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Why You Need To Know If You Have The Flu Or COVID-19, And Why It’s Hard To Tell

A health worker performs a COVID-19 test at a Test Iowa site at Waukee South Middle School, Tuesday, July 14, 2020.
Charlie Neibergall
AP file
A health worker performs a COVID-19 test at a Test Iowa site at Waukee South Middle School in July.

The flu and COVID-19 present similar symptoms. The upcoming flu season could complicate efforts to control COVID-19.

The return of flu season could complicate efforts to control COVID-19. The coronavirus can spread farther, faster and is deadlier than the flu, but the two infections often look the same.

The confusion puts people at a greater risk of spreading the coronavirus by going on with their daily routines thinking they are only sick with the flu. The flu itself should not be taken lightly, though, according to Dr. Ravi Vemuri, an infectious disease specialist with Mercy One in Des Moines. An outbreak of severe cases of the flu would add to the pressure felt by a health care system already under strain from the coronavirus pandemic.

“We need to try to reduce the influenza burden in the community, because we don't know how COVID-19 will behave as we enter these colder months,” Vemuri said.

Dr. Katie Imborek, a family physician with the University of Iowa Hospitals and Clinics said the flu vaccine is even more important than usual this year to hold down the number of flu patients in the hospital.

“As much as we can keep people out of our health system because they don't contract influenza, the better off that we will all be and the less chance we'll have at overwhelming our system,” Imborek said.

What are the symptoms?

Influenza and COVID-19 are both respiratory viruses and their lists of symptoms have a lot of overlap, which makes it difficult to tell them apart. Here are some symptoms that can occur with both the flu and the coronavirus:

· Fever
· Cough
· Runny nose
· Headache or body aches
· Fatigue
· Difficulty breathing

There are a few unique symptoms that can occur with COVID-19 such as a loss of taste or smell, but they’re not reliable enough distinguish one from the other.

“Essentially every single symptom of influenza might be a symptom of COVID, but there are symptoms of COVID that may not be symptoms of influenza,” Imborek said. “Everyone who has symptoms of influenza may have COVID, and everyone that has symptoms of influenza should be tested for COVID."

Imborek said testing for both the flu and the coronavirus will be key to making a diagnosis, and the two tests could each come back positive - it is possible to be infected with both viruses at once.

Even though the symptoms are the same, tests for the viruses can correctly identify each one because they detect the virus’ unique genetic material, said Dr. Nicole Gilg, a family practice physician at Broadlawns Medical Center in Des Moines.

“If you had the flu and got a test for COVID-19, it would be unlikely to be positive just because you had the flu,” Gilg said. “There isn't a known cross-reactivity between the tests where you would inadvertently be mis-diagnosed with COVID-19 if you had the flu.”

Gilg said the best thing a person can do if they feel sick is isolate themselves and contact a health care provider. Imborek added that it’s best to call ahead because walking into a doctor’s office when you might have COVID-19 could expose others. Clinics may have a separate space for patients to be examined and tested safely, or they may do a remote examination first before deciding whether to follow up in person.

How do the flu and coronavirus spread?

Influenza and COVID-19 both spread through the air and on surfaces through droplets that carry the virus when they are breathed out by someone who is infected.

“When you're next to somebody, if they blow their nose or sneeze what's released into the air is called droplets,” Gilg said. “That is how typically it spreads from one person to another. If the droplets from someone’s sneeze gets on their hand and then they shake hands with another person or if you touch a door handle or something in common with somebody that had the virus, it can be spread that way as well.”

According to the Centers for Disease Control, both the flu and the coronavirus can be spread before a person feels symptoms. With the flu, they may be contagious one day before feeling sick whereas with COVID-19 they may be infectious for two days before the onset of symptoms. A person with the coronavirus is also likely to be contagious longer, 10 days compared to 7 days for the flu.

Finally, COVID-19 is also much easier to spread. The flu is not associated with the kind of “superspreader” events that happen with the coronavirus. Vemuri said that’s a big concern as people change their habits in colder weather.

“They're indoors, they're closer to each other, so the virus has more opportunities to jump from person to person and we could get clusters of outbreaks as we head into the fall and winter months here.”

How are they treated?

Most people who are sick with the flu or COVID-19 will recover at home using over-the-counter medicines to manage their fever or other symptoms. Flu patients may also be prescribed the antiviral drug Tamiflu, but it has no effect on the coronavirus.

While a few drugs, such as remdesivir, can be used to treat severe cases of COVID-19, there is no vaccine and no other therapies have been approved by the FDA.

For either virus, doctors say the best protection is prevention. They stress that people should wear masks and physically distance in public, and isolate from others when they feel sick. They also recommend that everyone over six-months-old get the flu vaccine.

“I think that this is going to be one of our most important years when we look at how did we do as a community and as a population with our flu shot rate,” Imborek said.

It won’t protect against COVID-19, but it could decide whether hospitals are overwhelmed by outbreaks from two viruses at once.

Grant Gerlock is a reporter covering Des Moines and central Iowa