Industry Trends & Insights

Flu Season 2020-2021: What to Expect

Dr. Dan Weberg, PhD, RN
September 7, 2020
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The Current Situation

Flu season 2020-2021 has the potential to be very different from past years due to the continued impact of COVID-19. Planning for this flu season by health systems will likely be reactionary, as their focus has been largely on the pandemic. Here's what you need to know.

The Seasonal Flu


The season flu is caused by a virus that infects a person and causes fever, respiratory, and gastrointestinal symptoms. The flu causes symptomatic infections for between 3-11% of the US population each year and is the cause of death for over 35,000 people.

The 2019-2020 flu hospitalized roughly 500,000 people in the US, which is a medium level compared to other years. Yearly hospitalizations in the past have ranged from 300,000 to 1.4 million hospitalizations.


Flu capacity planning for health systems usually begins in the August to late-September time frame. Flu season officially starts in October and typically lasts until May the following year.

Typical flu seasons impact several factors of the supply and demand for health systems (especially nurse staffing) including:

  • Call out and sick time for full-time employees
  • Increased census from flu related illness
  • Increased co-morbidity related illness
  • High utilization of travel nurses
medical flu material water ice pack stethoscope thermometer flu season 2020-2021

Possible Scenarios for 2020-2021

The 2020-2021 flu season has the potential to be very different from previous years due to COVID-19. There are three probable scenarios that we are likely to experience this season. Winter needs will also be compounded by nurses and other frontline responders taking more than normal time off due to COVID-19 stressors and other societal factors.

Scenario 1: Double Whammy (Worst)

COVID infections and hospitalizations remain high through flu season and overwhelm hospital capacity. This is compounded by a moderate or heavy flu season, which further strains hospitals and clinicians. States with relaxed social distancing and more aggressive reopening will suffer more. Acuity of patients will remain high due to delayed care, lack of vaccine, and co-morbidity associated with chronic illness and COVID infections. 


  • New York in early stages of the pandemic

Scenario 2: COVID-19 Down + Flu Average (Best)

Those at risk for COVID-19 and not actively social distancing will get the flu, but the overall flu will be down due to remote school and work. COVID-19 will be in the containment phase, allowing hospitals to increase capacity for flu patients. Some states will be hit hard, but generally the health system will not enter a major crisis.

Nurses may get a break from COVID-19 roles before the flu season hits hard, allowing for a renewed workforce. Pay will follow trends of previous years and supply of nurses will be healthy to meet demand.


  • Last year’s flu season

Scenario 3: Covid Lower but Flu Impact Higher than Average (Middle)

COVID-19 resolves to a controlled rate, but flu infections are higher and more impactful due to COVID-19 illness comorbidity. Not only do COVID-19 cases continue to linger, but those who have been infected with COVID-19 will now experience worse flu symptoms due to respiratory and cardiac disease. Additionally, those who have delayed care due to COVID-19 will likely not get flu vaccines and therefore experience flu more acutely.

The Major Caveat: COVID-19 Vaccine

COVID-19 Vaccine effectiveness and availability remains in question. There is competing information related to whether or not a vaccine will be ready and safe by the end of 2020. Currently, the main vaccine candidates have completed Phase 1 trials and have entered into P2/P3 phase, which has significant challenges and requirements.  

If P2/P3 is not completed in the next three months, data will not be available for clinicians to make an informed and safe decision to recommend the vaccine before year’s end. While clinicians may not recommend the vaccine, political factors may attempt push usage. This may increase distrust in vaccines, lowering uptake of both flu and COVID-19 vaccines.  

If this above is true, Scenario 1 will be most likely; conversely, if a vaccine is safe, ready, and recommended by average physicians, Scenario 3 will be more likely.

To make things easy for you, we have a Trusted Health Immunization Record Form you can download and use for your 2021 health records. Just print it out and get it signed when you get your next shot.

For more nursing resources and flu season updates, create a free Trusted profile.

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