The annual roll out of the flu vaccination to eligible patients across Scotland gets under way this weekend.
The need to physically distance, and at the same time see huge numbers of “at risk” patients, is going to make it one of the most challenging vaccination programmes Scotland has delivered.
Priority groups will be offered the chance to attend a dedicated walk-in or drive-through clinic - with community centres, schools, local GP practices, and even city centre landmarks being used as venues.
There is plenty of tape, hand-sanitiser and one-way systems in place, and the Red Cross has even been drafted in to help.
Dr Drummond Begg is a GP at Penicuik Medical Centre. The surgery has about 5,000 eligible patients to see over the coming weeks.
“It is different this year with the pandemic, and across Scotland there are different ways in which people will get their vaccine,” he said.
“Sometimes in practices, sometimes the boards will be using big campaigns.
“So I think the key message is to check whether you are eligible, use the NHS Inform Website but probably most importantly to check your practice’s website to know what the local arrangements are.”
Will everyone who is eligible get a vaccine?
There have been concerns raised about supplies of the vaccine. Boots confirmed that it has had to close new bookings due to the level of demand and limited stock.
In Scotland vaccines are procured nationally by the NHS for those in eligible groups. That has been extended this year.
In addition to over 65s, health workers, and those with medical conditions; social care workers, families of shielders and over 55s will be offered the jab this year.
The Scottish government has said it has enough vaccine to ensure that all those in the eligible groups will get it in the coming months and if supplies allow, they plan to extend the programme further to everyone over 50.
It has acknowledged that a shortage of global supplies could impact on those who want to pay privately for a vaccine.
Nevertheless, Dr Drummond said supplies could be an issue if everyone comes for their vaccine at once.
He asked that patients bear with them as it is all new, but he said GPs have been assured over the next few months, they will get vaccines to those who need them.
Some patients have told the BBC they have struggled to get appointments. NHS Borders has asked people for patience because of the exceptional demand.
In Musselburgh, Betty Irving and Tolena Struthers said they had trouble getting information.
Betty said: “When I went onto the website there was nothing there, so I’ve tried several times to phone the surgery.
“First of all they say if it’s urgent, 999, and then it says ‘we are experiencing a high degree of calls, please phone back’ and then it goes dead.”
Tolena added: “It’s even more important to get the jag because of our age. I just don’t know what to do now, where are we meant to go?”
The Scottish government said that with Covid-19 circulating at the same time as the flu, it was “more important than ever” to get vaccinated this year.
A spokeswoman added: “NHS Boards have invited eligible priority groups to book an appointment by phone rather than from individual GP practices as in previous years.
“We aim for everyone eligible for a free flu vaccination to receive an appointment after the programme commences on 1 October.”
How will Covid impact on the flu season?
Little is known about how flu will impact on Covid. An increase in respiratory infections in the general population could also stretch the Test and Protect system.
Hospital staff will need to work out the appropriate treatment for patients. Keeping all admissions down is the desire.
The NHS already works near capacity and winter always brings with it additional pressures.
Pre-Covid, a severe flu epidemic would have had consequences that could see routine work postponed or cancelled.
The pandemic has already placed the NHS on an emergency footing with a backlog and many services running at a limited capacity.
A surge in coronavirus cases coupled with flu could have severe implications.
Prof Pablo Murcia is a virologist based at Glasgow University who specialises in influenza.
“Flu on its own is a really important human pathogen,” he said.
“We have excess mortality due to flu every single winter so even before Sars-CoV-2 we really have to take care of ourselves and get the vaccines, and now we have another pathogen that can cause mortality in certain patients. “
He said little is known about virus interactions, particularly about influenza and Covid-19.
But Prof Murcia said data emerging from countries that have already had their flu season suggested some positive influence from social distancing.
“What we know from countries in the southern hemisphere is that they found historical lows with other respiratory virus infections,” he said.
“And this is because when we put in place these intervention measures that are aimed to stop the transmission of Sars-CoV-2, they also stop the transmission of other respiratory infections.”
But the truth is, we have never faced a situation like this and the winter will be challenging.
That is why there is much emphasis on getting the flu vaccine if you are eligible. It is at least one virus where a vaccine exists.