A southern US state has recorded its first death from the flu for the 2025 to 2026 winter virus season.

Health officials in North Carolina have reported the death of an adult in the western region of the state due to flu complications during the first week of October.

No further details were revealed, such as the patient’s name, age, or how long they were sick with the virus.

The death is among the first recorded for the 2025 to 2026 respiratory virus season, which is set to last from this month to May next year.

This news coincides with the reintroduction of mask mandates in certain health care settings by at least six counties in California. These mandates apply to visitors and health workers in locations like nursing homes, long-term care facilities, and dialysis centers.

State experts maintain that masks can aid in preventing infections, although a significant review indicated they had ‘little to no difference’ on Covid transmission during the pandemic.

North Carolina state epidemiologist Dr Zack Moore, said: ‘This is a sad reminder that flu infections can be serious and, in some cases, even fatal.

‘We urge everyone to take precautions against flu and other respiratory illnesses, such as getting your annual flu shot, regular handwashing, covering your mouth when coughing, and staying home if sick to prevent spreading the illness to others.’

North Carolina has announced the first flu death of the 2025 to 2026 flu season (stock image)

Typically, flu patients do not succumb to the infection itself, but to complications it incites. The illness can compromise the immune system, increasing the risk of conditions like sepsis or pneumonia, which can be deadly.

According to CDC surveillance, flu activity is currently ‘minimal’ across the nation, but there has been a slight increase in four states, including North Carolina. The other states experiencing elevated levels are Connecticut, Illinois, and Wisconsin.

Levels of RSV and norovirus are also low nationwide, but Covid levels are ‘moderate’, according to wastewater surveillance.

Experts warn that as colder weather hits, people will spend more time mixing indoors, allowing respiratory viruses to spread easily between individuals. They say levels are currently low because the nation is in the early stages of the winter virus season.

Every year, infections, hospitalizations and deaths from respiratory viruses tend to peak between December and February, before gradually declining.

Last year, an estimated 40million Americans were infected with the flu, while 400,000 were hospitalized and 25,000 died from complications linked to their infections, in what the CDC called ‘one of the worst’ flu seasons in over a decade. In that year, cases peaked in early February, before gradually declining. 

In North Carolina, the state recorded its worst flu season last year since the 2009 H1N1 pandemic, registering 544 fatalities. 

North Carolina’s Department of Health revealed the flu fatality in a press release posted online on Wednesday.

It comes after six counties in California, including Sonoma County (shown above), reimposed their mask mandates

It is now urging all residents aged six months and over to ensure they receive a flu vaccine. 

It also said Covid vaccines were recommended for everyone aged six months and over, even after the Robert F Kennedy-run CDC shifted its guidelines to recommend Covid vaccines to those aged 18 years and older. The agency says parents of children aged six months to 17 years should discuss the benefits of vaccination with their doctor.

Data from the CDC shows that in the week to September 20, the latest available, there were eight flu-related deaths recorded nationwide.

This is outside the start of the 2025 to 2026 flu season, which the CDC says begins in October, but indicates that flu deaths were likely recorded elsewhere in the US this week.

Wake County Director of Nursing, Tina Payton, with Wake County being the North Carolina County for Raleigh, the capital of the state in its central area, told ABC11: ‘We see more respiratory illnesses as it gets colder and we’re headed into that season.

‘It gives you a chance to build your immunity before the holidays come up, and that’s always a big time where people get together indoors and there’s a higher opportunity for illness.’

The news comes after at least six counties in California’s Bay Area – Contra Costa, Santa Clara, Sonoma, Napa, San Mateo and Santa Cruz – reimposed mask mandates in some health care settings.  

The above graph from the North Carolina Department of Health shows the proportion of ED visits due to respiratory viruses over the last year

Flu activity remains minimal across much of the US, although it has ticked up slightly in four states, Connecticut, Illinois, North Carolina and Wisconsin

Starting November 1, each will require health workers and, in some cases, visitors or patients, to wear face coverings in medical settings used by frail, ailing or vulnerable patients.

The mandate in Sonoma County has been set to be renewed every year unless it is repealed. 

There are scant reports of other counties considering face mask mandates at present, although experts say this may shift as cooler weather approaches. 

Data for North Carolina shows visits to the state’s Emergency Departments for a respiratory disease dropped to 5.4 percent of the total in the week to October 4, the latest available, down from 6.4 percent in the previous seven-day period.

Covid-like illnesses, infections that are suspected to be Covid but are not confirmed, were the most common reason for ED visits, behind 1.8 percent in the latest week, followed by flu-like, at 0.6 percent, and RSV-like, at 0.2 percent, with both of these also being infections suspected to be down to these diseases that had not been confirmed via tests.

The remaining 2.8 percent did not have the type of respiratory virus they were suffering from determined.