Signs outside a CVS Pharmacy in Cherokee County advertise free flu and COVID-19 vaccines. Health care experts hope flu shots along with masks and social distancing will help keep the coming flu season mild.

Signs outside a CVS Pharmacy in Cherokee County advertise free flu and COVID-19 vaccines. Health care experts hope flu shots along with masks and social distancing will help keep the coming flu season mild.

Credit: Ross Williams/Georgia Recorder

It won’t be long before autumn comes to Georgia, but the changing season could bring more than just cooler temperatures and beautiful foliage.

For pharmacists, cold weather means more people coming through their doors looking for relief from stuffy noses and sore throats or to ward off infection with a flu vaccine. October marks the start of the annual flu season, which typically worsens as the mercury drops before ending around May. And with Georgia hospitals still packed with COVID-19 patients, a bad flu season could mean even more strain on already stressed health workers.

“Typically during flu season, our hospitals are much busier from an inpatient standpoint,” said Anna Adams, senior vice president of external affairs for the Georgia Hospital Association. “When we have this number of COVID inpatients on top of our regular patient population, the beds and the staff are just not there, so we’re already running into issues where people are experiencing extremely long wait times, ambulances are having to wait a long time to get patients into the hospital because we just don’t have the space and staff. When you add a flu surge to that, it pushes our inpatient numbers way beyond capacity.”

Experts recommend getting the flu shot as early as possible because it can take up to two weeks to provide full protection.

The start of the season

Nikki Bryant, owner of the Adams Family Pharmacy in Preston and Cuthbert, said both locations have started receiving vaccines, and people are beginning to come in for their yearly flu shot.

“In retail pharmacy, for flu vaccines, we have to pre-order those vaccines early, like in February or March, so we pre-ordered those; we already have the high dose for 65 and older available, but we still haven’t received the regular flu shots for under 65,” she said. “Last year, it was pretty mild. I mean, we still gave a lot of shots, but the flu season was very mild because people were washing their hands more, wearing masks, social distancing because of COVID, so there wasn’t a lot of spread for flu.”

In fact, less than 1% of respiratory specimens tested by U.S. clinical laboratories were positive for an influenza virus, according to the Centers for Disease Control and Prevention. In a typical year, the number of positive tests would be closer to 30%. Hospitalizations and deaths from influenza were also significantly lower than normal.

And while it’s difficult to predict the severity of a flu season before it begins, last year’s low rates could be a sign of a stronger flu season this year, Bryant said. She’s hoping more people will get vaccinated early against the flu before they have to ask her advice for treating its symptoms.

“The reports are saying this year is going to be worse than it has been in the past because people don’t have any immunity,” she said. “Once you’re exposed to the flu every year, if you have the flu or have the vaccine, you build up immunity, and people were not exposed as much last year, and plus people are out and about more. They’re going to ballgames and kids are in school. And so all of those factors with people congregating and being in groups and just returning to normal is going to expose them more to the flu. So we are encouraging more people to get their flu shots, but vaccination rates in this part of the country are quite low.”

Georgia behind in flu shots

Much attention has been paid in recent months to Georgia’s lagging COVID-19 vaccination rates. Only 43% of Georgians are fully vaccinated for COVID-19, putting the state 44th after North Dakota, Mississippi, Alabama, Idaho, Wyoming, and West Virginia, according to CDC data compiled by the New York Times.

More Georgians have received at least one COVID shot, 53% of them, putting the state at No. 41 in that metric. That could be a sign that some vaccine resistant Georgians are changing their minds. But some health experts are pointing to another vaccine statistic that will likely be important in the months ahead, the flu shot rate.

Only 36% of Georgians got their annual flu vaccine last year, leaving the state second from the bottom in America’s Health Rankings’ annual report. Only Nevada’s flu vaccination rate is lower.

According to CDC guidance, it’s OK to get a COVID-19 vaccination and other vaccines at the same time.

That means health care providers can offer flu shots to people who come in looking for a COVID vaccine, potentially getting more Georgians immunized against the flu.

That’s the plan at Poole’s Pharmacy in Marietta, said co-owner Thomas Sherrer.

“We’re still doing a lot of COVID shots, we’ve been helping in the community with the health department going into homes and giving COVID vaccines for people who are homebound, and we said, ‘you know, we’ll have flu shots at end of the week, and we’re going out the following week, we might as well take flu shots with us, let’s try and double up,’” he said.

Sherrer said he filled a prescription last week for Tamiflu, which is used to treat flu symptoms.

Sherrer declined to predict how the flu season will go, but he’s hoping the lessons learned from the pandemic will help fight the flu again this year.

“We’re not quite sure what we’re going to see in the flu season, if masks and washing hands and everything continues, it will really cut down on flu,” he said. “And, you know, that’s what we tell everybody every year,  if you’re sick, stay home, wash your hands. So now with COVID around, it’s time to re-emphasize how well that works to keep the flu from spreading.”

The prospect of a bad flu season on top of the COVID-19 pandemic is concerning, but not inevitable, said Dr. Isaac Chun-Hai Fung, associate professor of epidemiology at the Jiann-Ping Hsu College of Public Health at Georgia Southern University.

“If we choose to return to our pre-pandemic behavior and not get vaccines, it is likely we will have a double epidemic, both the COVID and the influenza, but if we choose either to get the vaccine for both or we adopt very strong social distancing and facemask behavior, we can build up a defense against both,” Fung said.

Breeds of vaccine hesitancy

But convincing Georgians to take collective action against COVID-19 has been difficult so far. Many are weary of restrictions and others mistrust the experts who call for them.

But Georgians are not altogether opposed to vaccines. The same America Health Ranking report shows that nearly 80% of Georgia children have received their standard childhood immunization, putting the state at a respectable 14th place nationwide.

Oregon, the state with the lowest childhood vaccination rate, is well ahead of Georgia for COVID-19 vaccinations at 12th place.

Differences like these underline the fact that the vaccine hesitant are not a monolith and can come to their beliefs through starkly different political ideologies, Fung said.

“Those groups of people, their reason of not having their kids vaccinated will be very different from those Southerners living in rural Georgia who choose not to get themselves COVID-19 vaccinations,” Fung said. “So they are different groups of people who have very different ideology or worldviews and varying views about vaccines.”

The broader anti-vaccine movement got a major foothold out west, largely among liberal, mostly white and relatively affluent parents. That breed of anti-vaccine sentiment did not become as common in Georgia, but there does appear to be a correlation between Republican voters and COVID vaccine skepticism in the Peach State.

“I think both in the Democrat and the Republican camps here in Georgia, we have relatively high rates of childhood immunization, thankfully,“ he said. “Childhood immunization has not been politicized, and people across the political spectrum have strong faith in that. I don’t think the influenza vaccine is politicized even in Georgia, it is more to do with access.”

America’s Health Rankings lists Georgia as 49th for access to care, and rural residents have long suffered due to shuttering hospitals and scarce doctor’s offices.

“Either they don’t think that it is necessary, or for people living in rural Georgia, it takes a long drive in order to get that influenza shot, while for the COVID vaccination, it could potentially be politicized easily here in Georgia,” Fung said. “I think that people in general don’t reject the idea of vaccines, but for a variety of reasons I do not fully understand, it seems that some vaccines are being politicized in Georgia, and not the others.”

This story comes to GPB through a reporting partnership with Georgia Recorder.