SALT LAKE CITY — When the COVID-19 pandemic first hit Utah, it came toward the end of the traditional flu season.
Now, six months later, COVID-19 hasn’t left and the new seasonal flu season is quickly approaching.
It’s difficult to tell what influenza will mean for Utah this year, especially because there are many questions that still remain between how it and SARS-CoV-2, the novel coronavirus that causes COVID-19 in humans, can intermix. That uncertainty is why Utah medical experts say it’s more important than ever to get a flu vaccine this year.
Dr. Eddie Stenehjem, an Intermountain Healthcare infectious disease physician, explained there is some — albeit strong — data that suggests the flu virus and SARS-CoV-2 can coincide with each other; however, doctors in some Southern Hemisphere countries reported that the flu virtually disappeared during their winter months amid COVID-19 safety protocols, which could indicate the flu won’t be as large of a problem — in a best-case scenario — but it also means there were few research opportunities to learn more about how the two mix.
"We haven’t learned anything from the Southern Hemisphere at all, and now we’re going into the flu season," Stenehjem said, during an online discussion about COVID-19 last week.
There isn’t a set start to when the flu season starts, but influenza cases normally begin to increase by October, according to the Centers for Disease Control and Prevention. Utah’s last flu season began on Sept. 29, 2019.
With flu season on the horizon, here’s what experts recommend this year.
Flu vs. COVID-19
Now that there are months of research on COVID-19, medical experts know much more about it than when it first appeared in Utah. It’s why doctors can better point out the many similarities between the flu and COVID-19 that can make it difficult to distinguish at first.
"We know that influenza-like illness is the same thing as COVID-like illness. Influenza-like illness is fever and respiratory symptoms; well, that’s what COVID-19 does," Stenehjem said.
There are also similarities in how both affect people. Most people infected with the flu or COVID-19 end up with symptoms that are considered mild, but influenza kills tens of thousands of Americans every year — much like how COVID-19 has now led to 200,000 U.S. deaths this year.
Many of the deaths are people who suffer with other conditions that factor into how severe the case ends up being for both the flu and COVID-19. A CDC report recently listed 94% of COVID-19 fatalities in the U.S. involved some sort of comorbid factor; Dr. Randle Likes, chief medical officer and emergency department medical director for MountainStar’s Timpanogos Regional Hospital, explained that many flu deaths are caused by post-influenza pneumonia.
Major COVID-19 and influenza similarities:
- Symptoms include fever or feeling feverish/chills, cough, shortness of breath or difficulty breathing, fatigue (tiredness), sore throat, runny or stuffy nose, muscle pain or body aches, headache and some people may have vomiting and diarrhea (though this is more common in children than adults).
- People can spread both viruses at least one day before symptoms appear.
- Older adults, people with underlying health conditions and pregnant individuals are at higher risk for severe illness.
- May result in complications such as pneumonia, respiratory failure, cardiac injury, sepsis, acute respiratory distress syndrome, multiple-organ failure, inflammation of the heart, brain or muscle tissues or secondary bacterial infections.
- The virus spreads person-to-person, between people who are in close contact with one another (within about 6 feet). Both are spread mainly by droplets made when people with the illness (COVID-19 or flu) cough, sneeze or talk.
Major COVID-19 and influenza differences:
- An available vaccine to prevent influenza severity and prescription antiviral drugs to treat it. There are some drugs used to treat COVID-19 but none approved by the Federal Drug Administration to date.
- Signs and symptoms of COVID-19, different from flu, may include a change in or the loss of taste or smell.
- Young children are at higher risk of severe illness from flu.
- If a person has COVID-19, it could take them longer to develop symptoms than if they had flu. A person typically develops symptoms anywhere from 1 to 4 days after flu infection.
- A person suffering from COVID-19 may be contagious for a longer period of time than if they had flu.
- Complications of COVID-19 also include blood clots in veins or arteries of the lungs, heart, legs or brain.
