EAST LOS ANGELES, Calif. — Daily Covid-19 cases in the United States reached a new high on Thursday, with more than 163,000 reported cases. The U.S. has recorded daily case totals over 100,000 since Nov. 4, and 67,096 people were hospitalized for Covid-19 as of Thursday, which is also a record high.

Amid this most recent surge of the pandemic in the U.S., community health center doctors, pharmacists, and executives are continuing to stress the increased importance of getting a flu vaccination this year. Two health centers – one in Los Angeles and another in Chicago – are increasing access to flu vaccines for their patients as part of a new outreach effort, supported by Direct Relief and Clorox, at a time when health experts are warning about the possibility of a “twindemic,” a scenario where seasonal flu cases rise even as Covid-19 cases also continue on the upswing.

“The flu clinic is even more important this year because of the pandemic, We want to decrease the likelihood of other influenza-like illnesses like Covid-19, and so we want to get everyone protected, so they can protect themselves, their family, and the community,” said Dr. Edward Liao, chief medical officer at QueensCare Health Centers (QHC), a Federally Qualified Health Center with locations across Los Angeles County.

“There’s a much greater sense of urgency this year because of the pandemic and understanding our health care system is strained as it is,” QHC’s CEO Barbara Hines said. Her clinic has about 100,000 patient visits per year.

With the encouragement to get patients vaccinated, community health centers across the U.S. have created new initiatives to help expand awareness and access to flu shots during this pandemic.

“Things are very different this year and we had to think outside the box about how we could deliver flu vaccines to staff patients,” said Gabriela Alvarez, registered nurse manager at Esperanza Health Centers in Chicago, which serves over 20,000 patients. “Because of Covid, we figured it would be safer to do it outside the building,” she said, due to fears of overcrowding inside their facility.

The health center set up a drive-thru operation in their parking lot, which they are advertising across social media. It was set up in last month in hopes of getting as many people vaccines as they could prior to the onset of winter. Alvarez estimated that at least 30% of the patients being vaccinated are new patients for the clinic. Esperanza Health also conducts Covid-19 testing on the other side of the lot.

At the QHC location in East Los Angeles, a week-long flu clinic is set up this week on the second floor of the building. The clinic is the first flu-dedicated program QHC has done this season due to a shortage of flu vaccines for uninsured patients—a situation was rectified due to donations from Direct Relief and Clorox.

The clinic has two batches of the vaccine: one that they buy for their insured patients and one that they receive for free from the state for uninsured patients. This year, the state’s supply has been allocated differently, leading to delays and shortages for QHC, Snitman said. Other shortages have vexed them as well.

“It’s hard to get syringes and there are shortages everywhere, which makes it more difficult to run flu clinics such as these,” she said.

QHC decided to wait until they received both batches before administering flu shots, which they began weeks later than the usual start date, in mid-October, after receiving the donated vaccines. The reason they waited, Snitman said, was equity—they did not want to only vaccinate insured patients. Alvarez said Esperanza Health has not had shortages of the vaccines, but do have concerns about syringe availability.

Having product is key, but informing the public about availability and the importance of the vaccine is another, separate challenge—one Hines said was amongst the most difficult to address this year, due to many peoples’ reluctance to leave home, especially to go to a medical clinic. QHC produced videos and, like Esperanza Health, has engaged on social media as well. Providers at both clinics are also recommending the vaccine to patients during routine visits, as well as offering factual responses to patient questions.

“The usual concern is that people think they got the flu from the vaccines, which they didn’t, because it has an inactivated virus. But some people can get flu-like symptoms as a side effect. It’s even more important to get the vaccine this year because flu symptoms are so similar to Covid-19 symptoms, and that could lead to confusion and further complications in the health system,” Snitman said.

Another concern she often hears is related to the cost of the vaccine and, more broadly, cost of care at community health centers like QHC.

“We’re open to the community for whatever they need. People might not come in due to expense, but we don’t turn anyone away. We serve anyone regardless of their ability to pay. We’re here for you,” Snitman said.

On the QHC flu clinic’s opening day, Nilda Cruz, 41, of Maywood came in the morning for her first flu shot. She hoped to help “prevent what we’re going through,” she said, referring to the surge of cases and strain on medical resources. Her husband had reached out to the clinic directly to see if they had shots available.

Angelina and Alberto Tellez of East L.A. came on the first day of the flu clinic as well.

“It’s important for me to get the flu shot every year because I have asthma,” said Angelina Tellez.

“The winter is going to be harsher this year, so I think it’s important to get the shot,” said Alberto Tellez, who has received the shot for several years as well.

As the morning progressed, a steady stream of patients came in, each masked and screened for a fever before entering. Staff meticulously cleaned surfaces and reminded patients to keep physical distance from each other. Still, there was some congestion for limited periods of time. For health care providers, it’s yet another risk to balance.

“It’s inevitable to have another wave of Covid and we really want to make sure patients are as healthy as they can be and getting the flu shot is one thing they can do to stay safe this winter,” Alvarez said.