Ask the Pharmacist

Q) With COVID-19 around, should I even bother getting an annual flu shot?

A) Actually, the presence of COVID-19 makes getting a flu shot even more vital this year than any other that I can recall. While the flu shot unfortunately will not protect you directly from COVID, it will help a great many of us stay healthier than we otherwise might thereby reducing our need to go to doctor’s offices and emergency rooms and thus limiting our potential exposure to the coronavirus.

Getting the shot also helps limit the risk of overwhelming our hospitals (the flu is a major cause of hospitalization every winter), a situation that looks even more conceivable these days as the numbers of COVID cases has risen dramatically recently throughout Canada.

Lastly, both the flu and COVID-19 have many of the same symptoms. By receiving the flu vaccine and reducing your chances of getting sick, it helps reduce the likelihood you will need to get tested for the coronavirus and be forced to stay home for at least 48 hours if not a full two weeks. As someone who recently spent three plus hours in their car waiting for a nasal swab (or I could book an appointment for a week from today in Owen Sound- good planning Mr. Ford!!!) and is now at home writing this article awaiting my results, I can assure you that a small needle prick in the arm and 20 minutes of your time is very small price to pay to avoid all of this. And it’s not just me who thinks it’s more important than ever to get your flu shot.

A recent survey of 1,912 adult Canadians found that 57% of respondents plan to get vaccinated this year versus the 45% who got vaccinated in 2019. Similarly, 26% of those who were not vaccinated last year indicated they would definitely do so this year and cited COVID-19 as one of the reasons behind this. And this increase in interest is not just limited to adults and seniors as pediatricians report a spike in interest in parents wanting to get their kids protected as well. Anticipating this response (what a great word anticipating is when it comes to healthcare rather than reacting which has been the standard for far too long) , the provinces and territories have collectively ordered 22% more doses of the vaccine (13.7 million doses) when compared to last year.

There are concerns however that all will not run smoothly. It is possible that the increase in doses available may still not be enough, although government officials do not anticipate that supply will be an issue. As well, the ongoing pandemic will make administering the flu shot far more problematic due to all the necessary safety precautions that will only further tax already strained staff resources. If pharmacies start helping everywhere with COVID testing soon as has been rumoured, many will struggle with the many demands on their time, particularly in the chains which tend to staff in a very lean fashion.

Many, if not all pharmacies and clinics, will be doing modifications to their usual protocols such as holding clinics outdoors and increasing social distancing in order to help to protect staff and clients. Appointments will also be booked further apart than normal and patients will be required to fill out their paper work (this is the usual checklist where you indicate whether you have had the shot before, that you are not currently sick, etc. …) at home that morning and bring it with them in order to minimize their time at the store.

The long and short is it would be wise to book an appointment now, as many pharmacies and clinics will not be offering walk-in shots and available spaces. The Ontario government has committed to supplying drug stores with the vaccine somewhere between October 5th and 19th so most clinics will take place sometime after the 19th. This is not too late to receive the shot as one of the concerns, particularly in seniors whose immune systems are not as robust, is that its benefits will wear off before the end of the flu season. Typically, the flu dies out in the spring and it peaks in January. Too early an administration time risks having its benefits wane when it is needed most. As well, the flu vaccine only takes about two weeks to fully kick in so, receiving a shot in late October or sometime in November, is not an issue.

New for 2020, is that pharmacies will now be able to administer the high dose flu shot for the first time. This formulation, which has four times the amount of antigen, has been shown to reduce confirmed influenza by somewhere between 18 to 24% in patients 65 years and older when compared to the standard trivalent flu vaccine. This does come with a bit of a trade-off in that recipients are more likely to have localized reactions (i.e. a sore arm) or suffer from mild flu-like symptoms (but not the flu itself, the flu shot does not cause the flu. Fact!).

Pharmacies are only receiving a limited supply of this higher potency vaccine so it is being reserved for those who need it most, in keeping with the golden rule of health care. Thus doses are being reserved strictly for those over the age of 65 but, given that the government has not specified just how many high dose vaccines individual pharmacies are going to receive, there is a strong chance that not all seniors will be able to get this version. This means that even among seniors, pharmacies will likely have to ensure that those at the greatest risk (such as seniors with COPD, asthma, diabetes…) are given first crack at being injected with the enhanced version.

For the rest of us, from ages 6 months to age 64, the standard four-dose flu vaccine should suffice and is even preferable in some age brackets as it contains protection against one extra strain of influenza type B that is not in the high dose version. Missing this extra “B” is not a concern for the 65 plus crowd as they are far more likely to be infected with an “A” type virus and still do receive some cross protection against type B from the high dose vaccine.

Pharmacies, as always, can still only vaccinate kids over the age of 5 (although this may be changing soon) but anyone over the age of 6 months can and should be vaccinated. For those with needle phobias, the intranasal vaccine is once again available, but not at most pharmacies. There was a brief period of time when it was the vaccine of first choice for infants but new data now shows it is no more effective than the injectable ones and cannot be given to anyone who is immunocompromised or has severe asthma (but it is considered safe for those with mild asthma) since it is a live vaccine whereas the injectable ones are not.

The injectable form should always be given to adults 60 to 64, or younger adults with chronic conditions (such as seizures, heart issues, neurologic conditions…) and in pregnancy. As a reminder you can be mildly ill (like a cold) and still safely receive the flu shot that day.

Now, given the similarity of symptoms between COVID and a run of the mill cold, you may well be rebooked for a different date anyways as everyone will be exercising extreme caution this year in order to limit potential harm to everyone involved. If you’re not sure, call ahead and your healthcare worker will assess you over the phone.

How effective will this year’s version be? That’s currently a difficult question to answer since the WHO made their assessments back in February (as per usual) as to which strains of the flu were to be included. Normally we can gauge it by Australia’s experience as their season starts earlier than ours. However, with social distancing, hand washing and masking, their number of influenza cases has been so low that it has been difficult to collect sufficient data to draw firm conclusions. The good news is that this low case load means that the virus is less likely to mutate meaning that the chances of the vaccine being very effective this year are actually quite good.

It’s funny. While I have always been a supporter of vaccines, I have often wondered that if I were living a different life, and not one as a health care practitioner, would I have “bothered” to make the time to get the flu shot most years given my health and age. Considering all that we have discussed here, I truly hope that in this alternative reality, I would not have been ignorant enough to have decided to skip it this year. For more information about this or any other health related questions, contact your pharmacist.