Flu hospitalizations for Thanksgiving week were the highest seen in over a decade, as nearly every state is grappling with high or very high levels of flu activity, leading to shortages of common over-the-counter medications.

Where the flu season stands

According to CDC, 47 states are reporting "high" or "very high" influenza-like illness (ILI) activity for the week ending in Nov. 26. Meanwhile, Hawaii and West Virginia are reporting "moderate" ILI activity, Alaska, Michigan, and Vermont are reporting "low" ILI activity, and New Hampshire is reporting "minimal" ILI activity.

For the week ending in Nov. 26, 19,593 lab-confirmed flu patients were hospitalized, and the percentage of outpatient provider visits for an ILI was 7.5%–above the national baseline of 2.5%. According to CDC, the cumulative hospitalization rate for influenza for the week ending in Nov. 26 was the highest observed during that period since the 2010-11 flu season.

So far this season, CDC estimates there have been at least 8.7 million flu illnesses, 4.2 million flu medical visits, 78,000 flu hospitalizations, and 4,500 flu deaths.

Two pediatric flu deaths were reported for the week ending in Nov. 26, bringing the total number of pediatric flu deaths for the 2022-23 season up to 14.

Public health experts say pandemic precautions kept the flu at bay the past two years but returning to pre-pandemic life has left Americans "immunologically naïve" and more likely to be infected.

Normally, "we might get exposed to a small bit of virus and your body fights it off," said John Tregoning, an immunologist at Imperial College London. But, "that kind of asymptomatic boosting maybe hasn't happened in the last few years," he added.

Flu vaccination rates remain low

While the flu is spreading quickly throughout the United States, CDC data shows flu vaccination rates remain low.

Through mid-November, flu vaccination rates for children are around 40%, similar to last year's, but lower than rates from the 2020-21 and 2019-20 seasons. Vaccination rates among U.S. adults range from 18.9% to 35.6%, a drop from recent years when adult vaccination rates ranged from 45% to 50%.

In addition, research shows that around 4 in 10 Americans have said they don't intend to get a flu shot this season, mostly due to concerns the shots don't work well or have side effects.

"We can't let up our guard," said Surgeon General Vivek Murthy. "We have to take the precautions that we need to prevent the spread of these viruses, like washing our hands, wearing masks in crowded indoor spaces, and like making sure that we're staying home if we're sick. And of course, again, with Covid and flu [to] get vaccinated as soon as you can."

High flu rates lead to shortages of OTC medications

As a result of high flu rates around the country, medications for treating fever and flu, especially in children, have been in short supply in some areas.

According to the Consumer Healthcare Products Association, sales of pediatric internal analgesics, like acetaminophen and ibuprofen, were up more than 26% in October compared to last year.

The University of Utah's Drug Information Service, which tracks drug shortages, received its first notification of a shortage of liquid ibuprofen on Monday, which is typically used for children, and confirmed it with manufacturers.

"There are definitely distribution and supply chain problems that still exist," said Erin Fox, the service's director. "These shortages seem to be mostly a demand spike and should resolve relatively quickly."

Johnson & Johnson, which makes Children's Tylenol and Children's Motrin, said there isn't a nationwide shortage, just a surge in demand.

"Consumer demand for pediatric pain relievers in the U.S. is high, but there are no supply chain issues and we do not have an overall shortage in the U.S.," said Melissa Witt, a company spokesperson. She added the company is "experiencing high consumer demand and are doing everything we can to make sure people have access to the products they need."

The shortage is "a huge problem" according to Kristina Powell, a pediatrician and president of the Virginia chapter of the American Academy of Pedaitrics. "This is a result of the 'triple-demic.' Parents run to Walmart or Target, the shelves are empty … This is going to be a long fall and winter of viral infections."

Steffane Battle, a pediatrician at the UAB-Huntsville Regional Campus, says shortages of these medications could be a problem for those suffering from common complications of the flu.

"The common complications that we see in the little kids, you can have a febrile seizure, you can get secondary pneumonia, secondary ear infections with those bacterial secondary bacterial processes, secondary pneumonia, and secondary ear infection," she said. "We would use the antibiotic and if that main antibiotic is short supply, we could be in trouble." (Bettelheim, Axios, 12/5; Carbajal, Becker's Hospital Review, 12/2; Hou, "Changing America," The Hill, 12/2; Scribner, Axios, 12/3; Lee, WAFF, 12/2; Wamsley, "Shots," NPR, 12/3; Portnoy et. al., Washington Post, 12/1)