One sore arm or two? COVID booster and flu shot dilemma is path to avoiding ‘twindemic,’ Sonoma County officials say

During a medical visit Monday at Santa Rosa Community health’s Vista Campus, Craig Mohammed, 71, was given the option of getting both his COVID-19 booster shot and flu shot in the same arm or one in each arm.

Tanya Joseph, a traveling nurse, explained that some patients prefer the soreness in only one arm, while others opt to spread the pain a little.

“I don’t care,” Mohammed said, politely, as he lifted his long-sleeved shirt over his right arm, receiving first his flu sot then his Pfizer-BioNTech booster.

Mohammed, who described himself as a veteran Burning Man artist who lives in Santa Rosa, said he’s adamant about being protected this winter season — and not just for himself.

“I have human beings living around me, and they deserve to have me vaccinated,” he said. “We need to forget our choices and step up. No matter what.”

As North Coast residents return to more holiday gatherings this winter, local public health and medical professionals are watchful for signs of what some worryingly call the twindemic — new influenza cases piled on top of COVID-19 transmission.

But at least for now, that hasn’t happened, with few if any cases of flu hitting local hospitals in Sonoma County. Last winter, a time of rampant coronavirus infections, also saw little flu spread.

For signs of what’s to come in the Bay Area and the rest of the country, UC Berkeley infectious disease expert Dr. John Swartzberg, looks to the Southern Hemisphere, where the winter months of June, July and August brought a light flu season.

“You can look at the potential good news that we’ll have another very, very mild flu season, like last year,” Swartzberg said. “But one of the things that weighs against us this time is that people are not being as careful as they were last year.”

He said other factors that could exacerbate the spread of flu this year include fewer people getting the influenza vaccine this year. Swartzberg said last year many people got a flu shot to give themselves some level of protection, since the COVID-19 vaccine was not yet available.

He said a massive outbreak of influenza at the University of Michigan, with more than 500 infections reported, is proof of the potential for large flu outbreaks even as COVID-19 continues its course. Last year, influenza viruses essentially took a back seat to SARS-CoV-2, the virus that causes COVID-19 illness.

Swartzberg added that with so few people getting the flu last year, a lack of natural immunity could set the stage for a comeback. That’s one of the reasons, health officials are encouraging people to get both a flu and COVID-19 shot.

“There are two ways to be protected — get infected or get the vaccine,” Swartzberg said. “Last year, people got the vaccine but very few got the natural immunity. If we see the same strains, we won’t have as many people immune to it.”

In Northern California, flu season lasts from Nov. 1 to May 1. Swartzberg said it usually peaks between late January and early February and starts to subside by March.

Recognizing the potential for a twindemic, Dr. Sundari Mase, the county’s health officer, issued a health order in October requiring flu shots for medical and congregate care workers, while recommending them for all residents.

Officials said the potential for both viruses circulating at the same time this winter could put a great strain on hospital resources. Last winter, local hospitals were slammed with COVID-19 admissions, which surpassed 100 patients in early January. That month saw 70 Sonoma County residents die of coronavirus-related complications and became the deadliest of the pandemic.

So far this fall, the number of COVID-19 hospitalizations on any given day has hovered in the low 20s, about the same as last year. Hospital officials hope to avoid flu-related admissions on top of expected COVID-19 hospitalizations.

Siamack Nemazie, assistant physician in chief for Kaiser Permanente in Santa Rosa, said holiday behavior will determine whether local hospitals will face another surge this winter. He said there aren’t any patients currently being treated for flu at the local Kaiser hospital, though traditionally severe cases don’t start appearing until the beginning of the year, after holiday gatherings.

Nemazie described the absence of influenza last year as a “complete aberration,” with historically low numbers of new cases in North America. Pandemic precautions, such as masking, hand washing and social distancing, which blunted the spread of the highly contagious COVID-19 strains, completely halted the spread of influenza, he said.

Nemazie applauded the indoor masking rule currently in place in Bay Area counties, which is likely to remain in place through the holidays. He said the “roller-coaster” of COVID-19 surges over the past 20 months is largely the result of the periodic lifting of pandemic restrictions.

The Kaiser physician pointed to the recent reinstatement of indoor masking in Santa Cruz due to a rise in COVID-19 cases and hospitalizations. “This is one of the first counties in this area that relaxed its mask mandate and now it’s going back and reimposing it,” he said.

Brandi Lazorek, a registered nurse and chief nursing and operations officer for Providence Medical Group in Northern California, said it’s “pretty quiet” as far as the flu goes, at facilities like Providence’s Santa Rosa Memorial and Petaluma Valley hospitals.

“The big concern, which is on the news and everywhere out there, is holiday travel,” Lazorek said. “We do have states that are very lax in masking guidance and with different immunization rates.”

Lazorek said we won’t know if holiday travel will exacerbate the spread of flu until several weeks later. In the meantime, she said, health care professionals are doing a full-court press to get people their flu shots, first-time COVID-19 shots and, for those who are eligible, COVID-19 boosters.

“It’s a race to the finish for vaccination immunity as we head into the holidays,” Lazorek said.

Lazorek said both the flu and COVID-19 inoculations are being administered at Providence’s new COVID-19 vaccine clinic for kids 5-11. She said according to the CDC, it’s safe to get both shots at the same time.

Nemazie said continued vigilance against both the flu and COVID-19 will drive down hospitalizations and illness as a whole, especially COVID-19.

“It’s not great to have COVID, and it’s not great to deal with post-COVID syndrome either, which can linger … we don’t know for how long,” he said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.