The United States is entering its second flu season in the COVID-19 pandemic. The convergence of the two could pose a risk to those infected, and to hospital capacity. Dr. Robert Klugman with UMass Memorial Medical Center and the UMass Medical School joined GBH’s All Things Considered with Arun Rath to discuss. What follows is a lightly edited transcript.

Arun Rath: So before we talk about this season, I want to look back on last year a little bit. It seemed that, at the time, that the vaccination rates for the flu seemed that they were higher compared to a typical year. Was that the case? Were there more people getting vaccinated last year compared to previous years?

Robert Klugman: Last year was a robust year for vaccination. I don't think it was dramatically higher, but I think a lot of people were worried about whatever virus, and the flu vaccine seemed like a good idea.

Rath: And we also had this sense that maybe the flu season, the number of infections, might be limited because of all the other COVID precautions — from vaccines to things like social distancing protocols, wearing masks. How did the flu infection numbers compare last year to previous years?

Klugman: Well, it was remarkable. There were 20-odd thousand reports to the CDC versus the normal 35 million.

Rath: Wow, is that as extraordinary as it sounds?

Klugman: Beyond extraordinary. And I think a lesson for this year.

Rath: Exactly, yes. Well, how do — in that context — how do preparations this year compare with last year, and what are your feelings about where we are right now with preparations?

Klugman: Well, we're very concerned, as you can imagine. I mean, for one thing, because last year, the incidence was so low, people's natural immunity tends to reduce because there isn't as much activity.

Additionally, when the vaccine makers have to predict which components to put in the vaccine — because it’s a quadrivalent vaccine, it has four standard flu viruses, and then they add four others based on what's circulating in the world — they have less to base this year's decision upon. And at best, as we know, the flu vaccine tends to be 50 to 60% effective, it's not close to the high effectiveness of the COVID vaccine, even at its best.

Rath: So on the first part, it sounds it's even more important to get it this year, right?

Klugman: Yeah, I think certainly everybody who possibly qualifies for a vaccination should get one, because we're going to have a hard time differentiating flu from COVID. Flu makes people sick — it causes hospitalizations and deaths quite significantly, maybe not to the COVID level, but still substantially, including children.

And so really, for your own safety, as well as the fact that we'll be dealing with the sort of "twindemic" — not to mention the RSV virus, which is more prevalent — we could really be seeing a lot of overcapacity in hospitals with people with respiratory infections.

Rath: And tell us a bit about your preparations. We know hospitals, like your own in central Massachusetts, you have been worried about capacity. How are things going right now, and how do you feel about where we are, looking ahead to the next couple of months?

Klugman: Well, it's very concerning, particularly for eastern Massachusetts, and I think even beyond. Hospitals have been running at or above capacity pretty consistently now for months, a combination of COVID and the huge impact of people who deferred and delayed care who are now quite ill.

So hospitals really don't have any bandwidth to absorb an additional influx of acute respiratory infections. It's going to be very challenging. Staffing is down for a variety of reasons, and there's a national staffing shortage in terms of travelers and other folks.

So it's not a great situation if we were to see a major surge in respiratory infections this winter.

Rath: It seems that the planning we were talking about that last spring — everybody was expecting that there would be a lull in the summer, and that COVID would come back probably strong right around flu season. And then we had the unexpected spike with the Delta variant, and now it seems like cases are starting to trend down. Nationally, certainly, it also seems like our numbers in Massachusetts are — the last week or so, at least — starting to go in a downward direction. How do you feel about where we are there?

Klugman: Well, there's certainly a downward trend, but we're still busy. At UMass Memorial, we still have presently, I think 29 people across our campuses in the hospital with COVID and some under investigation. So there are still COVID cases coming in. Certainly in August and then into September, whatever number wave this was, it was a dramatic increase.

A good hunk of those were breakthrough infections, fortunately, which tended to be very mild to moderate, so they didn't fill up to hospitals. But there's still enough unvaccinated individuals getting COVID and getting very ill, so we still have that to deal with — and then prepping for the usual winter influx, which can be substantial.

Rath: And on those unvaccinated individuals, you know, our numbers in Massachusetts have been good, but it seems that those who are still reluctant may be harder to get to — the ones that are still left. Are the same populations that are resisting the COVID vaccination, resisting the idea of a flu vaccine? And how are you trying to get to them in your area?

Klugman: Well, that's an interesting question — and the answer is, in many cases, yes, people who are vaccine averse are vaccine averse. But that being said, COVID vaccine is somewhat unique. Across the hospital systems, flu vaccination is mandated, as it was last year for our healthcare workers.

But in the general population, it's really up to the practices and the clinicians and public health to really promote and push people to get flu vaccine. Fortunately for a lot of people, flu vaccine is the norm: they're used to getting it, particularly the elderly and immunocompromised and at-risk patients.

But there's still another population. As you know, we still have upwards of 30% of the people in Massachusetts are unvaccinated, 68% are fully vaccinated — and actually [74%] have had one shot. But still, millions of people who are unvaccinated are at risk for COVID.

And we don't know whether you can have COVID and flu at the same time, but that would be even a bigger worry. Generally, when you get one virus that kind of blocks the other, but we don't have any experience. That could be very overwhelming if we had people with COVID and influenza at the same time — would be very lethal, I would expect.

Rath: Now we've heard about hospital staffers — again, most of these stories that I can think of are from outside of Massachusetts — but people who may be suspended or fired from their jobs because they don't want to get vaccinated against COVID. They are healthcare workers who would resist the idea of a vaccine mandate. Have you seen or encountered any of that in your hospital or anywhere?

Klugman: Oh yes, we have quite a substantial number of folks that are very reluctant to get vaccinated. We have our deadline coming up shortly, as every organization does, and we're hoping that folks will choose to get vaccinated.

If not, we're going to have more of an issue with shortage of staffing from those unvaccinated individuals, plus they're at risk — they put their families at risk, and we can't continue to have them put our patients at risk and their coworkers. Hence, the mandate.

Rath: It's a tough final question, but I'll throw it to you: what are your thoughts on how you, and all of us, might be able to do to reach those those individuals and get through to them?

Klugman: There's a lot of misinformation in the media, a lot of disinformation. Unfortunately, people have become very wedded to a lot of this information, and I've had many, many conversations with very intelligent people who are really fixated on their personal beliefs and their view of the research.

So I think there’s been a lot of effort there. Clearly, there are — you and I have talked about this, there are folks of color, in the minority population, who may have less access to good information. And we're making every effort at our organization to reach out in every medium and every language to educate folks, and hoping that that will move the needle.

We're hoping that positions in practice, the clergy, public leaders will continue to sing the praises of the vaccine. And as the literature comes out and shows more and more the ill effect — even if you survive COVID, you've got a 50% chance of having a long-term effect on your body, so people understand that that far outweighs the potential tiny risk associated with vaccination.

So we're pushing out the information as best we can, but it's been an interesting social dilemma.

Rath: Dr. Klugman, it's good to speak with you. Thank you.

Klugman: Thank you.