As coronavirus surges in much of the United States, that other virus we start to worry about this time of year—flu—is slowly starting its annual invasion. There have been a few cases in Pennsylvania and New Jersey, but the numbers are still low, as they are in most of the country.

This could be because precautions that prevent coronavirus infection like masks, social distancing and hand washing also make it hard for flu to spread. It could be that Americans have heeded the call to get flu vaccines this year so hospitals aren’t swamped with flu and COVID-19 patients at the same time. Or it could just be the usual calm before the storm.

Flu typically starts off slow in October and November, picks up speed around Thanksgiving, picks up more speed after the December holidays and peaks in January and February. But it is hard to predict. Sometimes it starts late or has more than one peak.

“Flu is fickle,” said William Schaffner, an infectious diseases specialist at Vanderbilt University Medical Center.

The southern hemisphere has given us some reason to hope for a mild flu season, Schaffner said. Both New Zealand and Australia, whose flu seasons occur during our summer, had far fewer cases than usual this year. Their residents also got many more flu shots than usual and did a very good job of following social distancing recommendations.

America has been a lot more divided on the social distancing front. Public health officials have strongly encouraged flu shots this year, and that may have had an effect. CVS said it has already given more shots than it did during the whole season last year. It is prepared to administer 18 million shots, twice last year’s total. Walgreen Co. said it has given 60% more flu shots this year than during the same period last year. Rite-Aid also has seen higher demand. Patient First, an urgent care provider, said demand for shots was two to three times higher than last year during the first two weeks vaccines were given. After that rush, it’s been about the same.

On the other hand, Kimberly Mazur, medical director of AtlantiCare’s Federally Qualified Health Center in Atlantic City, said she’s seen an increase in vaccine hesitancy among patients. They’ve been influenced by the anti-vaccine movement, she said, and are concerned that development of coronavirus vaccines has been rushed. Gemma Downham, director of infection prevention at AtlantiCare Regional Medical Center, said some employees have questioned the need for shots when they’re wearing masks all the time to prevent spread of coronavirus. Downham tells them the masks aren’t foolproof, are often worn incorrectly and usually aren’t worn at home.

Schaffner said some Americans will have to work harder to get a vaccine this year. Big workplace vaccination campaigns will be less common. High-risk people who are sheltering at home are not seeing their doctors in person as much as usual. “You have to depend on individual initiative to go to the vaccine,” he said.

Nationally, almost all of the United States is green, the color the U.S. Centers for Disease Control and Prevention uses to denote “minimal” infection rates. An outlier in the most recent report was yellow Iowa, which has low flu activity.

New Jersey has low flu activity now, said Tina Tan, state epidemiologist for the New Jersey Department of Health. “This is what we’re expecting at this point in flu season,” she said.

In Pennsylvania, which has had 365 laboratory-confirmed cases so far this fall, Ray Barishansky, deputy secretary for health preparedness and community protection, said the cases are slightly higher than last year, but still low.

One problem with flu data worth noting, however, is that only a fraction of people with flu are tested for the disease.

Public health leaders say it’s more important than ever to get a flu shot this year for multiple reasons. One is that health care providers could have their hands full with COVID-19 cases. Another is that flu and COVID-19 share many symptoms. If you haven’t had a shot, that means you’ll have to get more testing and may endure more anxiety if you get, say, a fever or cough.

While rare, it is possible to get both flu and COVID-19. “What we worry about this year is that, if people get both at the same time, it can really overwhelm the body,” Downham said.

And, Tan said, flu can also be a dangerous disease. The CDC estimates that it led to 400,000 hospitalizations and 22,000 deaths last season. “It’s not insignificant,” she said. Flu tends to hit children harder than coronavirus does.

She said coronavirus precautions likely will decrease flu this year, but they’re not enough. “Whatever we do to prevent COVID also helps to prevent flu, but the difference with flu is, obviously, there’s a vaccine.”

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