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Australia is wrapping up its worst flu season in years. In May, the Australian Government Department of Health and Aged Care reported that confirmed flu cases were double that of May 2019, which was the country’s worst flu season on record. And with the virus flat out like a lizard drinking—that’s Aussie slang for working hard and fast—experts warn that we should brace for a rough flu season 2022-2023 in the US, too.

“We look very closely at Australia,” says Ryan Maves, MD, professor of infectious diseases at Wake Forest School of Medicine and chair of the American College of Chest Physicians’ COVID-19 Task Force. Thanks to similarities like societal behaviors and areas of population density, flu patterns in the Northern hemisphere tend to mirror Australia’s—so their earlier season can offer clues of what’s to come for us. “That being said, it’s not always predictive,” Dr. Maves explains, adding: “But I think we should be prepared for a bad flu season.”

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Will flu season 2022-2023 be bad?

A September 2022 report published in the peer-reviewed international journal, The Lancet, suggested 85% of flu cases in Australia this year were caused by influenza A (H3N2,) a strain of the flu associated with more severe epidemics. By the numbers, the Australian government reports there are 217,898 flu cases year-to-date, creeping back up to levels at this time in 2019. Keep in mind that confirmed flu cases represent just a fraction of the true total because most people don’t get a laboratory test when they’re sick.

In the US, the Centers for Disease Control and Prevention’s (CDC) weekly influenza reporting doesn’t swing into gear until the start of October, says Linda Yancey, infectious disease specialist at Memorial Hermann Health System in Houston, TX. “Right now we are in the yearly summertime lull—only 40 cases of influenza were reported nationally last week. This is consistent with previous years.”

Given this data, experts suggest we should expect cases to return at least to pre-pandemic levels. But there are several other factors at play that make the prospects of flu season 2022-2023 stand out.

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First, flu activity has been historically low since the start of the pandemic. The CDC reported just 1,675 confirmed flu cases during the 2020-2021 season, and 134,683 cases in 2021-2022. For comparison, the agency estimates there were 38 million cases of the flu in 2019. This lack of exposure to the flu over the past few years works to lower our population’s collective immunity—also called “herd immunity”—which can pave the way for more serious waves of the flu virus, according to a 2022 report published in Nature Communications.

So, our natural immunity against the flu waned during the pandemic. But flu vaccination rates are in decline, too. A UCLA study found that after decades of holding more-or-less steady, adult flu vaccinations are dropping in states with low rates of Covid-19 vaccination. And among children, flu vaccinations are decreasing across the board. This is concerning because the flu can affect kids more severely than adults—and in 2019, 78% of children who died from the flu were unvaccinated.

Then there’s expert concern of a “twindemic.” Whether we get a truly bad flu season—Dr. Maves points to 2009-2010’s H1N2 (swine flu) pandemic as an example—or just a regular flu season, he says there will be the additional challenge of having highly-transmissible Covid strains circulating on top of it.

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When does the 2022-2023 flu season start and end?

In general, flu season in the US lasts from October to as late as May, peaking between December and February. But “the timing of this influenza season is a bit of a question mark,” Dr. Maves says. “And so the question is, Is influenza going to reassert its normal seasonal patterns?”

The timing of the last two flu seasons has been unusual. For instance, while the 2021-2022 season was mild, it went on for far longer than expected. “[There were] a significant number of cases occurring in April, May, and early June,” explains Edward Telzak, MD, Chair of the Department of Medicine at St. Barnabas Hospital Health System. And ordinarily, cases past mid-April are considered atypical.

In addition, reports from Australia indicate that flu season 2022-2023 could start earlier than usual. That’s why CDC health officials urge everyone six months and older to get their flu vaccine by the end of October. This guidance is especially vital for children. Australia’s flu report points to kids as a high-risk group, with children and teenagers having the country’s highest rate of infection and hospitalization in 2022.

Here’s what doctors want you to know about the flu in children

What flu shots are available this year?

“The flu shots this year are called ‘quadrivalent’ because they contain four different flu virus strains,” explains Robert Amler, MD, the Dean of School of Health Sciences and Practice at New York Medical College and a former Chief Medical Officer at the CDC Agency for Toxic Substances and Disease Registry.

For those under age 65, the CDC does not recommend any one type of flu vaccine over another. “They’re all comparably effective,” Dr. Maves explains. So, whatever’s available at your local pharmacy or doctor’s office is likely to do the trick.

But if you’re over age 65, “three different flu vaccines are preferentially recommended this year because they provide an extra measure of protection in that age group,” Dr. Amler says. These include the Fluzone High-Dose Quadrivalent vaccine, Flublok Quadrivalent recombinant flu vaccine, or Fluad Quadrivalent adjuvanted flu vaccine.

Should I get the flu shot?

The flu vaccine is not 100% effective at preventing the flu, but it greatly lowers the risk you’ll catch a bad case or develop serious complications, Dr. Maves says. This is particularly important for people with chronic health conditions. Even if you’re not at high-risk, getting your flu shot is still important. “Many of us don’t have chronic lung disease, don’t smoke, are generally healthy,” Dr. Maves explains. “But unless you live in some extraordinary bubble, you have a parent, a grandparent, a child, a friend, someone you work with who does fit into one of those [high-risk] categories.” By getting your flu shot, you improve their protection, along with your own.

He points to the rubella vaccine as a similar example. This infection causes mild or no symptoms in most people, so getting vaccinated isn’t necessarily about protecting your own health. But the disease can lead to devastating complications in newborns. “So all of us are vaccinated against rubella so that pregnant women don’t get it, preventing catastrophic birth defects.”

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In terms of timing, the experts say it’s best to get your flu shot this year as early as September or October. They say that’s especially important since we still don’t know when the season will be in full swing. “We are headed into what very well might be the worst flu season in the past five years,” says Dr. Yancey. “We want everyone to get protected as soon as possible.”

As Covid-19 circulates, it’s recommended to top up your protection against that as well. “The new Covid boosters will be available this fall,” Dr. Yancey says. “It’s perfectly safe to get the booster at the same time as the flu vaccine.”

Along with getting your flu shot, here are expert-recommended ways to stay healthy this flu season

What to do if you get the flu

If you do get sick this season, Dr. Amler says that it’s a good idea to get a Covid-19 test as the symptoms can be pretty similar. But if you are down with the flu, aim to stay at home for about five days after your symptoms begin. “As long as people are feeling better, not running fevers, and it has been five days since the start of their illness, they are considered non-infectious,” Dr. Yancey explains.

You should still get a flu shot if you’re unvaccinated after recovering. There is the chance you can catch a different strain of the virus, and you don’t get the same “cross-protection” from having the flu as you get from the vaccine.

And whether you get sick or not, here’s how to handle awkward flu season situations this year

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