In the latest installment of our occasional conversations with Fort Worth leaders, Diana Cervantes, an infectious disease epidemiologist and assistant professor at the University of North Texas Health Science Center, explains how the flu differs from COVID-19, how the pandemic has affected flu season and how people can protect against both illnesses.

This conversation has been edited for length and clarity. For the unabridged version, please listen to the audio file attached to this article.

Alexis Allison: Can you tell us about the flu season? When is it? Why is the flu seasonal? 

Diana Cervantes: The flu season begins in October, and it runs through May. And usually we see peak activity though and between December to February. Of course, flu is detected year round. But we do see an increased number of cases during this flu season. And, it really has a lot to do with the way it’s spread. It is spread through these large respiratory droplets, like we see with COVID. And so we do see some more during the winter, because that’s when people tend to be together, but also the composition of the virus itself — it tends to be more stable in the cooler weather. So this is the reason why we see these peaks in that winter time.

Allison: How does the flu compare to COVID-19?

Cervantes: As I mentioned, they are both passed and transmitted primarily by those large respiratory droplets. People always ask me, ‘Isn’t it airborne?’, but you have to think that it’s really a spectrum. It’s not black or white. It’s not droplets or airborne. There can be situations where you can have some of that potential airborne transmission, but again, primarily those respiratory droplets. Now we’ve had a long history of being exposed to flu viruses. At this point, we really see that COVID seems to spread more easily, so that’s one of the differences, I’d say. That has to do with the virus itself, but, as I mentioned, how our defenses are built against the virus — we’ve had a long history with flu. So that also comes into play. 

Another thing that’s a little different about flu: We hear a lot about the COVID variants, and we also have flu variants, but we have flu types. There’s different types of flu viruses. You may have heard of type A and type B. Depending on the type of flu virus, you may have a flu season that you may see more illnesses and more hospitalizations and more deaths. So maybe like a flu B, you see that less compared to certain A’s. Now with COVID, there’s only one COVID. There are different variants. But there are also variants of flu and, just like COVID, we continue to track flu in terms of the types and the variants to make sure that our medications, our treatments, our tests are still effective against the disease. 

Now in terms of signs and symptoms, they’re very similar. You can have that fever, the cough, the feeling tired. You can see a lot of those same symptoms. But of course, with COVID, we do see more severe illness, especially in younger adults, than you see with flu. And then with both flu and COVID, they are spread by those respiratory droplets, but also, with both flu and COVID, you can pass that virus on before you even have signs and symptoms. But with COVID, you’re contagious, you’re able to pass the virus for longer periods of time. So with flu, you’re usually contagious about a day before you start signs and symptoms. And then you can pass it for about three or four days afterward. With COVID, it’s a couple of days before you have signs and symptoms, and then you’re considered contagious for up to 10 days after being infected or having those signs and symptoms.

Allison: How can we protect ourselves against the flu?

Cervantes: We’ve all gotten so used to those COVID measures to protect ourselves. It’s the same thing with flu: We want to avoid those crowds, the cramped spaces, the close contact as much as possible. The same things that help protect us against COVID protect us against flu because again, it’s transmitted in that same way through those large droplets. So physical distancing, wearing the masks, and of course, very importantly, is the vaccine.

Allison: Who should consider getting the flu vaccine and what are the benefits or consequences of doing so?

Cervantes: Generally, the vaccine is recommended for anyone 6 months of age and older. Of course, you want to reach out to your provider and make sure you don’t have anything going on with any conditions that may require you to delay the vaccine. Now, we think about the flu shot, it is what we think of as being a traditional shot: They take the flu virus, and they make some changes or they make it weakened. And that’s what’s used in our vaccines, where the COVID vaccine, we’re talking about the mRNA, DNA, so it is a little bit different. Also the flu vaccine, there are different types. So there’s a high-dose flu vaccine for people who are 65 and older. We don’t have that yet for COVID. With the flu vaccine, you get it once a season, and that’s it. But with COVID, we’re going to have to just wait to see what the regular schedule is going to be.

Allison: And for people who don’t love needles, can you tell us what the flu shot feels like compared to say the COVID vaccine?

Cervantes: I can only, of course, speak to my personal experience. I got both the flu and the COVID vaccine. And it was similar. You do have some minor pain, of course, on your arm where you got the site of the injection. Basically the same type of feeling. Now with COVID, you do hear a little bit more about having fevers or not feeling well for maybe a day or two. But you do also hear that with flu. You tend to hear that a little bit more in younger kids. But, of course, we haven’t vaccinated our younger kids with COVID. We’ll see what happens. But you can see those types of reactions after the vaccine for both of them.

Allison: How has the pandemic affected the flu and flu season?

Cervantes: Last year, our flu activity was extremely low. I mean, it was historically low. And still, testing for flu was pretty steady. So we can’t say, “Well, maybe there was just less testing going on for flu.” It was pretty steady, comparable to other seasons, but it was just very low activity— about maybe 0.5%-1% of the specimens were positive for flu, where typically in a year, you maybe see 25-30% of those coming back positive. So it had a very big impact on reducing illnesses and deaths.

Allison: And do we know what this flu season has looked like so far?

Cervantes: So far, the activity does remain low. Last year, the reason we did see that big decrease in flu activity was because we were doing so many of the precautions to prevent COVID. Because again, it’s transmitted in the same way. And because of that, whenever we implemented measures to prevent COVID, we were also preventing flu. And so we’re going to have to see how that plays out this year. If people are still adhering a lot to those prevention measures. It’s really difficult to predict, because, how are things going to play out with the holidays and other things? The important thing is, flu is still around. It hasn’t gone away. The activity remains low, but it is starting to slightly bump up and hopefully it’ll stay low. But that, of course, is completely in our hands on the prevention measures we take.

Allison: If someone wanted to snag a flu shot, where might they find one?

Cervantes: You can pretty much go to any pharmacy, go to your provider and get one. They’re widely available. And again, there’s different preparations. There’s some that use eggs, some that don’t, some that are injectables, there’s even the type you can use in your nose. So there are different formulations, obviously a little different from COVID. We only have one. But I’m sure as time goes by, we’ll see more formulations with COVID as well. But again, for flu shots, you can just see your physician, your provider, even just go to your neighborhood pharmacy to find a flu shot.

Allison: The Tarrant County Public Health Department is also offering free flu shots for people who don’t have insurance at quite a few pharmacies throughout Tarrant County. So if someone’s listening who doesn’t have insurance and wants to find a flu shot, you can go to tarrantcounty.com/freefluvaccine and find a participating pharmacy there.

Is there anything else you want people to know about the flu? 

Cervantes: Just don’t think the flu has gone away. It is still there. And we want to make sure to protect ourselves against it, because it can cause some severe illness. It can cause death. And even if we just get minorly sick with the flu, it keeps us from doing the things we want to do every day and leading our normal lives. So we always want to keep in the back of our mind that there are easy ways to prevent flu: Get your vaccine, make sure you’re avoiding people as much as possible and washing your hands — very important still with COVID and flu season.

​​Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here

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