From the Rocky Mountains to New England, hospitals are swamped with people with flu symptoms. Some medical centers are turning away visitors or making them wear face masks, and one Pennsylvania hospital set up a tent outside its ER to deal with the feverish patients. 
 
 Dr. Meeta Khan wears a face mask as she examines a respiratory patient at the Rush University Hospital emergency department, Thursday, Jan. 10, 2013, in Chicago. Flu season in the U.S. has hit early and,... (Associated Press) 
 
 Registered nurse Michelle Newbury, left, and physician assistant Scott Fillman meet with patients, not pictured, in a tent set up for a people with flu symptoms, just outside the emergency entrance at... (Associated Press) 
 
 A tent is set up for a patients with flu symptoms, just outside the emergency entrance at the Lehigh Valley Hospital Thursday, Jan. 10, 2013, in Allentown, Pa. The Pennsylvania Department of Health designated... (Associated Press) 
 
 Damien Dancy puts masks on his children Damaya, 3, left, and Damien, 7, on Wednesday, Jan. 9, 2013 at Sentara Princess Anne Hospital in Virginia Beach, Va. Hospitals in Hampton Roads are urging patients... (Associated Press) 
 
 Vials of flu vaccine are displayed at Philly Flu Shots on Thursday, Jan. 10, 2013 in Philadelphia. The flu season arrived early in the U.S. this year, but health officials and experts say it's too early... (Associated Press) 
 
 A public health nurse demonstrates drawing flu vaccine from a bottle at the Oklahoma City-County Health Department in Oklahoma City, Thursday, Jan. 10, 2013. Flu season in the U.S. has struck early and,... (Associated Press) 
 
 Physician assistants Scott Fillman, left and Andrew Hunadi meet with patients, not pictured, in a tent set up for a people with flu symptoms, just outside the emergency entrance at the Lehigh Valley Hospital... (Associated Press) 
 
 Flu season in the U.S. has struck early and, in many places, hard. 
 
 While flu normally doesn't blanket the country until late January or February, it is already widespread in more than 40 states, with about 30 of them reporting some major hot spots. On Thursday, health officials blamed the flu for the deaths of 20 children so far. 
 
 Whether this will be considered a bad season by the time it has run its course in the spring remains to be seen. 
 
 "Those of us with gray hair have seen worse," said Dr. William Schaffner, a flu expert at Vanderbilt University in Nashville. 
 
 The evidence so far points to a moderate season, Schaffner and others say. It looks bad in part because last year was unusually mild and because the main strain of influenza circulating this year tends to make people sicker and really lay them low. 
 
 David Smythe of New York City saw it happen to his 50-year-old girlfriend, who has been knocked out for about two weeks. "She's been in bed. She can't even get up," he said. 
 
 Also, the flu's early arrival coincided with spikes in a variety of other viruses, including a childhood malady that mimics flu and a new norovirus that causes vomiting and diarrhea, or what is commonly known as "stomach flu." So what people are calling the flu may, in fact, be something else. 
 
 "There may be more of an overlap than we normally see," said Dr. Joseph Bresee, who tracks the flu for the Centers for Disease Control and Prevention. 
 
 Most people don't undergo lab tests to confirm flu, and the symptoms are so similar that it can be hard to distinguish flu from other viruses, or even a cold. Over the holidays, 250 people were sickened at a Mormon missionary training center in Utah, but the culprit turned out to be a norovirus, not the flu. 
 
 Flu is a major contributor, though, to what's going on. 
 
 "I'd say 75 percent," said Dr. Dan Surdam, head of the emergency department at Cheyenne Regional Medical Center, Wyoming's largest hospital. The 17-bed emergency room saw its busiest day ever last week, with 166 visitors. 
 
 The early onslaught has resulted in a spike in hospitalizations. To deal with the influx and protect other patients from getting sick, hospitals are restricting visits from children, requiring family members to wear masks and banning anyone with flu symptoms from maternity wards. 
 
 One hospital in Allentown, Pa., set up a tent this week for a steady stream of patients with flu symptoms. But so far "what we're seeing is a typical flu season," said Terry Burger, director of infection control and prevention for the hospital, Lehigh Valley Hospital-Cedar Crest. 
 
