Australia and New Zealand are often viewed as the canary in the influenza coal mine. Their flu season normally occurs between June and September, but this year it started early, in April, and has already peaked. It offers countries in the Northern Hemisphere a "sneak peek" of what their Winter 2022-2023 flu season may look like.

This year, the warning is severe: Australia and New Zealand are coming out of the "biggest surge in winter illness ever." Here are four takeaways that health care leaders can learn from in preparation for their 2022-2023 winter flu season.

1. Plan for a 'multidemic' winter: a combo of flu and Covid-19 coupled with a massive rise in other viruses and respiratory illness

Australia and New Zealand had some of the tightest Covid-19 lockdowns and travel restrictions in the world and loosened them comparatively later than most countries. As a result, the Omicron wave that has swept both nations in 2022 also constitutes their first mass transmission surge, with the rise in Covid cases during flu season fueling a so-called 'flurona' scenario.

In New Zealand, weekly hospitalization rates for flu were 93% higher than in 2019, and considerably higher than during the notoriously difficult winters of 2015 and 2017. Moreover, at the peak of the 2022 flu season, Covid-19 cases were down to 177 per 100,000, a decrease from an Omicron high of 413 per 100,000 – but still a sizeable cause of pressure on providers.  Overall, providers in the Northern Hemisphere should also brace for a Covid-heavy winter, as vaccine and infection-triggered immunity continues to wane.

Additionally, health care providers should prepare for the return – with a vengeance – of a wide variety of other respiratory and viral illnesses that pandemic restrictions kept at record lows these last few years. Both New Zealand and Australia are seeing a resurgence in rhinoviruses (culprits of the common cold), respiratory syncytial virus (RSV), Human Metapneumovirus (HPMV), and adenoviruses.

And while many of these common viruses represent a minimal risk to healthy adults, they can cause serious illness in the elderly and in children. Health providers should prepare staff and resources accordingly to deliver care for a potentially massive – but diverse – increase in winter patient presentations.

2. Prioritize vaccines and masks, as they are still your best preventive measures

The message for flu and Covid-19 prevention is the same as it has ever been: get vaccinated to reduce the likelihood of serious illness. Even with waning immunity, in New Zealand the unvaccinated are five times more likely to be hospitalized with Covid-19 than those who've received a full dose; meanwhile, those vaccinated against the flu are more than 50% less likely to develop a fever and cough than the unvaccinated.

Yet, despite the clear data, the rate of vaccination against influenza in New Zealand is markedly lower than it was in 2020, suggesting that trends of vaccine fatigue may be manifesting. Now more than ever, health providers must get ahead of the potential problem and encourage vaccination and mask wearing well-ahead of the start of flu season.

3. Make your contingency plans now for delays in planned care

It's almost a foregone conclusion that this winter flu season will adversely hit planned care backlogs. Every year flu season means an increase in ED presentations, hospital capacity rising to 100% or more, and a struggle to keep planned and elective procedures going.

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But with patient backlogs at all-time highs post-Covid—and with delayed care actively exacerbating health outcomes—providers should start planning today for how to minimize flu season disruption to wait lists.

In Australia and New Zealand, providers are taking a close look at wait lists, combing through to determine which patients qualify for more urgent care in an attempt to get ahead of worsening patient outcomes. Partnerships with private providers are increasingly being activated, while growing interest in high-volume surgical sites has spurred investment in surgi-centre models of care.

4. Prepare to flex your staff or face paralysis from workforce shortages

Workforce shortages are perhaps the most immediate challenge facing health care providers today – and there's no way that they're not going to get worse this winter. In Australia and New Zealand, workforce shortages are compounded by rising staff absenteeism and home isolation during this flu season, stretching the workforce to the limit.

A variety of solutions have been employed, including increased reliance on telehealth, GP after-hours clinics, and urgent care centers, but the common denominator has been a willingness to flex both staff and funding across the care continuum. Just as in the early days of the pandemic, the only way to keep operations running at a baseline is to dynamically move resources where they're needed most.

One Advisory Board member in New Zealand has put together a Winter Nurse Taskforce of float nurses and allied health professionals, held in reserve every day to be shifted to the wards where they are most needed. This approach offers a level of flexibility that enables health system operations to respond in real-time to evolving pressures, helping protect staff from burnout and patients from adverse clinical outcomes.

Coming after two and a half years of unprecedented disruption in the health care landscape, the promise of a difficult flu season is unwelcome news. But only by taking steps now to minimize the pressure on patient volumes can health systems ride out the coming storm.