Flu shots down as Thanksgiving nears. And that’s only one threat.

• Flu spread started early this year in other parts of the country 
• Though it’s minimal currently in Michigan, doctors here say this year might be more severe and urge vaccines before the holidays
• Meanwhile, RSV and other respiratory viruses are pressuring ERs and doctors’ offices, causing longer Michigan wait times

The flu hasn’t hit Michigan yet, and that worries doctors. 

A false sense of security may make Michiganders, already pandemic weary, even less motivated to roll up their sleeves this year for a flu shot.

“Some people are just vaccined out,” said Dr. Delicia Pruitt, a long-time family doctor in Saginaw, and medical director of the Saginaw County Health Department.

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• More Michigan parents opt to skip school vaccines for their children

But the flu is undoubtedly on its way, health authorities say, even as medical offices and emergency rooms see a surge in other respiratory viruses, including RSV, she and others said. 

Early increases in seasonal spread of influenza are being seen in other parts of the U.S., with the highest levels in southeast and south-central states. At a Virginia high school, about half of the student body was out sick last week, and a school in Texas closed for a long weekend because of an apparent flu outbreak.

Another bellwether: Australia’s flu season, which starts six months before the U.S. season, was particularly severe this year, worrying experts that the same is in store here. 

Flu-related hospitalizations elsewhere are at their highest levels in 10 years and the U.S. Centers for Disease Control and Prevention reported the nation’s first pediatric death on Friday.

Unlike some diseases, all flu cases aren’t reported. Rather, the CDC uses a surveillance network of hospitals and labs to track flu trends each year.

In the first three weeks of October, one surveillance network covering just 13 states reported 443 flu-related hospitalizations — the highest number of hospitalizations reported by this point in the fall in a decade, the CDC reported Friday. 

Declining levels of flu shots 

About 1.6 million Michiganders have received a flu shot this year, less than half of the way toward a goal, set out by the Michigan Department of Health and Human Services, of 4 million vaccines, according to state data.

By this time last year, nearly 2 million Michiganders had a flu vaccine; the year before — the first of the pandemic — nearly 2.6 million Michiganders had their flu vaccine, likely a result of a feared “twindemic.” (As it turned out, masking and other social protocols all but zeroed out that flu season.)

And that could mean a “rough flu season” ahead, Pruitt said.

This year, the flu could hit Michiganders just as they begin to cluster tightly around holiday tables, said Dr. Beena Nagappala, a family doctor for 20 years and president-elect of the Michigan Academy of Family Physicians.

“As long as people are moving, as long as they’re socializing, the flu will arrive soon enough,” she said.

As families drift through each other’s homes, the influenza can survive up to 48 hours on hard surfaces, such as plastic or stainless steel, and up to 112 hours on paper, cloth and tissues, according to the CDC.

Those commands you heard from your Mom — Wash your hands. Cover your cough. Stay away from others while sick.  —  are critical this time of the year, Pruitt said.

Nagappala, the family doctor, noted that flu shots take up to two weeks to be effective. Which means residents may want to get vaccinated soon, so they have enough time to build immunity before the turkey goes into the oven. 

RSV, other viruses

Meanwhile, other respiratory viruses are surging, including respiratory syncytial virus (RSV), a disease generally seen among children. But Pruitt, of the Saginaw County Health Department, said she had to hospitalize a 60-year-old recently with RSV and treated another adult with the same infection.

In more than 20 years of practice, Pruitt said she couldn't remember any prior adult patients who had tested positive for RSV.

It suggests, she said, that “after two years of masking and doing other things to protect against COVID, we’re a little more susceptible to other respiratory viruses.”

At emergency departments of Corewell Health East (formerly Beaumont Health) in southeast Michigan, 95 of 1,587 patients screened through September tested positive for RSV — a positivity rate of 6 percent. This month, the positive rate rose to 15 percent.

The number of inpatients also has surged. In September, 132 of 2,546 patients screened for RSV, or about 5 percent, were positive for RSV; in October, 13 percent of screened patients tested positive.

“We do see a surge in RSV every year — usually in December and January — but this year we’re seeing it a bit earlier, and last year we saw it even earlier,” Dr. Andrea Hadley, a pediatrician at Helen DeVos Children's Hospital in Grand Rapids, said last week in a virtual call with reporters. 

For adults, RSV is “usually a common cold, some chest congestion,” she said. For babies, older Michiganders and the immunocompromised, RSV can be serious, even deadly.

With the added stress in understaffed healthcare, RSV is causing delays in ERs and in getting children admitted to hospitals, she and others said.

There are “some hospitals that are holding kids that don't normally take care of sick children,” said Dr. Matthew Denenberg, chief of pediatric services at Beaumont Children's Hospital in Royal Oak, part of Corewell Health East.

Denenberg, who is also chair of the Michigan Health & Hospital Association’s Council on Children’s Health, said children’s hospitals across the state and nation are also being squeezed by RSV.

“We're taking care of so many kids that the ratios are not the same as they normally are. It's very difficult, instead of having six or seven sick kids this time… you have 15 or 20” children, he said. “It's just harder to keep track of that many kids and keep it safe.”

There’s also a seasonal return of rhinovirus and adenovirus that cause the common cold, doctors said. 

Most concerning to the Michigan medical community is the possible collision of flu, RSV and an anticipated rise in COVID, he added. On Monday, Michigan hospitals reported 1,246 patients had confirmed or suspected COVID, the highest levels in the state since last February. 

“If flu were to start hitting, as (RSV) is peaking right now, and with COVID — somebody called it a tri-virus” threat, he said. “We could have all three at once.”