 On Wednesday, Boston declared a public health emergency, with the city's hospitals counting about 1,500 emergency room visits since December by people with flu-like symptoms. 
 
 All the flu activity has led some to question whether this year's flu shot is working. While health officials are still analyzing the vaccine, early indications are that it's about 60 percent effective, which is in line with what's been seen in other years. 
 
 The vaccine is reformulated each year, based on experts' best guess of which strains of the virus will predominate. This year's vaccine is well-matched to what's going around. The government estimates that between a third and half of Americans have gotten the vaccine. 
 
 In New York City, 57-year-old Judith Quinones skipped getting a flu shot this season and suffered her worst case of flu-like illness in years. She was laid up for nearly a month with fever and body aches. "I just couldn't function," she said. 
 
 But her daughter got the vaccine. "And she got sick twice," Quinones said. 
 
 Europe is also suffering an early flu season, though a milder strain predominates there. Flu reports are up, too, in China, Japan, the West Bank, the Gaza Strip, Algeria and the Republic of Congo. Britain has seen a surge in cases of norovirus. 
 
 On average, about 24,000 Americans die each flu season, according to the CDC. That's an estimate _ the agency does not keep a running tally of adult flu deaths each year, only for children. Some state health departments do keep count, and they've reported dozens of flu deaths so far. 
 
 Flu usually peaks in midwinter. Symptoms can include fever, cough, runny nose, head and body aches and fatigue. Some people also suffer vomiting and diarrhea, and some develop pneumonia or other severe complications. 
 
 Most people with flu have a mild illness and can help themselves and protect others by staying home and resting. But people with severe symptoms should see a doctor. They may be given antiviral drugs or other medications to ease symptoms. 
 
 Flu vaccinations are recommended for everyone 6 months or older. Of the 20 children killed by the flu this season, only two were fully vaccinated. 
 
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 AP Medical Writer Maria Cheng in London contributed to this report. 
 
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 Online: 
 
 CDC flu: http://www.cdc.gov/flu/index.htm ||||| Atlanta (CNN) -- The spread of the flu across the United States appears to have slowed in some areas, but officials won't know for weeks whether the cases have peaked, the CDC director said Friday. 
 
 Twenty-four states and New York City were reporting high levels of flu activity, according to the Centers for Disease Control and Prevention's flu advisory report for December 30 through January 5. That's down from 29 states the previous week, said Dr. Thomas Frieden, director of the CDC. 
 
 However, "The only area of the country that's still relatively unaffected ... is the far West Coast," although plenty of cases have been reported there, Dr. Joseph Bresee, chief of the Epidemiology and Prevention Branch of the CDC's Influenza Division, said Friday. 
 
 The number of pediatric deaths associated with influenza rose by two, according to the CDC. 
 
 There have been 20 deaths of people under the age of 18 since the flu outbreak began. While the CDC does not count the number of adult deaths related to the flu, some states do, and that data suggests dozens have died. 
 
 According to the latest CDC activity map, flu levels dropped in several states, particularly in the Southeast, including Georgia, Florida, South Carolina, Arkansas and Kentucky. In the Northeast, levels in some states have also improved, such as New York, but New York City remains among the areas of high activity. 
 
 The number of states reporting widespread activity, however, increased to 47 from 41, according to the CDC's flu advisory report. The only states without widespread activity are California, Hawaii and Mississippi. 
 
 "Widespread" means that more than 50% of geographic regions in a state -- counties, for example -- are reporting flu activity. It addresses the spread of the flu, not its severity. 
 
 "Bottom line: It's flu season," Frieden told reporters. Flu activity is "elevated" in most of the United States, he said, and "it may be decreasing in some areas, but that's hard to predict ... influenza activity ebbs and flows." 
 
 Officials will know in the next couple of weeks whether the season has peaked, he said. "The only thing predictable about the flu is, it's unpredictable." 
 
 "... We are into what would classically be described as a flu epidemic," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health, told CNN's Wolf Blitzer on Thursday. 
 
 "It's still on the uptick," he said. 
 
 "Remember, once it peaks, you still have a considerable amount of time where there is a lot of flu activity, and right now it may have peaked in some places, but for the most part, it has not yet peaked," Fauci said. 
 
