Families at Advanced Pediatrics have long enjoyed the light-hearted, fun approach to getting protected against infection with the influenza virus, in our annual Advanced Pediatrics Flu Fest.

Sadly the Pandemic of COVID-19 will disrupt yet another wonderful routine.  For two reasons, we need to rethink how to offer flu shots to families in our practice.

Special Perceived Urgency of Time

The first reason is that there is a special perceived urgency of getting the flu shot ASAP, mainly because of the lurking presence of the COVID-19 danger.

Families should know that the influenza virus does not appear in our neighborhoods until mid-December, so there it time to get your flu shot, but there is a sense of pressure this year, unlike others, to get the protection in place soon.

Physical Distancing

The most fun part of Flu Fest has been seeing everyone, saying hi, lingering in the waiting room to enjoy the gift of Mitchell’s Ice Cream from Mitchell’s.  But crowds are out for now, especially indoors.

Different Approach this Year

As a result, this year, we will be offering flu shots much earlier in the year.  Most of them will be given during the course of our regular business hours, and there will be no ice cream, sadly.

Basic Facts about Influenza

As we approach giving flu shots, it is always helpful to be reminded of just what they are designed to do, what the virus is that they protect against.

Much confusion comes from two meanings to the word flu.  

The most common use of the word refers to a bad cold, any bad cold.   And bad is totally subjective.  One person could have some troubles and be thought have a cold, and another person have the same troubles and be thought to have a flu.  Flus in this sense can be caused by any virus that causes colds and flus.  The viruses that cause colds and flus include rhinovirus, RSV, adenovirus, parainfluenza virus, influenza virus,  4 very old coronavirus, and the new coronavirus, SARS-CoV-2.

Now most of these cold and flu viruses are around all the time, with two exceptions.  The first, of course, is SARS-CoV-2, it didn’t exist until 2019, hence its name, COVID-19.  But it is here and it makes every cold and flu far more complicated than in past years.  That is of course because now it is more urgent to know the name of the virus causing your child’s cold or flu, because if it is COVID-19, then a new world of concerns opens up.  The second exception is the influenza virus, which normally only is present from mid-December through April, which brings us to the second meaning of the word flu.

The second meaning of the word flu, is reference to a very specific species of virus, called the influenza virus, which comes in two types- A and B.  You have seen that colds and flus are caused by all sorts of viruses, but one of them is the species called the influenza virus, again types A and B.

So, when someone says, Bob had “the flu” they could mean he has a bad cold, or that he was tested and found he had an infection with a very specific virus, the influenza virus, either type A or B.

Now, the influenza virus causes colds and flus much like all the other respiratory viruses listed above. (remember?- rhinovirus, RSV, adenovirus, parainfluenza viruses, coronaviruses old and new).  The main differences are that:

1. As noted, the influenza virus has the schedule of being here mid-December through April.
2. The SARS-CoV-2 virus, although typically causing mild illness, can cause terribly dangerous, even deadly, disease in large numbers of people.

The Flu Shot

The flu shot is a very specific immunization, it ONLY protects against ONE species of virus, the influenza virus.

The flu shot is recommended for all people ages 6 months old and up.

For all people who get their first flu shot age 8 and under need two doses at least one month apart.  Anyone at any age who had any type of flu shot in a past year, only needs one flu shot this year.  Anyone age 9 and up who gets one flu shot this year, whether they have ever had one before, needs only one.

Influenza Season, COVID-19, and the Flu Shot

A big question yet to be answered is what will the presence of this new coronavirus, SARS-CoV-2 do to the influenza epidemic season of mid-December-April?

It is a very big question because one thing we know for sure- sometime in mid-December, COVID-19 and the influenza epidemics will collide.

Several outcomes are possible:

• The COVID-19 could make the influenza infections, flus from influenza much worse somehow
• The COVID-19 could make the influenza infections, flus from influenza much better, perhaps by interfering with the influenza virus infecting us
• The arrival of the influenza virus could make COVID-19 worse
• The arrival of the influenza virus could make COVID-19 better
• The infections circulating at the same time could have no impact on each other

Again, we have no idea what the impact of them both circulating at the same time will be.

And so it does make great sense to get a flu shot this year, for two reasons:

1. The flu shot could prevent a more serious influenza infection with SARS-CoV-2 circulating around.
2. The flu shot could prevent a more serious bout of COVID-19 with influenza virus circulating around.

The Current Advanced Pediatrics Plan to Give the 2020 Influenza Immunization- the Flu Shot

To avoid the crowding of Flu Fest, we will be booking appointments for getting the flu shot, to children and adolescents in the practice starting the week of Labor Day.

We are starting before all our flu shots arrive, to accomodate giving them as early as possible, but it means that we may give flu shots until a current shipment runs out, and then need to wait a week or so for the next shipment to arrive before we can resume giving the flu shots.

As you may recall, in anticipation of more fevers happening once some schools open, we are offering our well-child check-ups in the morning, and sick visits in the afternoon, starting the week of Labor Day, and so flu shots will be available only in the morning, during well-child appointment times, to reduce exposures to children with fever.

If we are able to administer all this year’s flu shots this way, we will, and if the flow requires some Saturday mornings, we will do that.  But in contrast to past years, if we need to use Saturday mornings, we will manage the flow differently to ensure the waiting room and hallways remain as close to empty as possible.

A key difference this year will be that since we will be offering the flu shots as shipments arrive, there will necessarily be times when we run out of one shipment while we await the next one, the suppliers always ship our order in spaced intervals.  We want everyone to know that since the influenza virus, the only virus the flu shot protects against, does not appear until mid-December, then there is no rush to get a flu shot before December.  This means if you call and we are waiting in September for a new shipment of flu shots, you are perfectly safe waiting until our new supply arrives and getting that flu shot in September, or even October or November.

BOTTOM LINES:

1. Flu shots ONLY protect against one species of virus- the influenza virus.
2. The influenza virus only is present from mid-December through April, so the flu shot can only protect you against a disease that is present here after mid-December.
3. All the “flus” people have in September, October and November are not due to the influenza virus, but many other viruses.
4. This year, one of the viruses that will cause runny nose, achiness, cough, fever, will be the SARS-CoV-2 virus.  And therefore, we are prepared at Advanced Pediatrics to keep children with such illnesses separate from those coming in for well-child check-ups.  Further, we will be able to test your child with cold or flu symptoms and determine which virus they have, as well as if COVID-19 and/or strep is present, all with one swab, with results known in 2-3 days.
5. Flu shots are recommended for all people 6 months old and up.
6. If you are 9 years or older you only need one flu shot this year no matter if you have or never had one before.
7. If you are 8 years old or younger, you need a two flu shots this year if you have never had a flu shot before.
8. We will begin offering flu shots starting September 8, and scheduled only in the morning, the time the office will only be scheduling well-child check ups.
9. From time to time from September 8 on, we will have intervals when our supply of flu shots will run out, and we will hold scheduling more flu shot times until the new shipment is received.
10. Keep in mind, since the influenza virus, the only virus the flu shot protects against, does not appear in Ohio until mid-December, we have plenty of time to administer flu shots through September, October and even November.
11. This will be the first cold and flu, and influenza season that humanity has had COVID-19 present too, ever.  Therefore, no one knows what impact the presence of COVID-19 will have on the usual colds and flus, and the influenza cases.  We at Advanced Pediatrics stand ready to help find out, report what we learn, and respond to any trends.

We do hope everyone stays well.  Masks and social distancing along with delayed school openings, could reduce the frequency of colds and flus, and after mid-December, even influenza cases, time will tell.

To your health,
Dr. Arthur Lavin