This fall, COVID-19 and the flu will circulate in the United States at the same time, and what will happen then is a bit of a wild card. Wearing masks, washing hands, and keeping six feet away from other people to avoid COVID-19 are measures you can take that will also help protect you from flu. But some will still get the flu, and COVID-19 is still with us. What if both viruses surge and then mingle in the emergency room, straining health care resources as doctors try to care for everyone?
Doctors and public health experts have no way of predicting how things will go in the coming months, so they are responding with an urgent message: Get a flu shot. Even if you’ve never gotten the vaccination before, do it this year.
“I would tell people who don’t typically get flu shots that the coronavirus makes this year a different story,” says Matthew Grant, MD, a Yale Medicine infectious disease specialist. Flu alone fills many hospital beds in normal years, so doctors are already preparing for the higher numbers of sick patients that could happen this season, he says. “This year, if we don’t do things right, the flu has the potential to take a much greater toll.”
Children need to get vaccinated as well, says Caitlin Hansen, MD, a pediatric infectious disease specialist. “I start to sound like a broken record, but the one thing we know you can do is get a flu shot. It is the best thing we have in our toolbox for flu.”
How does the upcoming flu season look?
Based on reports of fewer flu cases in Australia and other countries below the equator (where the virus peaks during their winter, which is our summer), public health experts here in the U.S. are hoping for a mild season. But nobody knows for sure—there are many flu viruses and the predominant ones are always changing.
Vaccine makers have increased supply and are making enough flu vaccine for a record 194-198 million doses. The Centers for Disease Control and Prevention (CDC) recommends every adult and child who is 6 months or older get vaccinated in September or October (although the vaccine will be available through the end of the season in March 2021).
There are several vaccination options, including standard-dose shots, high-dose shots for people ages 65 and older, shots made with virus grown in cell culture (making it safe for people with egg allergies), and the live attenuated vaccine given by nasal spray (for people ages 2 through 49).
If you still have doubts, here are five reasons to consider getting the flu vaccine this year.
1. It will help avoid overwhelming a system that may be stretched as it manages both flu and COVID-19.
Even in years when there isn’t a threat like COVID-19, “flu can lead to bed shortages in the hospital,” says Dr. Grant. At Yale, he has been participating in extensive planning for the possibility of a “twindemic” that could result from severe outbreaks of both COVID-19 and the flu—a scenario that some doctors say would mean initially treating every patient as a COVID-19 case, isolating them until they are tested and diagnosed.
“A lot of work goes into reacting to the epidemiology of the outbreak in the community and figuring out how best to meet the needs of our patients,” says Dr. Grant. “If the rate of either flu or coronavirus infections goes up by as little as 10%, it affects how health care workers will need to respond.”
In addition, avoiding the flu can protect other people, Dr. Grant says. Flu is contagious in the 48 hours before people who are infected begin to have symptoms, so you can spread it to other people before you know you have it, he says.
2. Getting the flu shot may help cut down on symptom confusion.
Flu and COVID-19 share many symptoms. While you can always call your doctor if a symptom is confusing, it could be easier to figure out what it means if you’ve had the flu vaccine. “There is a lot of overlap,” says Dr. Hansen, “and I think it is going to be a challenge for us to differentiate between these illnesses. Although getting a flu shot doesn’t mean someone couldn’t still get the flu, knowing if a patient had one is important information during a pandemic.”
Both viruses can cause illness that may range from mild to severe. According to the CDC, both flu and COVID-19 may cause the following symptoms:
- Fever or feeling feverish/chills
- Shortness of breath or difficulty breathing
- Fatigue (tiredness)
- Sore throat
- Runny or stuffy nose
- Muscle pain or body aches
- Some people may have vomiting and diarrhea, though this is more common in children than adults
It’s important to note, however, that loss of taste and smell is a symptom of COVID-19 that doesn’t occur with the flu.
3. You may have more protection from the worst-case scenarios.
Precautions such as social distancing that are already in place for COVID-19 could help prevent flu. “We know from years of experience with influenza that there are things that can interrupt transmission. Surgical masks are the primary mode of reducing in-hospital spread of influenza, along with handwashing,” Dr. Grant says. But the flu vaccine is considered to be the most important tool for preventing flu and is, indirectly, a strategy for preventing COVID-19, because it can keep people out of the emergency room. “The emergency room is a location where you are at risk to be exposed to coronavirus,” Dr. Grant says.
A flu shot may also protect people from COVID-19 in other ways. Doctors can’t say for sure if getting the flu would make someone more susceptible to COVID-19, or vice versa—although they do know that having the flu makes people more vulnerable for bacterial infections like pneumonia, Dr. Grant says. They can’t say what would happen if someone contracted both flu and COVID-19, either. “We really don’t know, but one might imagine the two viruses could act synergistically and make you more ill.”
4. A bad flu can be life-threatening.
While illness and death statistics from COVID-19 have been alarming, the numbers of people seriously affected by flu alone are also formidable. During the 2018–2019 season, an estimated 35.5 million people got the flu. Many had a mild enough case that they were able to take care of themselves at home. But 16.5 million consulted a health care provider, 490,600 were hospitalized, and 34,200 died, according to the CDC. “People who have had flu before know how bad it can be,” says Dr. Grant.
But it could have been worse: According to the CDC, during the same period, the flu vaccine is believed to have prevented an estimated 4.4 million flu-associated illnesses, 2.3 million medical visits, 58,000 hospitalizations, and 3,500 deaths.
Similar to COVID-19, older people are at highest risk for flu complications, but young, healthy people get seriously sick too. “Sometimes we see perfectly healthy teenagers and young adults who have influenza so serious we need to put them on ventilators—and some who die. It can be very tragic,” Dr. Grant says.
Dr. Hansen adds, “Younger kids also can get very bad flu that makes them very sick, lands them in the hospital, and even in the intensive care unit. It can be a very serious illness for children, even if they’re otherwise healthy.”
5. The vaccine can help even if it's not 100% effective.
It’s true that the flu vaccine’s effectiveness varies from year to year. (Studies show that when it’s most effective it reduces risk for flu illness by 40 to 60%.) But if you turn out to be one of the people who gets sick despite getting the vaccine, chances are you will have a milder flu and a lower chance of being hospitalized.
Contrary to what some people think, the flu shot will not give you the flu, although some have experienced mild flu-like reactions such as achiness and fever. Another myth is that the flu shot could protect against COVID-19. It will not, but scientists are currently testing more than 35 potential vaccines for the new coronavirus in clinical trials and hoping to find one that can be deemed safe and effective enough for general use.
How and where you get a flu vaccine may change this year due to the pandemic. If you aren’t sure where to go, call your doctor, or go to VaccineFinder, an online tool recommended by the CDC to help find a vaccination site close to home. Patients and members of the community who have questions about COVID-19 or a symptom that could be either COVID-19 or the flu can call the Yale Medicine/Yale New Haven Health Call Center at 203-688-1700 (toll-free, 833-484-1200).