 Many reports of emergency rooms and clinics being overwhelmed with patients could be linked to other illnesses, too. This is also a prominent season for many other respiratory viruses, Bresee said. Norovirus, which causes diarrhea and vomiting, has also been circulating. 
 
 Vaccination 
 
 Although the flu vaccine is far from perfect, it's the best prevention tool we have, Frieden said. You can still get it -- it's better late than never. 
 
 The flu vaccine is about 62% effective, Frieden said. 
 
 "The 62% -- we'd love it to be better, but it is actually a substantial public health benefit for the population," Bresee said. 
 
 Based on vaccine coverage surveys, 37% of Americans had been vaccinated by mid-November, CDC officials said. That's about on track with what was seen at this time last year. 
 
 "We have seen a lot of vaccination happening in the last couple of weeks," Bresee said. "I don't know where we'll end up this year." 
 
 Vaccine manufacturers told CNN on Thursday that there is plenty of vaccine for those who want to get a flu shot. 
 
 However, there are reports of spot shortages of the vaccine, Frieden said, so call your provider ahead of time if you still want to get the vaccine. 
 
 "You may have to check in several places to find the vaccine, because most of the more than 130 million doses that were produced by vaccine manufacturers this year have already been given," he said. 
 
 Early flu season 
 
 The flu came early this season, and cases are more severe than last year, health officials say. 
 
 Massachusetts is one state that the CDC had identified as having high activity of influenza-like illness based on the week ending December 29, but downgraded it to "moderate" activity in Friday's update. 
 
 Boston Mayor Thomas Menino had declared a public health emergency in the city Wednesday because of the flu. 
 
 Since October 1, there have been 700 confirmed influenza cases among Boston residents, according to Menino's office; that's 10 times more than were seen in all of last year's flu season. 
 
 There have been 18 flu-related deaths this season in Massachusetts, CNN affiliate WCVB reported. Hospitalization rates are higher than in the last two years, Kevin Cranston of the state's Bureau of Infectious Diseases told WCVB. Most deaths have been in older patients, he said. 
 
 Menino is collaborating with the Boston Public Health Commission and community health centers to offer free vaccination clinics this weekend. The mayor urged residents to stay home from work or school if they are sick, and to get flu shots. 
 
 "This is the worst flu season we've seen since 2009, and people should take the threat of flu seriously," Menino said in a statement. More than 4% of emergency department visits at Boston hospitals are from flu cases, up from 1% during non-flu season. 
 
 Massachusetts General Hospital has already counted 532 cases of flu among patients, which is more than the Boston hospital saw in any of the previous three flu seasons, spokeswoman Kristen Stanton said Wednesday. 
 
 Signs posted throughout the hospital discourage anyone from visiting who has a cough or fever, she said, and anyone who does visit with those symptoms must wear a mask and perform hand hygiene. All staff must wear a mask when caring for possible flu patients, and staff members who have not been vaccinated must wear a mask while caring for any patient. 
 
 As an extra precaution amid flu fears, Bishop Robert P. Deeley of Boston sent a note to all pastors in the Boston Archdiocese suggesting that during the Sign of Peace, "the faithful, instead of a handshake, may bow to the persons nearby." Similarly, in Washington, a note from the Archdiocese's communications office says that parishioners don't have to shake hands or receive communion from the chalice. 
 
 "Those who are sick may wish to watch the Sunday TV Mass on their television at home and pray in solidarity with their parish community," the statement said. 
 
 Deaths in other states 
 
 The CDC only tracks pediatric flu-related deaths, but some individual states release reports of influenza deaths among adults. 
 
 The Oklahoma Department of Health said Thursday the state has had eight influenza-linked deaths since September 30, while the Minnesota Department of Health has recorded 27 flu-related deaths. 
 
 "We are clearly at a high level of influenza activity in the state," Minnesota Health Commissioner Dr. Edward Ehlinger said in a statement. "But it's important to keep this year in perspective: What is occurring has happened before." 
 
 The number of flu-related deaths elsewhere, according to state health officials: 
 
 -- Pennsylvania has had 22 deaths. Most of the deaths were among people older than 65. 
 
 -- Indiana has 13 confirmed adult deaths and two pediatric deaths. 
 
 -- Arkansas has seven confirmed flu fatalities. 
 
 -- South Carolina has counted 22 deaths. 
 
