How bad will California’s flu and covid season be this year?
Last year’s flu season was the worst California has seen in years — and state health officials are warning that this year could be just as bad.
While predicting the disease is not an exact science, there are some troubling symptoms. In Asia, the flu quickly returned, and quickly grew to epidemic proportions in Japan and Taiwan.
And in the state, some experts are sounding the alarm about continued low uptake of the flu vaccine. There is also the possibility of seasonal COVID-19 waves — the likes of which did not occur last winter, but have been common since the outbreak — as well as a concurrent increase in respiratory syncytial virus, or RSV.
California health officials had previously predicted that the fall and winter respiratory virus season would be similar to last year. If this is the case, influenza will again be the dominant virus for hospital admissions compared to COVID-19 and RSV. During the winters of 2022-23 and 2023-24, COVID accounted for the majority of hospital admissions in California due to respiratory viruses.
“Getting people vaccinated is going to be really key for influenza,” said Dr. Peter Chen Hong, an infectious disease specialist at UC San Francisco.
While the flu, COVID and RSV are currently at low levels in California, there are signs that respiratory virus season is starting as temperatures drop and people spend more time indoors.
Compared to rates recorded in the summer, the Los Angeles County Department of Public Health has seen an increase in people reporting coughs, fevers, colds, aches, sore throats and runny noses, officials said, citing a text-based health survey. The test positivity rate for rhinoviruses and enteroviruses, which commonly cause the common cold, is 19.87%. This is higher than the virus that causes COVID-19, 4.2%; or flu, 1.04%.
In San Francisco, doctors have seen double the number of colds reported to the hospital, Chen Hong said. Some workplaces in the Bay Area have seen some employees call in sick.
With rates of RSV, flu and COVID-19 expected to rise during the holidays, “this is the perfect time to get vaccinated,” the LA County Department of Public Health said in an email.
According to the US Centers for Disease Control and Prevention, the fall and winter of 2024-25 brought the nation’s worst flu season in years.
The number of children who died from the flu last season was the highest since the 2009-10 H1N1 swine flu season, according to the latest report published in the CDC’s Morbidity and Mortality Weekly Report. Officials reported 280 confirmed deaths among children last season, and about 9 in 10 children were not vaccinated.
Health officials have been particularly concerned about reports of a rare, severe complication that targets the brain — influenza-associated encephalopathy, or IAE, which was reported in 109 children nationally last season.
Three out of four children with IAE require intensive care treatment. The median age of children with IAE was 5, and 55% of those diagnosed with the condition had no underlying health conditions.
Of those children, 37 had acute necrotizing encephalopathy, or ANE, a specific form of the disease that results in rapid neurological decline. Two of the five children with ANE died.
Health officials say only 1 in 6 children with IAE was immunized.
The CDC recommends that everyone 6 months of age and older get the flu vaccine. New this year, officials are allowing people to order FluMist delivered to their homes. FluMist is approved for people ages 2 to 49 and is administered by nasal spray rather than injection.
Doctors are concerned about falling flu vaccination rates. As of late April, only 49.2% of children had received flu shots, down from 53.4% who had done so at the same time last season, according to preliminary national survey results. Both figures are significantly lower than the last flu vaccination rate for vaccine-eligible children during the 2019-20 season, which was 63.7%.
Among adults, 46.7% have received their flu shots, down slightly from 47.4% at the same time last season, according to preliminary survey results.
“Prior to the COVID-19 pandemic, flu vaccination coverage was increasing slowly; declines in coverage occurred during and after the pandemic. Flu vaccination rates did not reach pre-pandemic levels,” the CDC said.
Preliminary data from the Southern Hemisphere show that the effectiveness of the flu shot has been good this season – reducing the risk of hospitalization by 50%.
Asia is already reporting many flu cases.
“Influenza is spreading rapidly in Asia right now,” said Chen Hong.
The flu is considered epidemic in Japan – where news reports say it was the second earliest start of the season in 20 years – and in Taiwan. Hong Kong health officials have described the flu situation in September and October, before shots became widely available, as “relatively severe.”
The situation there could provide a glimpse into how the flu season will play out in California and beyond.
In the San Francisco Bay Area, officials are also closely monitoring “elevated” levels of a particular type of cold virus — enterovirus D68, or EV-D68 — in sewage. In rare cases, the virus can cause polio-like paralysis in children called acute flaccid myelitis, or AFM. According to WastewaterSCAN, high levels have been reported in large parts of Silicon Valley and San Francisco. High levels of sewage have also been found in western San Bernardino County, including Ontario, Chino and Fontana.
The LA County Department of Public Health has yet to detect an excess of EV-D68, and no cases of AFM have been reported in Los Angeles or Orange counties this year.
The virus can be transmitted through an infected person’s saliva and mucus and is likely spread “when an infected person coughs, sneezes or touches a surface that is then touched by others,” the CDC said.
Parents should call the doctor if their child has any symptoms of AFM, including slurred speech, difficulty swallowing, difficulty moving the eyes, pain in the neck, back, arms, or legs, weakness in the arms or legs, or facial drooping.
To protect yourself against respiratory viruses, experts recommend getting vaccinated, washing your hands frequently, keeping rooms well ventilated, wearing a face mask in crowded public settings, and staying away from sick people.
The California Department of Public Health is recommending the new COVID-19 vaccine for everyone over the age of 65, from 6 months to 23 months; Also older children, adolescents and adults who either have risk factors for severe COVID, or are in close contact with at-risk people.
Children who have never been vaccinated against COVID-19 should get the vaccine, as should pregnant women and anyone else who wants to get the shot, the department says.
The RSV vaccine is recommended for everyone age 75 and older, babies younger than 8 months, and women between 32 and 36 weeks pregnant.
The vaccine is also recommended for adults 50 to 74 years of age with risk factors, as well as for children 8 months to 19 months of age with risk factors. Older adults who have already been vaccinated against RSV generally do not need another vaccine according to current guidelines.
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