Marin health officials urge flu shots to avoid ‘twindemic’

As the Bay Area records its first influenza cases of the season during the COVID-19 crisis, some medical professionals are fearing a possible “twindemic.”

The coronavirus’ unknowns have left doctors hamstrung, Marin public health officials said. But the flu is a virus that medical professionals know how to manage well. Part of this year’s strategy is to administer the flu vaccine to as many people as possible to prevent illness and keep sick people out of hospitals.

“The time to get vaccinated is now,” said Lisa Santora, Marin County’s deputy public health officer.

Marin has about a 40% vaccination rate. The Marin County Health and Human Services Department has had a flu vaccination requirement for health care workers, and this year that has been expanded to staff in long-term care facilities as well, Santora said.

While the vaccine doesn’t guarantee complete immunity, it could help lessen the severity of symptoms and reduce a patient’s risk of developing pneumonia, Santora said.

“This year, it’s more important than ever to get vaccinated for the flu and we’re going to do everything to mitigate a double impact, especially considering a possible second wave of COVID,” Santora said. “We’re trying to protect our health system. We are limited with what we have control over with the pandemic. What we know we do have control over, is the vaccination rate.”

Medical assistant Tiffany Jones gathers supplies for a flu shot at the Sutter Health walk-in clinic in Novato, Calif., on Thursday, Sept. 17, 2020. (Alan Dep/Marin Independent Journal)

This year’s flu vaccination clinics and distribution protocols will serve as a model for COVID-19 vaccinations when they become available, public health officials said.

In 2018, nearly 7,000 people died of the flu or pneumonia in California, according to the most recent state-by-state information available from the Centers for Disease Control and Prevention. Last year, there were an estimated 39 to 56 million cases in the U.S., and as many as 62,000 deaths.

There were at least two deaths linked to complications from influenza in the 2019-2020 flu season, according to the health department. Both people who died were over the age of 65. Previously, it was government policy not to report people 65 or older who died of the flu, since it was considered commonplace.

Before these incidents, the last influenza-related death in Marin was reported in January 2018 and prior to that there hadn’t been a death due to flu in Marin since the 2013-14 flu season.

The flu season typically kicks in in the fall, ramping up in November and December and continuing for five to six months.

Many Marin health care providers have begun administering the flu vaccine already.

“Our goal is to have all members vaccinated by Thanksgiving, or by Nov. 30,” said Dr. William Isenberg, chief quality and safety officer for Sutter Health San Francisco region, including Novato Community Hospital.

The health care providers’ walk-in clinic at 5800 Nave Drive in Novato started offering the vaccine earlier this month. Information is at

“It’s important to get the flu vaccine every year,” Isenberg said. “But because COVID is still with us, people with COVID and the flu do far worse than those who have one disease alone. The so-called ‘twindemic’ could be really problematic.”

Doctors at Kaiser Permanente Medical Center in San Rafael also have launched flu vaccination clinics, including drive-thru options.

Dr. Randy Bergen, a pediatric infectious disease physician and the clinic lead for Kaiser Permanente’s Northern California flu vaccine program, said the drive-thru vaccination is a new approach to avoid patients standing shoulder to shoulder in lines at doctors’ offices.

“We have to take into consideration the concept of social distancing, so we thought that in addition to the importance of getting vaccinated, we had to be doing it in a safe manner,” he said.

Bergen said doctors do not fully understand what would happen if a patient contracted COVID-19 and the flu at the same time, but said “both viruses could cause long-term damage to the body.”

“It’s time to protect yourself and those around you,” he said. Kaiser patients can find vaccination information at or by calling the flu hotline 1-800-573-5811.

At MarinHealth Medical Center in Greenbrae, Laura Hegarty-Moore, a registered nurse and the hospital’s infection prevention specialist, said they’ve just started offering the vaccine as well.

“You want to get vaccinated before the flu season begins,” she said. “It takes two weeks after you get your vaccine for it to fully protect against the flu.”

Social distancing, face coverings and better hand hygiene could bring a milder flu season, some public health experts said.

“I think that it is certainly possible that we’ll see a lighter flu season than usual, because people are hopefully taking a lot of precautions to prevent the spread of respiratory viruses at large — so that includes flu as well as COVID,” said Dr. Allison Bond, an infectious disease and hospital medicine doctor at UCSF.

Expert caution that many flu symptoms overlap with those associated with COVID-19.

“If you think you’re sick, contact your medical provider to see how to be treated,” said Hegarty-Moore, noting that for those who can manage the flu or cold on their own, it is recommended to self-quarantine and take over-the-counter medications to avoid spreading the disease.

If this year’s flu season is mild, it will be a relief to doctors who have been bracing for the dreaded overlap of influenza and coronavirus. Fewer flu cases mean more hospital staff, beds and equipment will be available for COVID-19 patients.

The Centers for Disease Control and Prevention recommend nearly everyone 6 months and older get vaccinated.

Some groups are more susceptible to severe flu symptoms, including pregnant women, children younger than 5 years old, adults 65 and older and people with chronic medical conditions such as heart disease, asthma and diabetes.

The Marin health department typically administers 1,100 free vaccinations annually and distributes another 1,100 to partnering providers for their patients. Vaccination information in Marin County is available at

The Bay Area News Group contributed to this report.

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