 -- In Illinois, there have been six deaths. 
 
 -- In Michigan, there have been four pediatric deaths. 
 
 Type of flu 
 
 The type of flu that is going around is called H3N2, which is often linked to more serious disease, compared with some other flu varieties, Fauci said. 
 
 That type of flu matches up well to the vaccine that is being distributed and given out throughout the United States. 
 
 People may get more complications from this particular strain of H3N2, "which may make them ill for a longer period of time," Dr. Michael Jhung, medical epidemiologist in the influenza division at the CDC, told CNN's Mary Snow. 
 
 Symptoms typically last up to seven days for a normal infection, he said. 
 
 If you have the flu, how are you treating it? Send photos of your flu survival kits. 
 
 CNN's Joe Sutton and Maggie Schneider contributed to this report. ||||| Joe Raedle / Getty Images file Russell Waddley of Miami received a flu shot in early December from Alina Pastoriza Garcia at a CVS pharmacy's MinuteClinic. Government health officials say new data show that the flu vaccine is about 62 percent effective at preventing illness this year. 
 
 Flu activity remains high across the United States, but there are signs this year's bad season may be waning in some areas, government health officials said Friday. 
 
 Forty-seven states reported widespread flu activity as of the week ending Jan. 5, up from 41 the previous week. Twenty-four states and New York City reported high levels of flu-like illness, but that was down from 29 states and NYC the week before, according to new data released by the Centers for Disease Control and Prevention. 
 
 Still, flu is unpredictable and illness could rebound or worsen, said CDC Director Dr. Tom Frieden. 
 
 "Really, only the next week or two will show whether we have, in fact, crossed the peak," Frieden told reporters in a conference call. "Nationally, it's likely that influenza will continue for several more weeks." 
 
 Flu activity was elevated all across the U.S., except in the far west region that includes Arizona, California, Guam, Hawaii and Nevada, the new report showed. 
 
 More than 3,700 people have been hospitalized for the flu since October, and 20 children have died, the CDC says. Most of the hospitalizations have been in people older than 65. For the first time this season, deaths associated with the flu rose into the epidemic category, though just barely, CDC officials said. 
 
 Vaccines given to fight this year's flu appear to be about 62 percent effective overall , according to data from some 1,155 children and adults with acute respiratory infections. Of people who got the flu, 32 percent were vaccinated. CDC officials characterize that level as "moderate" effectiveness and infection control experts say it's about what they expect from the shots. 
 
 "That's normal," said Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville, Tenn. "It's a good but not a perfect vaccine." 
 
 This year's vaccines appear to be about 55 percent effective against influenza A strains, which are responsible for most illness and more severe cases, and about 70 percent effective against influenza B, which is usually less serious, the report showed. 
 
 That helps explain why some people who've received flu shots -- which are recommended for everyone older than six months -- say they've still gotten sick. It argues in favor of using antiviral drugs such as Tamiflu to help bolster vaccine effectiveness, or VE, CDC's report said. 
 
 "These early VE estimates underscore that some vaccinated persons will become infected with influenza; therefore, antiviral medications should be used as recommended for treatment in patients, regardless of vaccination status," the report concluded. 
 
 Related stories:
– The CDC rolled out a mix of good news/bad news on this year's flu outbreak today: The bad: The number of states reporting widespread activity rose from 41 to 47 over the week. The far West (Arizona, California, Nevada, Guam, and Hawaii) has largely escaped the brunt of it so far, reports NBC News. The good: The number of states reporting high levels of the illness fell from 29 to 24, suggesting that it's on the wane in some areas. (Georgia, Florida, South Carolina, Arkansas, and Kentucky saw the decreases.) Deaths: So far, 20 victims under the age of 18 have died, reports CNN. More than 3,700 people, most of them elderly, have been hospitalized. Shots: This year's vaccine appears to be about 62% effective, a decent mark. Severe year? It may seem that way, explains AP, because this year's flu started early and is unusually rough on those who get it. Plus, last year was a mild one for comparison's sake. But we probably won't know until spring how this year's sickness stacks up. "Bottom line: It's flu season," says the CDC chief. Flu activity is up in most of the country, and "it may be decreasing in some areas, but that's hard to predict," he says. "Influenza activity ebbs and flows."