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We’re proud of the Americans who followed health recommendations last year. We wore masks, practiced social distancing, and followed guidance on sanitary practices like frequent hand washing. These common sense measures helped keep down the number of people infected with the coronavirus. At the same time, they also helped keep the flu season in check with the U.S. seeing a record-low number of flu cases. And we warded off a possible “twindemic.”

And deaths for the 2019-2020 season were down an estimated 95 percent from a typical year. Last season, one child died from the flu. In comparison, 199 children died during the previous season and 144 died the season before that.

But our primary care doctors at MD 2.0 in Jupiter see a possible downside from what, at first glance, appears to be good news.

Flu is lurking

Some experts worry our natural immunity to the flu has waned over the last year-and-a-half we focused on the coronavirus.

“As with COVID, when somebody recovers from a seasonal influenza infection, they retain some level of immunity that protects them against future infection, at least for a short period of time,” epidemiologist Lauren Ancel Meyers, director of the University of Texas COVID-19 Modeling Consortium, told CNBC.

“Since our COVID mitigation measures prevented influenza transmission last year, there are not a whole lot of people who were recently infected,” she explained. “So we may be entering flu season with a higher level of susceptibility than usual, which could exacerbate the risks.”

This could mean that, when the flu hits this fall and winter, it’s likely to impact people harder than normal.

“We do know the longer you go without being exposed to influenza, the more symptomatic you are,” Aubree Gordon, an epidemiologist who studies flu at the University of Michigan School of Public Health, told CNN recently. “Sicker individuals lead to more severe cases. We absolutely know that,” she said.

And because last year’s season was nearly non-existent, that means our collective defenses are down.

“Flu hasn’t been anywhere [in the world], with the exception of some activity in western Africa,” Richard Webby, an influenza specialist at St. Jude Children’s Research Hospital in Memphis, told CNN.

And he and other experts worry the temporary lull means, when it does return, it will slam us hard.

“The worst flu season we’ve ever had may be coming,” he warned.

A coming ‘twindemic’?

Experts worry an especially difficult flu season could couple with another surge in the coronavirus. This could lead to what some are calling a “twindemic,” a coupling of the two pandemics at once. The two together could result in a crisis as hospitals become overwhelmed with seriously ill patients needing critical care.

“The truth is, we’re due for a flu pandemic,” said Michelle Barron, senior medical director of infection prevention and control for the University of Colorado’s UCHealth. “We have flu pandemics, on average, about every 10 years, so we’re overdue.”

In addition, Americans have been more focused on getting coronavirus vaccines and neglecting other necessary vaccines, including the flu vaccine. 

And many have let up on the stringent distancing measures and mask wearing that helped keep both COVID-19 and the flu at bay. They’re vaccinated for the coronavirus and mistakenly feel they’re immune to it now, or they simply have COVID fatigue.

Remember that no vaccine, including that for COVID-19, offers 100 percent immunity against a disease. Immunization normally results in less severe cases.

Get your shots now, help avoid a twindemic

Fewer than half of Americans typically get a flu shot each year. This year, it’s especially important to get vaccinated for both the coronavirus and the flu to avoid a possible twindemic. Because infants under six months can’t receive a flu vaccine, we also must protect them from this potentially deadly virus.

In addition, the CDC cautions it’s possible to have the flu and other respiratory illnesses like COVID-19 simultaneously. And it may be difficult to tell them apart without testing, because the symptoms are so similar.

This year’s flu vaccine, which is available now, contains additional protection against two strains that last year’s vaccine did not.

The CDC recommends everyone have a flu vaccine by the end of this month. Even though flu activity is currently low, it could increase at any time. Remember, after vaccination, it takes about two weeks for your body to develop the necessary antibodies to protect you against the flu.

And yes, you can get vaccinated for the flu and the coronavirus at the same time.

“You can get the COVID-19 vaccine and any shots you need at the same time,” said Barron. “So I’m not just plugging flu shots. I’m plugging everything. If you need a shingles shot, get your shingles shot. If you need your flu shot, get your flu shot. If you need your pneumonia shot, get your pneumonia shot.”