In ‘normal seasons’ although we call October 1st the start of the flu season. We don’t see influenza starting to circulate widely until usually late November. At this time we’re preparing paediatrics for RSV.

Another phenomenon we’ve been seeing in recent years, are seasons where we have overlaps of flu type AH1 followed by AH3 with flu B either Co-circulating or arriving later. This means we been having long fiat seasons extending into May.

We’ve been following influenza in Wales through genome sequencing. Last year (prior to mitigation) we had influenza B, four clades of H3N2 and H1N1 circulating in Wales. It looked again that we might have seen a long tail of cases, but the March lockdown stopped it.

This year, influenza hasn’t arrived because quite frankly we wouldn’t normally expect to see it yet. Hopefully we’ll enjoy a Southern Hemisphere Christmas without it. Because If it meets SARS, the pressure on services will be enormous.

This is our most recent influenza report (next tweet), I urge you to look at figure 1, the consultation rate (people who visit their GP for flu symptoms). This corresponds in Winter with flu confirmation in labs (we use PCR 45 cycles- before I’m asked)

http://www2.nphs.wales.nhs.uk:8080/CommunitySurveillanceDocs.nsf/($All)/94C0C6D301B14D2080258601005BB44F/$File/PHW%20Influenza%20Surveillance%20Report%20for%202020%20week%2041.pdf This pattern is consistent across the UK and the republic (we meet as the 5 nations) and shows that at this point, we’re weeks away from any discernible flu activity,

Those who are bothering my clinical colleagues with ‘look no flu!’ Tweets I’m replying, it’s not here yet. We wouldn’t expect it yet. But if you live your lives without social distancing, like Arnie; it’ll be back. (Having the flu vaccine will help us -whatever your stance)

Another way to show this is to look at the dates we ‘switch on’ prescribing Tamiflu in the community. Often this letter from the CMO doesn’t go out until December when we have evidence of influenza circulation in the population. I’ve never seen one sent in October.