This is a flu season to remember. It’s not the worst in local history, not by a long shot. But at least 142 San Diegans have died so far, the most in at least two decades, and by one measure the flu death toll here is the worst in the state.
Outbreaks have forced nursing homes and assisted care facilities to go on lockdown. Flu medications are out of stock or extremely expensive, hospitals are turning away visitors and doctors have their hands full. National news outlets, meanwhile, have noted our high number of deaths and special tents to treat flu patients at local hospitals. There is good news, though: The worst may be over.
Here are questions and answers about the mighty flu.
How bad is the flu this year?
From a historic perspective, it’s quite bad. The county says 142 people have died of the flu during the 2017-2018 season, as of Jan. 13, the latest numbers available.
That’s the highest flu season death toll in at least 20 years, dating back to when the county began tracking flu deaths. Since 2003, the annual flu death toll has ranged from as few as 4 to a previous high of 97 in 2014-2015. (See below for details about the deadliest San Diego flu season ever.)
County health officer Dr. Wilma Wooten said other numbers — of outbreaks, overall confirmed flu cases and the number of flu visits to intensive care units — are also at unusually high levels. “All the factors are higher than we’ve ever seen since we’ve been tracking the numbers,” she said.
As of Jan. 13, the state reported 68 flu deaths among people under the age of 65. The county reported 16 as of that date.
Who is dying from the flu?
The flu usually is most likely to kill older people, although it can strike down the young and healthy too. This flu season has been typical on this front.
As of Jan. 13, 126 of 142 local flu deaths were among people aged 65 and older. It’s rare for children to die of the flu, but the county reports one death of a child, a 1-year-old baby. As of Jan. 6, the federal government reported only 20 children had died of the flu in the entire nation.
People with health problems are especially vulnerable to the flu. That’s why some local nursing homes, assisted living facilities and rehabilitation centers have gone on flu “lockdown”  to prevent the spread of the disease.
During lockdowns, these facilities may ban visitors or require them to wear masks and gloves, cancel activities and close dining halls so patients must eat from trays in their rooms or apartments.
According to Wooten, the county health officer, 101 outbreaks have been reported in facilities where groups of people live, mostly long-term care facilities.
How many people have gotten sick overall?
There’s no way to know for sure because health officials don’t track ordinary cases of the flu. However, during a week earlier this month, the county reported that 11 percent of emergency room visits were due to the flu; that number has since fallen to 7 percent.
Some medical offices in the county regularly test samples from patients so health officials can track changes in the prevalence of the flu. The number of cases confirmed was 2,070 in the week ending Jan. 13, down from 3,046 in the week ending Jan. 6. The total number of confirmed cases as of Jan. 16: 12,446.
Are those falling numbers good news?
Yes. Statistics suggest that flu season may have peaked around the beginning of the year, Wooten said, and finally started to fall after a rapid and sharp rise in cases in the final months of 2017. State flu statistics also suggest that the flu season has reached a peak and is now starting to dwindle.
But there’s a catch. “Usually there’s just one peak,” Wooten said, “but on occasion there can be more than one peak in a given flu season.”
How are hospitals and doctor’s offices doing?
At least three local hospitals — Palomar Medical Center in Escondido, Tri-City Medical Center in Oceanside and Sharp Grossmont Hospital in La Mesa — erected special tents  to treat flu patients. Palomar Medical Center reported seeing more than 400 patients  with possible cases of flu in a single day.
Hospitals in the Scripps chain have banned visitors  younger than 15 and forbidden patients from having more than two visitors at once.
Your doctor’s office may ask you to put on a mask in the waiting room if you’re sick, and your kids might not be allowed to wait with you if you’re there for your own appointment.
What if I need Tamiflu?
Good luck with that. There’s been a shortage locally, with the generic version of the drug, known as oseltamivir, in especially short supply.
Dr. Sally Rafie, pharmacist at Point Loma Shelter Island Drug, said she’s seen a steady flow of customers seeking Tamiflu because they’re sick, although research suggests it may only shave a few hours off the week or so that a typical infected person is ill.
The Point Loma pharmacy wasn’t able to find the generic version of Tamiflu to order, Rafie said. Instead, it could only offer the brand-name medication, which costs more, she said.
“Some people were forgoing it when their insurance didn’t cover it, especially for prevention,” she said. “We had parents of sick children who should have been taking it as a preventive but elected not to.” (Tamiflu appears to provide mild protection against infection with flu.)
According to GoodRX, a website that tracks drug prices, a discounted short-term prescription for generic oseltamivir costs $51.94 at Walmart in the San Diego area while the brand name version (Tamiflu) runs $161.48. Other pharmacies were listed as having roughly similar prices if customers use coupons.
What should I do if I’m sick?
Rest, drink liquids and try to stay upright to keep fluids from gathering in your chest.
Rafie, the Point Loma pharmacist, recommends over-the-counter medications based on a patient’s symptoms like fever or coughing. “For people who are trying to be functional during the day or if they have certain medical conditions, we’d advise against sedating medications. We reserve those for nighttime use.”
Is it too late to get a flu shot?
Nope. You can still get one, and it should provide some protection for the rest of the flu season, which could last for a few more months. But researchers say the vaccine hasn’t done a good job of preventing flu this year.
Why is this year’s flu season so bad?
Flu has struck nearly the entire nation, but California in general and San Diego in particular appear to be especially hard hit.
Blame the flu strain known as H3N2, which the medical news site Stat calls “the problem child of seasonal flu .”
“It causes more deaths than the other influenza A virus, H1N1, as well as flu B viruses,” Stat reports. “It’s a quirky virus that seems, at every turn, to misbehave and make life miserable for the people who contract it, the scientists trying to keep an eye on it and the drug companies struggling to produce an effective vaccine against it.”
How bad could it get?
The great worldwide “Spanish flu” pandemic devastated San Diego in 1918  and sparked intense debate about how far the government should go to close down the city to protect residents.
The deadliest epidemic in the nation’s history took the lives of 368 San Diego city residents, or 1 in every 200 people. Many of the victims were young and healthy.
Politicians and business people bitterly debated whether to shut down venues like stores and theaters. “There is a class of people blind and indifferent to the death and sick rate, apparently unconcerned about everything else but nickel nursing and sight-seeing,” declared the mayor. “If we cannot put life and health above dollars and pleasure for a few days, we had better abolish the Bible and the Constitution.”
The city eventually shut down schools, theaters, dance halls, churches and many other public places for several days late in the year. The flu, which killed an estimated 50 million worldwide, eventually faded.