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While all attention seems to be on the coronavirus pandemic and COVID-19 vaccines, doctors say flu shots are important as summer turns to fall and children have returned to in-person learning.

Last year, there were fewer cases of the contagious respiratory illness, a pleasant byproduct of widespread masking, social distancing and remote learning, said Dr. Russell Lampen, an infectious disease expert at Spectrum Health, based in Grand Rapids.

“My concern is that we are going to have increasing rates of influenza again. The flu, while low-level last year, has not gone away. And like all viruses, it’s looking for an opportunity and looking for susceptible individuals to infect,” Lampen said in a call with reporters earlier this month.

It is important to note, on average, about 25,000 to 35,000 deaths result from influenza, every year in the United States, he said.

Michigan health systems, struggling with staffing and an influx of patients, are presently overburdened. Some of this is related to the pandemic.

“And if we can do anything to prevent those deaths and those hospitalizations from occurring, that’s going to be important,” Lampen said.

In the 2020-2021 season, July 2020 to June, flu immunizations were up among adults in Michigan. Through June, about 3.4 million doses were administered. That is about 34% of the population. The goal was about 4.3 million doses administered.

A year earlier, in 2019-2020, about 32% of the population was immunized against the flu, caused by viruses infecting the nose, throat and lungs, according to data from the Michigan Department of Health and Human Services.

Last year, the state launched a “Facing the Flu Together” campaign to encourage flu vaccines, prevent illness and preserve resources needed to fight COVID-19.

The numbers were higher in all but one age group. The percentage of children 5-12 vaccinated in the 2019-2020 season was 29.4%, slightly higher than the 29.3% vaccinated in the last season.

Those 65 and older, a particularly vulnerable group, were vaccinated at the highest rate, about 60%. People 18-24 had the lowest rate, about 20%.

Throughout the last flu season, illness was down. At the peak of the 2019-2020 season, about 4.2% of patients who made office visits presented with influenza-like illness. At the same time last season, the percentage was well below 1%. The baseline is 1.9%. Flu activity usually peaks from December to February.

Overall, there were 14,388 patient visits reported as having influenza-like illness in the 2019-2020 flu season. For the 2020-2021 season, there were 2,391. However, fewer reports were submitted in the last flu season because of the pandemic. Many outpatient providers did not see patients in-office with flu-like symptoms and many declined to participate in the surveillance program last flu season, according to the Department of Health and Human Services. (The data, taken from a sampling of providers who volunteer to participate in about half the Michigan counties, cannot be representative of the entire state.)

There were 10 influenza-associated hospitalizations last season as part of an October-to-April surveillance project involving Clinton, Eaton, Genesee, Ingham, and Washtenaw counties and no pediatric deaths.

During the season beginning in 2019, there were 948 hospitalizations and six MDHHS-confirmed child deaths.

Reduced population immunity due to lack of flu virus activity since March 2020 could result in an early and possibly severe flu season, according to the U.S. Centers for Disease Control and Prevention.

Because there are no longer universal masking protocols, there is expected to be a flu season in 2021, said Kerry Ott, public information officer for the LMAS Health Department, serving four Upper Peninsula counties. People have largely returned to normal since the state lifted health orders restricting certain activities and COVID-19 vaccines became widely available. Many embraced the vaccines; others remain leery.

“We are concerned that lots of people won’t get their flu shot this year, just because of the association they’ve made between flu and COVID, and thinking they are the same thing. And they are not, completely different viruses,” Ott said.

She noted the much higher death toll. Nearly 21,000 people have died of COVID-19 in Michigan since the start of the pandemic, and coronavirus cases in Michigan and across the country have been increasing.

People should not wait for a rise in flu transmission to receive a flu shot. Ideally, people 6 months and older should be immunized by the end of October, according to the CDC. The oldest and youngest populations are most at risk.

Timing for flu vaccines could coincide with the expected approval of Pfizer’s COVID-19 vaccine for children 5-11, doctors said.

While there was some discussion about waiting weeks between COVID-19 vaccines and other immunizations, this is no longer the recommendation, Dr. Alanna Nzoma, a Michigan Medicine pediatrician at a Brighton clinic said during a recent live question and answer session hosted by the health system.

“We recommend that if your child is able to get the vaccine as soon as possible, we recommend that’s what you do for them,” she said.

Vaccines for COVID and flu can be safely administered at the same time, she said. This applies to adults too, doctors said.

Interestingly, Maryland-based vaccine developer Novavax is studying a combined flu-COVID-19 vaccine, said Dr. Elizabeth Lloyd, pediatric infectious disease expert at Michigan Medicine’s C.S. Mott Children’s Hospital in Ann Arbor.

According to the CDC, flu vaccines can prevent illnesses and flu-related doctor’s visits; reduce severity of illness in vaccinated individuals who still become infected; decrease risk of flu-associated hospitalizations; lower rates of cardiac events among people with heart disease; protect pregnant women; and reduce chances of flu deaths in children.

People can receive flu shots at most major pharmacies, such as Walgreens and Rite Aid, healthcare providers and health departments. Most health insurances cover flu shots.