The flu is back: What can Albertans expect this fall?

At a time when hospitals are plagued by severe staffing shortages, Alberta could be hit this fall by a double whammy of influenza and COVID-19 for the first time since the start of the pandemic.

The province's free flu immunization campaign is set to begin next month. High-risk groups, such as people living in care homes, are expected to start getting their flu shots the week of Oct. 3.

The vaccine should be available to everyone else — six months and up — starting mid-October.

"We do know that flu is back," said Craig Jenne, associate professor in the department of microbiology, immunology and infectious diseases at the University of Calgary.

"As these other general public health measures such as indoor masking or capacity limits are eased, the flu can transmit just as well as it did prior to the pandemic."

Influenza disappeared earlier in the pandemic, and while it has since re-emerged, the last flu season came unusually late. Case numbers were lower than the years preceding the rise of COVID-19.

Australia is Canada's bellwether

"The best evidence is suggesting that we can anticipate a near normal or perhaps slightly worse than normal flu season," Jenne said, pointing to Australia's extremely tough flu season.

Scientists look to the southern hemisphere for indications of what Canada's flu season will be like.

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Given Australia's higher than average flu numbers, Alberta needs to be prepared with a strong immunization campaign, he said.

Last year, just 27 per cent of Albertans rolled up their sleeves for the influenza vaccine, down from 37 per cent in 2020-21.

"Ensuring there is a good immunization campaign and good uptake is a critical tool in ensuring Albertans remain healthy," said Jenne, noting Australia still had some health measures in place when its flu season hit. 

Adding to the pressures, COVID cases are expected to rise yet again this fall, as the weather cools and people move indoors.

"As we have seen with previous years, we can expect an uptick in COVID-19 cases. The question is: How high?"

Hospitals prepare for 'twindemic'

That potential dual surge, dubbed the "twindemic," could put even more pressure on hospitals, which are already struggling to keep up.

Patient diversions, rural ER closures and extremely long emergency room wait-times are becoming increasingly common in the province.

"The part that worries me the most is will we be able to fill our staffing needs by the time the flu season rolls around," said Dr. Eddy Lang, department head of emergency medicine in Calgary with Alberta Health Services.

After 2½ exhausting pandemic years, many nurses, particularly those in more senior positions, have left for other jobs, he said, noting doctors are cutting back on their hours as well.

"Oftentimes, 80-90 per cent of our beds — and that's occurring even now in some Calgary hospitals — are being occupied by admitted patients waiting for beds upstairs."

At this time, it's predominantly mental health patients waiting for beds, and, according to Lang, work is going on behind the scenes to beef up staffing.

"We're recruiting from other provinces," he said, adding emergency departments are also reworking how they use front-line staff, opting to give licensed practical nurses some responsibilities that would typically be the domain of registered nurses.

While a COVID surge is expected, Lang doesn't anticipate a large upswing in people with severe disease requiring hospitalization.

Those who do become seriously ill tend to be the unvaccinated, he explained.

What he is worried about is what will happen on the front lines as transmission rises and health-care providers start needing to isolate.

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If there's a crisis, he said, one possible solution would be to delay non-urgent surgeries, a tactic that's been used through the pandemic.

"If we are unable to manage the flu season over the winter months, we may need to go back to a situation where our surgical units may need to be repurposed as flu units," Lang said.

"And that, of course, will mean people needing a knee replacement or a hip replacement … will be experiencing delays again."

Meanwhile, Alberta Health said it's "reasonable" to expect a return of viruses, including influenza and COVID, during the fall and winter months. 

"The more Albertans who continue with habits from the past few years — such as staying home when sick, washing hands regularly, accessing the protection of vaccines at recommended intervals, and considering mask use in indoor public places when transmission is high — the more the combined impact of all these respiratory viruses can be reduced" spokesperson Lisa Glover said in a statement.

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Albertans five and up can get their flu shots at the same appointment as a COVID vaccination, according to the province.

And the influenza vaccine will be offered to congregate care residents at the same time as they receive the new bivalent booster in early October.