Flu shots have started to hit local pharmacies and doctor’s offices. You might have heard messaging from Gov. Greg Abbott, federal, state and local health officials and your own doctors about how important the flu shot is going to be this year during the pandemic.


"This could probably be your most important flu shot ever," says Dr. Alan Rashid, pediatric department chair at St. David's Children's Hospital.


Why?


Both the flu and COVID-19 can cause the same inflammatory overreaction in the lungs, Rashid says. They also both make you more likely to get a second infection.


"If you get the flu, you are at high risk during that illness to get a viral respiratory illness or bacterial pneumonia," says Dr. Kazi Zaman, director of hospital medicine at St. David’s South Austin Medical Center. COVID-19 is one of those viral respiratory illnesses you could get.


Picture getting the flu and then getting COVID-19. Your body might not be able to fight them together or fight one after the other.


The same goes if you get COVID-19 first. Zaman says, "We have seen in patients with COVID, they do remain susceptible to other illnesses."


Flu and post-flu infections also fill up hospitals in a typical winter. With local hospital beds already at 71% filled and 85% of intensive care unit beds filled, in part because of COVID-19, doctors worry about what will happen when we add flu cases to those numbers.


"We are preparing for the worst, even if it’s a normal or average flu season," Zaman says.


Now is the time to get the flu shot. The rule of thumb is to get vaccinated before Halloween to be ahead of the bulk of flu season, but you can still get the vaccine afterward. It does take about two weeks after receiving the shot for your body to have the full protection.


While manufacturers have made 15% more shots this year than a typical year, you don’t want to risk your local provider running out as we get closer to Halloween.


"Do not wait," Zaman says.


Some people actually will need two shots this year. Anyone younger than age 9 who has had fewer than two flu shots in their lifetime needs one shot followed by a second one four weeks later to build up their immunity.


The typical flu shot is for anyone who is 6 months old or older, including pregnant women and anyone who is immune-suppressed or has asthma, but check with a doctor if you have a question about whether you can get a flu shot. Children between 6 months and 3 years old sometimes will receive a different form of the shot or half the dosage.


Sometimes people who are allergic to eggs have been told not to get a flu shot, but Zaman says that unless they have had a severe allergic reaction to a flu shot in the past, he would still advise people with an egg allergy to get the flu shot. He would just have them come into a doctor’s office rather than a pharmacy and be watched for signs of an allergic reaction following the shot.


People also can get FluMist, a spray that is squirted into the nose.


FluMist, though, is not for everyone. It is a live virus, versus the inactive virus in the flu shot. FluMist is only recommended for people ages 2 to 49. It is not for pregnant women or anyone with immune suppression or a history of cancer. Children ages 2 to 4 with asthma or wheezing in the last year should not be given it, and anyone with asthma should be cautious about its use. It also shouldn’t be given with other vaccines.


FluMist was taken off the shelves and reformulated after it was found to be ineffective. It returned in 2018, and doctors did not notice a difference between the effectiveness of the shot and the nasal spray in 2018 or 2019. Many doctors still do prefer the flu shot over FluMist, but if you are that person who has a severe shot phobia, FluMist could be a good choice.


For adults 65 and older, a high-dose flu vaccine is available. Kazam recommends it especially for patients who have had a bad bout of the flu despite getting the flu shot.


The side effects for all of these are similar, he says, and typically it’s irritation at the site of the shot.


Doctors recommend going to wherever you are comfortable to get the flu shot. The advantage of going to your doctor’s office is you can take care of your well check and any other vaccines you might need. There are also COVID-19 safety measures and screenings in place.


If you do go to a pharmacy or grocery store pharmacy, Zaman recommends going at a time when it will not be busy and calling ahead to make sure that is the case. Wear your mask, bring hand sanitizer with you and wash your hands after coming home.


Wait to go if you are having any symptoms such as fever, sore throat, loss of taste and smell, diarrhea, shortness of breath or cough.


If you do get the flu, call your doctor if you have difficulty breathing, cannot drink fluids, are continually vomiting, are so tired you’re not easily awakened, you have a fever longer than three days, and if you take Tylenol or Motrin and it doesn’t seem to make a difference.