same that it's going to be hard to differentiate that just based on symptoms alone.
Is there anything else you’d like to mention about this flu season?
We hope that our flu season isn't bad. We hope that we have the same experience as what we saw in the southern hemisphere, but we cannot be assured of that. We might still have a very severe flu season, even with all of our COVID-19 prevention measures in place. And so it is still very important for people to get their flu shots for this flu season.
The flu vaccine has changed a lot over the last year. We know that flu viruses mutate all the time, and so the flu vaccine has to also be updated in order to keep up with the changes in those flu viruses. And from last fall to this fall, that flu vaccine has changed substantially. So each flu vaccine usually contains four different flu viruses in it, and this year, three of the four have changed since last year. And so it is a very different vaccine, and people need to know they need to get the flu shot this year for this flu season.
