This season, doctors will need to pay careful attention to symptoms and their timelines to discern between COVID-19, the flu and even the common cold.
Throughout the year, most questions being asked by medical professionals are largely related to the ongoing COVID-19 pandemic.
But now, as the winter months approach, those questions give way to more questions about the season of the year known for the spread of another virus: Influenza.
Two weeks ago, Dr. Gary Visser — of PremierMed Family & Sport Medicine in Ocoee — saw the first case of the flu appear in the practice. Flu season normally starts slowly in October and can last until about May — though it usually peaks between November and February, Visser said.
And although the flu tends to keep to the winter months, COVID-19 doesn’t really seem to have a specific season, because it has survived throughout the year — including during the summer months, which some believed would slow it down because of the heat. Now, the medical field is preparing for both, and it’s changing how many get ready for the flu season.
In previous years, the Ocoee practice began to administer flu shots in October, but this year’s pandemic has changed that.
“We actually started end of September,” Visser said. “We were like, ‘Oh, we don’t want you to get the flu and COVID, so let’s get everybody set earlier,’ so we started a little bit earlier with the flu vaccines.”
DIFFERENTIATING BETWEEN VIRUSES
The biggest challenge that faces doctors now — besides treating a virus that currently has no cure — is that the symptoms of the flu and COVID-19 almost overlap entirely.
Ailments such as fatigue, fever, body aches and respiratory issues area just a few of the commonalities between the flu and COVID, but there are some small ways they differ, Visser said.
“It’s almost impossible to distinguish the two,” Visser said. “If you draw a big circle and you said, ‘OK, these are all COVID symptoms,’ and then you drew a smaller circle inside of the COVID circle, those are all of your flu symptoms. So pretty much everything you get with the flu, you can get with COVID.
“But COVID has the extra loss of smell and loss of taste we don’t normally see with the flu,” he said. “And it also has the blood clots that we don’t see with the flu — people are getting a lot of pulmonary blood clots … and that is mostly from inflammation in the arteries from the virus.”
Another aspect Visser has noticed is that the flu tends to make its presence known much more quickly. Often, the side effects of the flu happen within a day or two; COVID may take up to several days to present symptoms.
During a morning briefing at AdventHealth in September, Dr. Tim Hendrix — medical director at AdventHelath Centra Care — addressed a point that flu often strikes hard and with fury.
“Typically, flu is very distinctive — you’ll wake up in the morning and you’ll feel fine, and then by that evening, you have a fever, and you’re crawling into bed, and you just feel like you’ve been run over,” Hendrix said. “I joke during flu season that I can walk into a Centra Care lobby and I can look into the eye of every person (who) has a flu and diagnose them. I don’t really do it that way … but you can tell.”
Another difference is how the two viruses affect children.
“It’s almost impossible to distinguish the two. If you draw a big circle and you said, ‘OK, these are all COVID symptoms,’ and then you drew a smaller circle inside of the COVID circle, those are all of your flu symptoms. So pretty much everything you get with the flu, you can get with COVID.”
— Dr. Gary Visser, PremierMed Family & Sport Medicine in Ocoee
“The flu is worse in kids, whereas with COVID, it doesn’t seem to affect them as much,” Visser said. “Mostly young kids — newborns, 2-, 3- and 4-year-olds — are going to be more affected by the flu than what I have seen with COVID.”
The confusion when diagnosing a patient is further compounded with the common cold and allergies. Hendrix said those normally come with a scratchy throat, itchy eyes/nose and sneezing. And often with a cold or allergies, symptoms begin to dissipate in about four days, which is why Visser tells patients to wait a couple days before being tested for COVID. If things quickly worsen — a sign of flu — then he suggests being seen immediately so medication can be given to curb the flu.
At PremierMed, Visser and the other physicians perform a double-check with patients — testing them for both COVID-19 and the flu as a way to figure out what exactly is happening.
CO-INFECTION, FLU SHOTS
Another concern of medical professionals is the chance of co-infection — someone having both COVID-19 and the flu.
“Co-infection … happens,” Hendrix said. “We were in the middle of flu season when COVID-19 started — so back in February — and I didn’t think it did, but then we started seeing it happen where we were actually seeing people with COVID-19 and influenza.
“Those people got through it OK, but having two different viruses is never a good thing,” he said. “We look at co-infections when people get the flu and they have pneumonia … those are people that end up in the hospital, so the risk of complications is higher with co-infection like that.”
It’s because of this possibility of a co-infection that Hendrix stressed the importance of getting the flu shot this year while also abiding by all of the guidelines put forth by the Centers for Disease Control and Prevention.
There’s even hope there may be a quieter flu season because of all the precautions taken for COVID-19.
“I’m hoping — fingers crossed — with our masks and social isolation, and just being more cognizant about washing our hands and not being in close quarters with people, that it is probably going to reduce the severity of the flu this year,” Visser said. “But schools are open, so it is definitely going to be spread. I’m just hoping that number will come down this year.”