The flu season is here again, in case you have not heard. This year there are special concerns related to the voraciousness of this particular strain, the limits of the available flu vaccine and a medical supplies shortage caused by Hurricane Maria's shutdown of Puerto Rico's power grid.

According to the U.S. Centers for Disease Control and Prevention (CDC), this year's flu season began early and almost simultaneously in 46 states, then it spread rapidly. The South reports some of the highest flu numbers, especially in Arkansas, Texas and Mississippi.

In addition to the standard approaches such as frequent hand-washing and general healthy living, many people receive a flu shot to avoid illness. This year's flu strain, H3N2, is covered by the available vaccine, but the medical community is debating how effective it will be in combating a challenging epidemic.

A recent New England Journal of Medicine editorial presents evidence that this vaccine has not been entirely effective against H3N2 in Australia. If Australia's experience is any indication, the vaccine "may protect against the predominant strain of the flu only 30 percent of the time."

To add to this growing concern, as of Jan. 9, California reports that it has had 25 flu-related deaths among patients younger than 65. Not only is this news troubling because H2N3 is known for impacting elderly people the most, but in normal flu seasons California usually sees only 3 or 4 flu-related deaths this time of year.

It is possible, since the season started early this year that the numbers could be elevated. Officials are no doubt tracking the numbers closely, as we enter peak flu season in February.

To pour salt into this flu season's wounds is the additional news that the flu is especially deadly for those who are hospitalized. Hospitalization occurs when patients may arrive with symptoms too difficult to treat on an outpatient level, and facilities have been challenged and may grow overwhelmed by difficult cases.

This year hospital care presents a host of new complications as there's a distinct shortage of widely used small IV bags and nutrient solutions. Hospitals hydrate patients using hundreds or even thousands of these bags every day. The bags dilute antibiotics, painkillers and other drugs, then hang from a pole so the mix slowly drips into veins through a tube.

One of the only U.S. makers of IV bags is Puerto Rico-based Baxter International. The company's manufacturing capabilities were crippled by Hurricane Maria's impact. Just before Christmas, the last of three Baxter International factories that make saline bags and nutrient solutions was reconnected to power. Intermittent power outages are still slowing Baxter's production abilities, and it remains unclear when conditions for full production will be in place.

After Maria, IV bag shortages began, and medical supply resellers were marking saline bags up 600 percent. Most hospitals can not afford this expense, and they are left scrambling to develop alternatives.

This is accompanied by a "cascade effect" that also impacts other supplies. For example, one alternative method to IV drips is to inject fluid through syringes. Syringe supplies are also taking a hit, as injections become the alternative method for delivering fluids.

Other burdens on hospital staff include retraining workarounds and new lengthier time demands required by alternative methods devised during critical shortages. In response to bag, fluid and syringe shortages, the Food and Drug Administration, which is monitoring the situation, states that things should be improving in the next few weeks.

In the meantime, the best thing for people to do is get a flu shot if they are at special risk and follow all of the usual precautions to avoid needing hospital care.