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ATLANTA, Georgia (CNN) -- Before sunrise Saturday, thousands of people across the country had staked a place in lines outside malls, supermarkets and clinics hoping to get a dose of the dwindling supply of flu vaccine.
Mothers in Florida assembled temporary cribs before 3 a.m. where their infants slept until shots began. Children between the ages of 6 months and 2 years, the elderly and people with impaired immune systems are particularly susceptible to the bug.
The U.S. Department of Health and Human Services has ordered an additional 250,000 doses of the vaccine.
Michigan television station WDIV reported that the flu has nearly shuttered Malad, Idaho. With many of the 2,000 citizens in that city sickened by the flu, churches have canceled worship services, Christmas programs are postponed and a Santa visit has been delayed.
This year's flu outbreak isn't an epidemic yet, but a health authority said it soon will be.
Dr. Bill Schaffner, chairman of the Department of Preventive Medicine at Vanderbilt University in Nashville, Tennessee, and a liaison member of the Centers for Disease Control's advisory committee on immunization practices, said he is confident it will reach epidemic status.
"It is going to be a very noteworthy epidemic," he told CNN.
On average, flu kills about 36,000 people in the United States each year. This year's outbreak will likely kill more than that, Schaffner said.
But, he said, it is unlikely to reach the next level -- a pandemic.
A pandemic occurs when a new flu virus spreads quickly throughout the world, he said. "What we're having is a modestly changed influenza virus, as opposed to a radically new one," he said. (Pandemic pending)
So far, flu is widespread in 24 states and cases have been reported in all 50 states. This year's outbreak is unusual for its early onset.
Last week, pneumonia and influenza were blamed for 7 percent of all deaths logged by the country's reporting system that includes 122 cities, just below the 7.6 percent that the CDC said would represent the epidemic threshold.
The 2002-2003 outbreak never reached epidemic status. The flu reached epidemic levels for nine weeks during the 2001-2002 season, for 10 weeks during the 2000-2001 season and for 15 weeks during the 1999-2000 season.
A big uncertainty about this year's epidemic is whether the number of cases among children means they are at higher risk than in previous years. A CDC spokesman said that more than 20 children under age 18 have died during this year's outbreak.
"That's one of the studies that's ongoing," said CDC spokesman Dave Daigle. "We won't know that for a little while yet ... we're trying to determine if this is indeed a more severe strain."
"It's the question everyone wants to know," Schaffner said.
Colorado has tallied nine deaths among children and is investigating whether two other deaths were caused by flu, a spokeswoman for the state Department of Health told CNN. Last year, flu killed just two children in Colorado.
"Is this because we've been looking harder, and have asked for people to try to make the diagnosis more astutely in children, or is it indeed that this strain has had a particular tendency to cause serious disease in kids?" Schaffner asked. "We don't have the answer to that yet, but it is something that has us all fretting."
Vaccine effectiveness questioned
Another open question concerns the effectiveness of this year's vaccine.
Some 25 percent of influenza viruses found so far are the Panama strain of Influenza A, which is contained in the vaccine, but about 75 percent are the Fujian strain of Influenza A, which is not, according to CDC.
Though lab studies have shown the vaccine for the Panama strain is cross-reactive with the Fujian strain, "the level of protection remains uncertain until vaccine effectiveness studies are completed," the CDC reported Thursday.
"It will probably take through the influenza season by the time all those studies are done," Daigle said.
In addition to coping with the stress caused by dwindling supplies of vaccine and large numbers of sick patients, health workers are finding that the test kit they need to diagnose flu is also in short supply, Schaffner said.
"All of these resources are finite, and they're running out."
The same goes for the liquid form of an anti-viral agent called Tamiflu, which is used for children, though capsule forms are still plentiful, he said. Typically, anti-virals speed the recovery process by about a day.
In a shot of good news for those seeking protection, two of the nation's biggest insurers said Friday they will cover the MedImmune's alternative to the flu shot.
Aetna and Cigna say they will now pay for FluMist, the first U.S.-approved nasal-spray flu vaccine, even though it costs about $60 per dose, compared to about $10 for the injectable form. But the vaccine is approved only for healthy people between the ages of 5 and 49.
Though the two companies insure some 25 million people in the United States, a MedImmune spokesman said Friday that the company has only about 3.7 million doses left.