Every year around this time, public health officials start nagging Americans to get their annual flu shots. This season — mindful of the double threat posed by covid-19 and influenza — many providers are doing more than just nagging. They’re trying to make it easier and safer to get the flu vaccine, aware that many people still are afraid to leave home for fear of catching the coronavirus.

One idea gaining in popularity is to give the shots outdoors.

Bethesda, Md., internist Brent Berger, for example, hopes to “borrow” a nearby church parking lot and offer outdoor flu vaccinations, delivered either curbside or in the car. He’s even thinking about combining it with a canned food drive.

“We want patients who would rather not come into the office to have an alternative,” Berger says. “A food drive also allows us to give something back to the community. Most of all, we want to do everything we can to encourage patients to be immunized against the flu, especially against the backdrop of the covid-19 pandemic.”

“This fall we anticipate a double-barreled respiratory virus season,” says William Schaffner, professor of preventive medicine at Vanderbilt University, who points out that people can contract both influenza and covid-19 at the same time. “We expect the occurrence of severe disease and its impact on the health-care system to be substantial. It’s all the more important that everyone over the age of 6 months be vaccinated against influenza.”

The shot not only will prevent many cases of influenza but also increase the likelihood of a mild disease if a vaccinated person still develops flu.

“You’ll be less likely to end up in the emergency room or hospital, and less likely to die of influenza,” Schaffner says. “Most important, you’ll take weight off the medical care system so patients can be cared for more appropriately.”

Age can be a consideration in the timing of a flu shot. It takes two weeks after a shot to develop immunity, which wanes faster in older people than in younger people. Young people can get their shot as early as this month, but those over 65 might want to wait until October. The flu season begins that month and peaks between December and February.

(Experts say it’s better to get one too early or too late than not at all)

Older people also should ask about two flu vaccines associated with a higher immune response and approved for those 65 and older. Also, those over 65 are advised to get a pneumonia vaccination, which is also recommended for children under 2 and for those with certain medical conditions. Pneumonia can be a fatal complication of the flu, the Centers for Disease Control and Prevention says.

More than half of all American adults failed to get a flu vaccination last season, although compliance did inch up from the previous year, according to the CDC. Coverage was 45.3 percent during 2018-2019, an increase of 8.2 percentage points over the 2017-2018 season. The numbers were better for children; coverage was 62.6 percent last year, according to the CDC.

This year, the fear is that the pandemic could prompt the numbers to drop, either from fear of covid-19, or inconvenience. Many homebound employees, for example, won’t have access to flu shots in the workplace this year, as in previous years, and providers are trying to compensate by offering alternatives. “You can’t vaccinate by telemedicine, so we need ways to make it easy, quick and safe for people to come in, and we need to convince them to do it,” Schaffner says.

Berger, the Bethesda doctor, represents one example, but others, including clinics and medical centers, pharmacies and retailers, also have expanded their vaccination plans to the outdoors, which is considered safer than being indoors when it comes to covid-19 transmission.

“This season we will be setting up drive-through flu vaccination sites and clinics at many of our medical facilities to make the process easy and safe for people and maintain social distancing,” says Stephen Parodi, associate executive director of the Permanente Medical Group. “Also, in select Kaiser Permanente regions, we are piloting touch-free screening and check-in.”

Todd Prewitt, corporate medical director for population health for the insurance giant Humana, says the company is encouraging all of its members to get flu vaccinations, and will cover them. As part of its campaign, Humana sent two cloth masks to more than 7 million of its members.

Many pharmacies will offer drive-through vaccinations, says Mitchel Rothholz, chief of governance and state affiliates for the American Pharmacists Association. “We understand that people may hesitate about going into a doctor’s office, because that’s where the sick people are,” he says.

But consumers also can make appointments for shots inside drugstores, he says. “Patients can fill out paperwork before they come into a pharmacy,” he says. “Some pharmacies will have patients wait in their cars and will call them when it’s time to come in and get the shot. They are trying to streamline the process so you’re not having a lot of people standing around in the waiting area.”

Most people who feel comfortable going to their doctor’s office for a flu shot probably still can. Furthermore, if patients have an in-office appointment for another medical reason already scheduled, physicians recommend getting a flu shot at the same time. Regardless — inside or outside — consumers should be prepared for social distancing, temperature checks, screening questions and mask-wearing. They also should expect those giving the shots to be wearing personal protective gear, and to change gloves and disinfect areas between patients.

“Patients will be given a covid-19 screening questionnaire and have their temperature taken prior to any immunization,” says Matthew Blanchette, a spokesman for CVSHealth, which has 10,000 pharmacies nationwide. “They must also wear a face covering or mask, and one will be provided, if needed.”

Starting this month, CVS Pharmacy customers can make flu vaccination appointments at CVS.com, on the CVS app or by texting FLU to 287898, he says.

“They also will be able to complete a digital intake form prior to their visit to limit in-person contact at the time of vaccination,” Blanchette adds.

Some pediatricians also plan to offer outdoor flu vaccinations, although outside clinics present special challenges when dealing with children. Gary Bergman, a pediatrician who practices in Alexandria and Fairfax, Va., decided against vaccinating outdoors. He plans to hold indoor flu shot clinics during hours when the pediatricians aren’t treating sick children.

“Some practices are setting up tents and vaccinating outside, but what if it’s cold and rainy, and kids are crying, and you have to undress a 9-month-old to give a shot in the thigh?” referring to the site for vaccinating children before they are walking, he says. “We just didn’t want to go that route.”

Last year, the pediatricians in his practice delivered more than 8,000 flu shots to their pediatric patients, as well as occasionally to their parents, he says. This year, the practice ordered 12,000 doses, “figuring with the situation, parents who can’t get their flu shots at work might want to get them here,” he says. With social distancing, however, they expect to reduce the number of shots they give during each shift from 225 to 175, but plan to add several evening flu shot clinics.

Experts say that it is important to be protected against influenza before a coronavirus vaccine becomes available, which could happen early next year. If that is the case, “we want to make sure we get as many people protected from flu [first],” says Rebecca Snead, executive vice president and chief executive of the National Alliance of State Pharmacy Associations.

Meanwhile, vaccine manufacturers have boosted production of the influenza vaccine this year. And because routine childhood immunizations for other infectious diseases have fallen behind, federal health officials recently announced they will allow pharmacists in every state to administer childhood vaccinations, including for flu.

Vaccine manufacturer Sanofi Pasteur, for example, has produced nearly 80 million doses of influenza vaccine for this season, a 15 percent increase over last year, and the company has developed a “road map” to help providers prepare to deliver flu vaccines at alternative sites, including outdoors.

“The same people who were told to shelter in place, are also the same ones we must ensure get their flu shots,” says Elaine O’Hara, who heads Sanofi’s North America vaccine program. “Trying to overcome the limitations is very important. There’s no point in producing 80 million doses of influenza vaccine if they don’t end up in someone’s arm.”