Flu cases are already spiking in parts of the country, and the seasonal virus may be about to hit Utah hard.

“It’s moving quickly through the south central and southeast states and it will be here very soon,” Dr. Tamara Sheffield, medical director of preventative medicine for Intermountain Healthcare, warned, noting there have been school closures due to flu outbreaks, including in Texas, Alabama and Virginia.

Flu season can start in October, but usually doesn’t peak until the dead of winter. Throughout the COVID-19 pandemic, the flu all but disappeared. Now, with few still taking mitigation measures like masking and social distancing, the flu is making a comeback.

The Centers for Disease Control and Prevention reported that by mid-October, there were high levels of flu activity in Texas, Tennessee, Georgia, South Carolina, Alabama, Louisiana and New York, and even higher levels of the virus in Washington, D.C., while numbers were moving up through other parts of the eastern U.S.

Utah still was at a minimal level for influenza at that point, along with much of the West, according to the CDC. Intermountain Healthcare’s “GermWatch” website shows flu cases have already reached a moderate or even high level in some areas of the state, especially along parts of the Wasatch Front.

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And flu isn’t the only threat as Americans face what’s being called a “tripledemic” of flu, COVID-19 and RSV or respiratory syncytial virus outbreaks this winter. Like the flu, RSV is roaring back after being largely dormant throughout much of the COVID-19 pandemic.

“We are moving into the respiratory virus season,” Sheffield cautioned. “Hospitalizations have increased dramatically for respiratory syncytial virus at Primary Children’s (Hospital), so children are now passing respiratory viruses to each other.”

The doctor said vaccinations against the flu as well as COVID-19 are key to limiting the impact of the outbreaks on the health care system. Last winter, some hospitals had to turn away patients as COVID-19’s highly transmissible omicron variant sent coronavirus cases soaring to record levels.

While COVID-19 cases have declined dramatically since then, they are on the upswing again and another surge is feared as new variants of the virus continue to spread. Thursday, the state department of health and human services reported more than a 26% increase in the seven-day average case count, now over 305.

Earlier Thursday, the state said there were 14 additional deaths reported over the past week from COVID-19, including a boy between 1 and 14 years old, but later updated that total to nine and said the boy had not died from the virus.

“So we’re going to have COVID, influenza and RSV, respiratory syncytial virus,” Sheffield said. “That means our hospitals once again in the wintertime could become overwhelmed if people do not prevent the infection by going and getting their COVID and influenza vaccines, which can be given at the same time.”

Both COVID-19 and influenza vaccines are available for children as young as 6 months old and both are now on the CDC’s list of recommended routine immunizations for both children and adults. The recent addition of COVID-19 shots to that list is opposed by Utah Attorney General Sean Reyes and other Republican attorneys general.

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It’s up to the states whether to mandate vaccinations, and the only required immunizations in Utah are to attend school. COVID-19 shots won’t be added to that list, said Rich Lakin, immunizations director for the Utah Department of Health and Human Services.

Flu and several other recommended shots, including the HPV or human papillomavirus vaccine that protects against the sexually transmitted virus that can cause cancer, are not required for Utah students. Like the COVID-19 vaccine, there’s been pushback against including flu shots.

Lakin said it’s difficult to explain why flu shots aren’t required for Utah students.

“Flu has mild years and severe years. To make it a requirement would be difficult. There are political issues surrounding this also,” the immunization director said. “All I can say is this vaccine is really a choice of the parent if they want their child to receive it.”