- COVID-19 is more contagious among certain populations and age groups than the flu. COVID-19 has also been observed to have more superspreading events than flu, which means SARS-CoV-2 can quickly and easily spread to a lot of people and result in continuous spreading among people as time progresses.
Information:U.S. Centers for Disease Control and Prevention
Ironically, since they’re so similar, COVID-19 precautions likely helped reduce influenza spread during the winter in Southern Hemisphere countries like Argentina, Australia and South Africa.
The Associated Press reported that South Africa came close to no flu cases from May through August — the heart of the country’s typical flu season. Australia experienced a 93% decrease from the previous year. It's worth noting both countries reported many COVID-19 cases during their winters, according to World Health Organization data. As of Monday evening, South Africa reported 661,000 total COVID-19 cases while Australia reported nearly 26,000.
This is because influenza travels in a similar way as COVID-19, so the precautions to limit COVID-19 have often been recommended every year for flu season.
"Every time the flu season comes up, it’s kind of the same things that everyone has been inundated with the COVID, which is basically good hand-washing and people who are at higher risk staying at home," Likes said. "Transmission happens through droplets, so it can be on surfaces or on hands or from coughing and sneezing around other people.
"I think we’re going to be in pretty good shape as far as that goes," he added. "I think the big question mark is: nobody really knows the impact of COVID around and then having flu hitting on top of that."
A study conducted by Stanford researchers in March found there can be co-infections, Stenehjem said; however, since COVID-19 sprang out in the U.S. while the last flu season ended and there were few flu cases in the Southern Hemisphere, there hasn’t been much to add to it. It’s why Stenehjem recommends that people who feel sick with COVID-19 or flu symptoms should consider getting tested for both viruses.
While both viruses are similar, there is a key difference between the two heading into this year’s flu season. There’s an influenza vaccination available every year, while the race for a COVID-19 vaccination remains underway. It’s among the reasons why the mortality rates are lower for the flu. The flu’s rate is 0.1%, while the current COVID-19 mortality rate in the U.S. is 2.9%, according to Johns Hopkins University.
"There are some people who are at greater risk, which vaccination can help prevent hospitalization for influenza," said Rebecca Ward, a health educator with the Utah Department of Heath’s epidemiology bureau.
Why flu vaccines are more important this year
As the development for a COVID-19 vaccine continues, Ward said it’s "very, very important" that all Utahns 6 months and older receive their flu vaccine this year. Likes, Stenehjem and the CDC all agree with that assessment. The CDC recommends that people get their vaccines in September or October, which is just before cases usually start to creep in.
As medical experts point out, the flu vaccine leads to fewer severe cases. Fewer severe cases may lead to fewer flu-related hospitalizations, which would equal more bed space available for people who need to be hospitalized for COVID-19. On top of that, experts say it also might fend off the possibility of someone battling both viruses at the same time.
"Is the flu vaccine perfect? No. Not by any means; but that said, it does prevent severe disease," Stenehjem said. "It prevents people from being hospitalized and dying from influenza.
With what happened in the Southern Hemisphere over the past few months, it’s uncertain what will happen in Utah or even the U.S. this year — especially given the lack of data regarding how they mix. In speaking to the Associated Press on Aug. 26, Dr. Robert Redfield, the director of the CDC, said the COVID-19 pandemic on top of the flu might result in either one of the harshest or mildest flu seasons on record.
But health experts advise that it’s better to prepare for the flu in addition to COVID-19 than it is to believe the flu will dissipate this winter.
Ward added that people should "plan for it," especially as COVID-19 continues to circulate. She recommends anyone who comes down with symptoms of either virus should contact their health care provider and inform them in advance before getting tested for influenza or COVID-19 — or both.
"I think it would be very unwise for us to assume there isn’t going to be at least some level of flu this year," Likes added. "We should be very concerned about the flu season, especially since we don’t have any good cases or data that shows what the impact is going to be with the two viruses co-existing."