After virtually disappearing for the last two winters, the flu is back in the United States and worse than it has been in a long time.
The 2022-2023 flu season started earlier than usual, with cases rapidly increasing in some states as early as October, TODAY previously reported. And it shows no signs of slowing down as infections, hospitalizations and deaths continue to rise across the country.
Nearly all states are reporting high levels of influenza activity, according to the latest data from the U.S. Centers for Disease Control and Prevention, which estimates that the flu has caused at least 13 million illnesses, 120,000 hospitalizations and 7,300 deaths during this season so far (including 21 pediatric flu deaths).
According to the CDC, the number of flu hospital admissions nearly doubled during the week of Thanksgiving, and the cumulative flu hospitalization rate for the week ending on Dec. 3 was higher than the rate observed in the same week during every previous flu season going back to 2010-2011.
The timing, duration and severity of flu seasons varies each year, but it's clear this season is one of the earliest and most severe flu seasons the U.S. has seen in a long time.
"This is something we expected. ... Because of COVID interventions like masking and social distancing, we've had much less influenza since the beginning of the pandemic, and now we're releasing ourselves from those interventions," Dr. Albert Ko, infectious disease physician and professor of public health, epidemiology, and medicine at Yale School of Public Health, tells TODAY.com.
What are flu antivirals?
The flu can be treated with antivirals, and there are currently four FDA-approved drugs recommended for use by the CDC: oseltamivir phosphate (Tamiflu), zanamivir (Relenza), peramivir (Rapivab) and baloxavir marboxil (Xofluza). These all require a prescription from a doctor and cannot be purchased over-the-counter.
“(Antivirals) do not cure the flu. They help clear the viral burden faster compared to no treatment, and this translates into a shorter duration of symptoms and a lower likelihood of being hospitalized,” Dr. Luis Ostrosky, an infectious disease specialist at UTHealth Houston and Memorial Hermann in Houston, tells TODAY.com. Flu antivirals need to be taken within 48 hours after symptoms begin to have the maximum effect, he adds.
As flu cases surge and hospitalizations reach record highs, these antivirals are in demand and at much higher levels than normally seen for this time of year during pre-pandemic seasons, TODAY previously reported.
Is there a shortage of Tamiflu and other flu antivirals?
GoodRx, a digital health care platform, has been tracking fills for Tamiflu and its generic oseltamivir throughout the 2022-2023 flu season. "Our initial data shows that fills are higher at this time of year than they have been since 2013," Tori Marsh, director of research at GoodRx, tells TODAY.com.
“The fill rate reached a season high two weeks ago (Nov 20 to 26), where the percent fill rate was 14.7 times higher than the average of the same time point in all previous years,” says Marsh.
Although this trend appears to dip in week 48, says Marsh, this may be temporary, and Tamiflu fills could rebound, especially as people gather indoors during the holidays.
Two leading pharmacies in the U.S., Walgreens and CVS, confirm to TODAY.com that there has been an increase in demand for flu antivirals at stores nationwide, and some may be out of stock.
There have been reports of pharmacies scrambling to keep flu antivirals on the shelves and sick patients struggling to fill Tamiflu prescriptions, NBC News affiliate NBC Chicago reported on Nov 30.
“We are hearing, at least in local news stories (in Texas), about families not finding the medication as readily as we would like them to be able to,” says Ostrosky.
There is no official flu antiviral shortage listed by the U.S. Food and Drug Administration, but pharmacies in areas with high flu activity may not have enough stock this early in the season.
Some pharmacists have had difficulty obtaining the lower-strength liquid version of Tamiflu, NBC News reported on Nov 18. Tamiflu and its generics come in two forms: a pill and a lower-strength liquid suspension, which is often used for children, per the CDC.
In an FDA report published on Dec. 5, the agency wrote “although there currently is not a nationwide oseltamivir phosphate oral suspension shortage, we are aware there may be localized shortages where demand is especially high.”
There are anecdotal reports that the generic oseltamivir is less available than the brand name Tamiflu in certain regions, Brigid Groves, senior director of practice and professional affairs at American Pharmacists Association, tells TODAY.com. "Insurance plans would usually prefer the generic product (which is cheaper), so that's why it's used more and likely why we're seeing less availability," says Groves.
According to the American Society of Health-System Pharmacists, pharmaceutical companies such as Amneal, Camber, Zydus and Teva are experiencing shortages of the generic oseltamivir oral capsules and powder for liquid suspension.
However, Groves says this does not appear to be a supply issue on the manufacturer's end. "Everything that we're seeing points to this being an issue with increased demand due to the unexpected high rates of flu early on in the season," says Groves, adding that some pharmacies may just be slower to replenish their stock.
In a statement published on Dec. 7, Tamiflu manufacturer Genentech confirmed both its flu antiviral medicines, Tamiflu and Xofluza, remain available nationwide for pharmacies to order, adding: "We have sufficient supply to meet the demand and are continuously evaluating the need to increase production."
In an email to TODAY.com, Walgreens confirms that stores do have supply of the medication, but "in some cases, there are isolated and temporary shortages." Walgreens advises patients to call their local pharmacy to ask about availability.
CVS Health tells TODAY.com in an email statement: "While we’re not experiencing a widespread shortage of Tamiflu at this time, we are seeing increased demand at our stores nationwide and sporadic shipping from select manufacturers. ... There will be increased instances when individual pharmacies could be temporarily out-of-stock."
Those who would be most affected by shortages are the people who can benefit most from flu antivirals because they are at higher risk of severe outcomes, says Ko. These include people who are elderly, immunocompromised or have underlying conditions like diabetes.
What should you do if you have trouble getting flu antivirals?
“If you are not able to get it in the first 48 hours, you can still discuss with your doctor whether there could be a benefit, particularly if you’re immunocompromised,” says Ostrosky.
Once someone is past the window to take flu antivirals, they should focus on supportive care, says Ostrosky: staying hydrated, controlling fever and other symptoms and getting rest.
If your doctor prescribes a flu antiviral and you're concerned about availability, Groves suggests calling the pharmacy ahead of time to confirm they have it in stock. "People should be aware, but not alarmed, that this is a potential lower-availability product and they might need to go to a pharmacy outside of their local area."
Different pharmacies are able to get different amounts of drugs at a time, says Groves, and your pharmacist can help identify which locations have the medication you need in stock. "If it is totally unavailable ... they can work with you and your doctor to find an appropriate substitution or alternative," Groves adds.
If your child cannot swallow pills and the liquid suspension is unavailable, the capsules can be opened and their contents mixed with another thickened sweet liquid, according to the CDC.
The flu shot is the best way to protect yourself from flu and its complications
"Tamiflu is not a magic bullet. ... The most important thing is vaccination," says Ko. The flu shot may not only prevent infection but also severe illness, according to the CDC — which recommends everyone ages 6 months and older get a flu vaccine annually.
Even though cases are already surging, now is still a good time to get your flu shot. "It's never too late. You can get (it) all the way until the end of the season," which can continue into spring, says Ostrosky.
Since flu activity was low the last few years, people may have not been exposed or have immunity to the current strains, says Ko. The good news? “This year, (the flu shot) is a really good match for the strains in circulation,” Ostrosky adds.
It’s unclear how the rest of the flu season will pan out, but Ostrosky emphasizes that flu trends in the U.S. can be highly geographical, so different states may have different peaks at different times.
You can reduce the spread of flu by washing your hands, avoiding sick contacts, and covering coughs or sneezes, per the CDC. "If you’re sick, please don’t leave the house ... if you must, you need to be masking to protect others,” says Ostrosky.