Although COVID-19 certainly has caused some infections and deaths in children, they generally have fared well against the virus compared to other age groups. Influenza, on the other hand, can cause severe disease in children.

“The 2019-2020 flu season was terrible for kids,” Patricia Whitley-Williams, MD, a pediatrician and president of the National Foundation for Infectious Diseases (NFID), said at a press conference. “There were 188 flu-related deaths reported in children to the CDC. This matches the record set in 2017-2018 for the highest number of pediatric flu deaths reported during a regular flu season. We also know that the number of pediatric deaths reported to the CDC each season is likely lower than the actual number.”

What is truly devastating is that more than half of these children were healthy, with no pre-existing conditions, she added.

Flu vaccination is critical because it can reduce a child’s risk of death significantly, she said. For example, a six-year-old child was vaccinated three years ago. He developed a local reaction at the site and the parents forbade future vaccinations, she noted.

“The family members did not receive flu vaccine, either. Fast-forward to January of 2020 — this child is now nine years of age and has influenza A,” Whitley-Williams said. “He was subsequently admitted to the hospital and quickly developed a secondary bacterial pneumonia. Before you know it, he was in a life-threatening situation in our pediatric intensive care unit — all because of not getting a flu vaccination. Thank God the child did recover and was vaccinated. I can tell you this was a learning lesson for that family. All of the family members got vaccinated.”

Despite heavy emphasis on seasonal influenza immunization during the ongoing pandemic, only 59% of U.S. adults said they will take the vaccine this year, according to an NFID survey.1

Those not planning to be immunized for flu cited several reasons, including 17% who fear they might contract COVID-19 if they go out to get a flu shot. Other reasons were familiar antivaccine myths:

  • 32% said they never get the flu;
  • 29% are concerned about potential side effects from the vaccine;
  • 22% are concerned about getting flu from the vaccine.1

“We in the infectious disease community have been talking about a potential double-barreled respiratory virus season when flu and COVID-19 converge,” NFID Medical Director William Schaffner, MD, said at the same press conference. “There is a real risk that, even if we only have a moderate flu season, we could be in for a rough few months ahead.”

It will be an unusual flu immunization for healthcare workers as well, since those working from home will be difficult to reach through typical in-house campaigns.

“Our employee health teams had to come up with a plan to make sure individuals working virtually can get the vaccine,” says Connie Steed, MSN, RN, CIC, director of infection prevention and control at Prisma Health in Greenville, SC. “We have developed drive-throughs for flu vaccine that these employees can use, including giving them certain times of the day at every one of our locations.”

Although flu vaccine efficacy can vary year to year, Schaffner made the traditional argument that immunization could keep people out of the hospital or the morgue.

“Flu vaccines help prevent tens of thousands of hospitalizations each year and other serious complications, such as heart attack and stroke,” Schaffner said. “Even if you do get flu — despite getting vaccinated — you are likely to [experience] a less severe and shorter illness. You are far less likely to get pneumonia or to be hospitalized, and you are less likely to die.”

The NFID survey revealed 46% of U.S. adults are worried about co-infection with flu and COVID-19. The fear of co-infections was cited by 28% as making them more likely to seek immunization for flu.

Complicating matters, the two respiratory diseases present the clinician with similar symptoms, except for possible loss of smell that can occur with COVID-19. The CDC has developed a new rapid test that can detect and differentiate both SARS-CoV-2 and influenza A and B.

Overall, the CDC estimates there were 38 million flu illnesses, 18 million flu-associated medical visits, 400,000 flu hospitalizations, and 22,000 flu deaths during the 2019-2020 season. In addition, the CDC estimates that flu vaccines prevented 7.5 million flu illnesses, 3.7 million flu-associated medical visits, 105,000 flu hospitalizations, and 6,300 flu deaths last season.2

The results of the NFID survey revealed Black (61%) and Hispanic adults (53%) are more likely to be worried about contracting both infections at the same time compared to white adults (39%). However, despite this concern, about 62% of Black adults said they are either unsure about getting the shot or will not get immunized this year.1

“This disconnect is a big concern,” Whitley-Williams said. “Black adults are more worried about being infected with COVID-19 and flu at the same time — more so than their white counterparts. This makes sense. Black adults in the [United States] are more likely to be hospitalized and to die from COVID-19 as they are for flu.”

The survey results also showed that 39% of Blacks will not take an antiviral medication for flu, even if recommended by a healthcare provider. Explanatory factors include unconscious bias, institutional racism, and a warranted distrust of traditional medicine by at-risk populations.

Twenty-two percent of U.S. adults who are at high risk for flu-related complications (e.g., adults age 65 years and older and adults with diabetes, asthma, or heart disease) are not planning to seek vaccination this season.


  1. National Foundation for Infectious Diseases. U.S. health officials urge influenza and pneumococcal vaccination amid COVID-19 pandemic. Oct. 1, 2020.
  2. Centers for Disease Control and Prevention. Estimated influenza illnesses, medical visits, hospitalizations, and deaths in the United States — 2019-2020 influenza season. Page last reviewed Oct. 6, 2020.