There are currently two tropical storms approaching the Gulf Coast, an unprecedented weather phenomenon. While the immediate threat to Texas, Louisiana and other states is clear from satellite models, another menace to America silently looms. That is, coupling the coming flu season with simmering COVID-19 outbreaks. Indeed, experts have already called this coming season “a perfect storm.” It’s time to start worrying about the flu season in the context of SARS-CoV-2.
Each year, the influenza virus results in tens of thousands of emergency room visits and in-patient hospitalizations, as well as deaths. Despite a vaccine that millions take each year, the deleterious consequences of the flu are enough to cause large increases in physician visits, school and work absences, and morbidity and mortality.
There is little to distinguish the initial symptoms of these two illnesses: both start with fever, cough, and other cold symptoms. While some manifestations such as loss of taste/smell and diarrhea may help identify COVID-19 specifically, having to deal with both of these illnesses simultaneously could exacerbate confusion and frustration.
The CDC currently recommends that all those above age six months receive a flu vaccine. Nonetheless, large variations exist in who gets it, a trend that overlaps with mask wearing, social distancing, and COVID-19 hotspots. Those at highest risk from complications of flu are also more vulnerable to complications of COVID-19. Viewing the CDC graphic of flu spread is like watching someone sunburn in slow motion, as the map of the US becomes increasingly red throughout the winter until it is nearly covered.
Rita Rubin recently highlighted in JAMA several important reasons it is critical to distinguish flu and COVID-19; among them, misallocation of resources and potential harm. As she points out, it remains to be seen how the convergence of these two viruses will affect Americans.
But, like impending hurricanes, we must be prepared for the worst. A new test has already gained FDA’s Emergency Use Authorization approval. Called the “Multiplex,” the test combines flu and COVID-19 and promises to be an extremely important tool, as physicians nationwide grapple with differentiating between the two diagnoses. It is particularly important to do so since treatment and disease course vary, in addition to guidance on isolation. Selecting the right therapy early is crucial for the flu for instance, which requires initiation within 48 hours of symptom onset.
CDC Director Robert Redfield said this week that, “This fall, nothing can be more important than to try to increase the American public’s decision to embrace the flu vaccine. This is a critical year for us.” Increased adoption of the flu vaccine could prevent large numbers of people contracting the flu while COVID-19 continues to spread.
Brace yourselves, this one could be a category 4.
Important facts for this coming season, here are the seven main differences between flu and COVID-19 per the CDC: