COVID-19 first entered the U.S. early this year and by March stay at home orders were in full effect. While orders have lifted and case numbers aren’t growing as rapidly, the current pandemic is about to overlap with an epidemic — flu season.

Flu cases typically ramp up in the beginning of October through the middle of May with peak season taking place between December and March, though it varies from year to year, said Karen Martin, Senior Epidemiologist with the Minnesota Department of Health.

The state department and county health departments are preparing for the upcoming season, but there are concerns about the burden COVID-19 and Influenza may have on the healthcare system.

Hospitalizations

The availability of hospital beds may once again become a concern during flu season. Even when the country is not in the middle of a pandemic, hospitals typically see an increase in hospitalizations this time of year, Martin said.

“We see anywhere between 1,000 to 6,000 hospital patients due to the influenza every season, depending on the season,” she said.

Resource tracking programs have been implemented within the state to monitor bed capacity in hospitals, explained Richard Scott, Deputy Division Director of Carver County’s Health & Human Services Division.

“So far we have been under our capacity challenges for COVID and many hospitals have already returned to providing elective type work which would require hospital beds,” Scott said. “With the daily surveillance we would be able to have a fairly quick knowledge of when those beds are being threatened and thereby make a decision about elective types of surgeries or procedures, making those beds available for patients with COVID or flu-like symptoms. So hopefully we will have the capacity, but that is something that we’re definitely aware of and mindful of and attentive to.”

Testing capabilities

With patients visiting doctors, unsure if they’re displaying flu or COVID-like symptoms, it’s reasonable to assume that there will be an increased demand in COVID tests, Scott said.

“Whether or not we can increase that capability in time to meet the growing need, that is to be determined,” he said.

Many labs, including the Minnesota Public Health lab, are looking into combined COVID-19 and influenza tests, Martin said.

“We do have treatments for influenza and a vaccine, so we’d want to know the difference if someone was sick,” she said.

Similar symptoms

Displaying flu-like symptoms was identified as an indicator of COVID-19 early on in the pandemic, but there are some distinct differences in symptoms, Martin and Scott agreed.

Fever, cough and body aches are symptoms shared between the two diseases, but there are COVID-specific symptoms doctors will be looking out for such as shortness of breath and loss of taste and smell.

The risk of comorbidity

The Centers for Disease Control and Prevention estimates that the flu has resulted in between 9.3 million and 49 million illnesses each year in the U.S. since 2010, according to its website.

And it is possible to be infected with the flu and COVID-19 simultaneously, though there have not been many cases of co-infection yet as flu season was winding down when COVID-19 began to spread, Martin said.

Comorbidity, the presence of two conditions or diseases in a patient at one time, increases one’s risk of serious complications.

“That’s because any other disease including the flu can complicate the impact of COVID-19,” Scott said. “Those with pre-existing conditions are more at risk for negative outcomes with COVID, well having the flu can be one of those pre-existing conditions that can complicate COVID-19.”

Lower number of flu cases expected this season

Due to COVID-19, the majority of the general public is already taking steps to prevent the spread of communicable diseases by washing their hands often, socially distancing, disinfecting frequently touched areas and wearing masks.

“So we would anticipate that people will be less apt to even get the flu if they continue to practice those,” Scott said. “We’re hoping that people who are doing things because of COVID will have the serendipity benefit of reducing other types of illness as well.”

Martin hopes the awareness of these preventative measures will lead to flu season looking a little different than in years past.

She said health experts often look to the Southern Hemisphere to get an idea of what the oncoming flu season may bring.

“Because of social distancing, or for whatever reason, we’re really not seeing a lot of flu right now in the Southern Hemisphere in places like Australia where this is typically their sort of peak season there,” Martin said. “I don’t know if this is going to translate into a milder season for us, I certainly hope so. But one thing about the flu is it is very unpredictable, so we are planning and preparing for a flu season and we do have a lot of really great surveillance programs in place so we can determine what’s happening and who’s being affected.”

Disease surveillance includes labs within the state reporting the number of flu tests conducted and how many positive cases found to the Minnesota Department of Health.

Vaccines especially important this year

According to the Centers for Disease Control and Prevention, flu vaccination coverage among adults was 37.1% during the 2017-2018 flu season. But getting a flu shot may be even more important amid a pandemic, Martin and Scott said.

While the vaccine won’t prevent individuals from contracting COVID-19, it will protect them and others who may be high risk from the flu and ultimately lessen the burden on the healthcare system, Martin said.

“We know the healthcare system is going to be strained,” she said. “We want to minimize impact so we have resources to respond.”

There are many places to receive a flu shot including primary care providers, retail stores like Target and pharmacies.

“We encourage everyone to take advantage of that and be mindful this year to protect the health of others around them,” she added.

Scott echoed that sentiment.

“Anyone that’s six months and older is recommended to have a flu shot regardless, so that is always our strong recommendation because the regular flu can also cause complications including death, but clearly with the additional COVID-19 concerns we’re even more concerned and encourage people even more to make sure they get their vaccine for flu.”

Scott has noticed families have been hesitant to bring children to regular wellness exams due to COVID-19, but it’s important children are still seen and receive their vaccines, he said.

Scott noted that there is a lot of misinformation surrounding vaccines.

“Flu vaccines are very, very safe. We’ve been providing them for 50 plus years,” he said. “From my understanding there may be a pretty significant adverse reaction one or two times out of a million. Now you might have some local reaction, but the frequency of a severe reaction is so rare that your chances of dying from [the flu] are much greater, so clearly flu vaccines have been known to be very, very safe.”

For more information on local vaccination options, visit the CDC’s Vaccine Finder at https://vaccinefinder.org/

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