Predicting Flu Season Remains Difficult, but Get Ready for a Doozy

By John Palmer

Is your facility trying to get ready for flu season? Good luck, because this year might be a bad one.

The CDC and other health officials around the globe are having a hard time estimating the severity of the upcoming U.S. flu season, and we’re already technically in its early stages. Flu season tends to start in mid-October, according to the CDC, and will peak between December and February. In some cases, the season can last as late as May.

CDC statistics show that the 2018–2019 season broke records, logging in at 21 weeks long, from October 1, 2018 to May 4, 2019. Up to 42 million cases of the flu were reported, resulting in 20 million medical visits, 647,000 hospitalizations, and about 61,000 deaths.

Still, it could have been worse. The 2017–2018 season was the worst flu season since the H1N1 swine flu pandemic in 2009, according to the CDC. In 2017–2018, the flu caused nearly 49 million illnesses and 80,000 deaths.

All that said, the 2009 season is the one that health officials compare others to, as that was the year the new H1N1 strain emerged. The CDC, which along with the World Health Organization declared a worldwide flu pandemic, estimated that 151,700–575,400 people worldwide died from the H1N1 flu virus during the first year it circulated. More frighteningly, 80% of those deaths were estimated to have occurred in people younger than age 65—in contrast, during typical flu seasons, 70%–90% of deaths occur in immunocompromised people 65 and older.

While the CDC tells people to get their flu shots by the time the season gets going in October, getting the shot doesn’t always guarantee protection, as it’s difficult to predict what strains will affect the population in any given year.

For instance, the CDC reported that most people who were infected with the flu early last season had the H1N1 strain, but the dominant flu strain changed later into the season. By late winter and early spring, a new strain known as H3N2 appeared, infecting larger numbers of people. By the time health officials realized what was happening, it was too late to change the vaccines to protect people from the new strain.

Before H3N2 hit, the 2018–2019 flu season was on track to be short and mild. The new strain thus came as a surprise to many medical experts who study the flu and use forecasts to formulate the annual vaccine.

To prepare for the onset of flu season in the United States, the rule of thumb is to look at virus activity in the Southern Hemisphere, which concludes its flu season shortly before the Northern Hemisphere’s begins.

The bad news on that front: Early reports from health organizations show that Australia’s latest flu season was one of the longest on record, with an unprecedented number of flu cases in recent months.

“That bothers me. I’m tightening my seatbelt in anticipation that we may have something similar,” said William Schaffner, PhD, an influenza expert at Vanderbilt University in Tennessee, in a report from Healthline Medical Network.

“Australia’s influenza season, which of course immediately precedes ours, is not an exact template but can give us some ideas about what we might expect,” he said. “So I’m concerned we might, once more, have this odd double-barreled influenza season with two dominant viruses.”

Already, flu shot manufacturers have had to change their vaccines. In early September, federal officials announced that 70 million flu shots would be delayed due to the need to recalibrate the vaccine. A total of 162 million–169 million doses will be available in the United States this year, the CDC reported.

The time to prepare is now

Infection control experts say right now is the time to prepare for a difficult flu season. And while the flu is always a consideration, it’s also time to start preparing for a flu pandemic—even if one doesn’t occur.

“The best time to prepare for a pandemic is before it happens,” says Jason Burnham, BE, MBA, associate marketing director for Halyard Health, a worldwide supplier of personal protective equipment (PPE) and surgical equipment for hospitals and healthcare organizations.

“For hospitals, an ongoing challenge is trying to align their PPE supply chain with their care delivery model,” Burnham says. “An important consideration is wanting to be prepared for an event such as a potential pandemic flu outbreak by having enough PPE on hand to protect patients, staff, and family members should a surge in demand occur.”

Speaking of PPE, here are some general tips to keep in mind while you prepare for the arrival of flu season:

You can never have too much. Of course, Halyard is a PPE provider, so Burnham isn’t without bias in that sentiment. Still, he says that hospitals should always err on the side of having a bit more than they need for flu season.

“Most importantly, all workers who may come in contact with a flu patient need to wear a mask,” he says. “For tasks that may create splashes or pose additional risk, staff should wear gloves, gowns, and eye protection. If a procedure is aerosol generating, hospital [staff] should consider having a fit-tested respirator and goggles.”

To estimate the strategic supply of PPE you should keep, figure out how many staff members (doctors, nurses, etc.) may come in contact with flu patients, how often they’ll come in contact, and what PPE they’ll need based on their involvement with patients.

Lastly, store PPE in a temperature-controlled, low-moisture room as close as possible to where staff members will be delivering patient care so they can get it quickly.

Know your suppliers. Burnham notes that the Association for Healthcare Resource and Materials Management (AHRMM) has created a manual for disaster preparedness, part of which recommends conducting a hazard vulnerability analysis (HVA).

“This HVA can help supply chain managers and those they coordinate with to plan for pandemic outbreaks such as flu,” he says. “In fact, the quantity of PPE required for a pandemic flu outbreak can be significantly more than seasonal flu. Supply chain managers should never feel like they’re on their own.” Plus, the HVA is something all hospitals should be doing to satisfy their accreditors.

Hospitals should find a supplier they can partner with, then discuss how much time the supplier would need to meet surge demand and how an outbreak could affect timely sourcing and delivery of PPE, Burnham says. The CDC can also provide guidance on how to plan for each type of stockpile.

Train. You’ve been told this repeatedly, and there’s only so many ways to say the same thing: You can institute all the policies in the world, but if your staff doesn’t know how to implement them when it’s game time, things will fall apart.

The government requires hospitals to regularly conduct emergency drills that test staff readiness in case a surge of patients comes in the door. Make sure one of those drills simulates the intake of patients and donning of PPE during a flu pandemic.

After you’ve held an in-service training explaining intake and triage procedures, design a small drill using volunteer “patients” who come into your facility all exhibiting the same symptoms. Have your frontline staff practice calming them down, asking the right questions, and isolating them from the rest of the waiting room.

John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at