COVID + Flu: Tips to manage the “twindemic” - MetroFamily Magazine
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COVID + Flu: Tips to manage the “twindemic”

By SSM Health

by Dr. Jason Onarecker

Reading Time: 7 minutes 

It goes without saying that 2020 has brought with it a smorgasbord of stress-inducing events. Global pandemic? Check. Protests and widespread political unrest? Check. Raging wildfires and one of the worst hurricane seasons we have had in decades? Check and check. While nearly everyone is ready to hit the reset button and start over, primary care clinics and emergency departments around the country are preparing for the next impending storm, flu season. Adding flu to an already-overwhelming COVID-19 pandemic can feel like an insurmountable challenge, but knowledge and preparation are the best tools to alleviate fear and successfully endure what winter 2020 has in store.

How can families best mitigate the health risks this fall and winter season could pose?

  • DO get your flu shot. This will be your No. 1 defense during flu season, and now is the time. Yes, due to the multiple strains that circulate each year, the flu shot isn’t quite as effective as other routine vaccinations; however, at worst it will prevent roughly 1 of 5 cases of the flu and at best it will prevent about 2 of 3. And the more people get vaccinated, the more protection it provides to the community. There are some specific groups who should not receive a flu shot (like those less than 6 months of age), so confirm with your doctor that the vaccine is safe for you and your family.
  • DON’T let your COVID guard down. COVID fatigue is real, and everyone just wants masks to go away, but keep up the good fight! Masking, social distancing and good hand hygiene continue to be crucial health habits. Limit unnecessary risks like crowded gatherings and indoor public spaces. The closer you are to an infected individual and the longer amount of time you spend with that person, the higher your chances of being infected. Take extra measures to protect the most vulnerable groups – the elderly and those with weakened immune systems – like wearing a mask when visiting or making trips to the store for them.
  • DO get tested and embrace temporary solitude if you get sick. At the first sign of illness, isolate yourself the best you can and contact your doctor to see if you need to be tested. If you have been exposed to COVID, testing is very inaccurate until at least four days later, especially without symptoms. Those infected are most contagious around day four to five of symptoms. If you do test positive, continue isolating until at least 10 days since the start of your symptoms and until you have been without fever for at least 24 hours without fever-reducing medications. Under some circumstances, your doctor may recommend isolating even after a negative test. Isolating applies to the flu as well, although the recommendation is seven days after symptoms start.

Are there key differences between flu and COVID-19 symptoms?

The biggest question everyone will be asking throughout this season: “Do I have COVID or the flu?!” Flu and COVID-19 have more in common than different, which makes distinguishing them particularly challenging, but this also means that a lot of the same precautionary guidelines will apply to both.

  • The flu is a seasonal viral infection well known to cause potentially severe illness especially for those at far ends of the age spectrum, less than 2 years and greater than 65. The most common symptoms are fever, headaches, muscle aches and fatigue along with the typical cough, sore throat and runny nose. Younger children often experience intense fevers (above 103°F) and more gastrointestinal symptoms like nausea, abdominal pain, diarrhea and poor appetite. Most primary care clinics and emergency departments have rapid flu testing available that is accurate and provides results within about 15 minutes.
  • And then we have SARS-CoV-2, or COVID-19, a new player and relatively unknown entity, although our understanding is increasing exponentially due to the tireless efforts of researchers around the world. Currently Oklahoma has surpassed 79,000 total cases resulting in nearly 1,000 deaths. These are staggering numbers, and nearly everyone has been directly affected in some way. Thankfully and in contrast with the flu, COVID tends to spare the youngest age groups with those under 4 years old making up only 2 percent of cases in Oklahoma and zero deaths. Severity of illness tends to increase with age, and those older than 65 are extremely vulnerable. The symptoms of COVID are very similar to flu in many cases but can vary tremendously. Adults frequently experience coughing, headaches and body aches, but around half of COVID victims never report having a fever at all. About half of people report losing their sense of smell and/or taste.

Throughout this flu season, primary care clinics and emergency departments will likely be testing for both viruses in many cases. Anyone developing symptoms should contact their doctor to see if testing is warranted (it probably is), but these guidelines can be helpful in determining which virus may be the cause:

More likely to be flu More likely to be COVID-19
Runny nose NO fever
Nasal congestion Loss of taste and/or smell
Sneezing Shortness of breath with minimal activity
Sinus pain Confusion
Productive cough Dry cough
3 or fewer days since an exposure 4 or more days since an exposure
Age under 18 years
Age under 4 years MUCH more likely flu
Characteristic rash:
– “COVID toes” – painful red bumps on fingers and toes
– “Prickly heat” – small itchy red bumps
– Hives

What are your other concerns for children and families as we head into the “twindemic” of COVID-19 and flu season?

The other pandemic not enough people are addressing is mental health. Anxiety, depression and other mental health conditions have run rampant throughout 2020 and the ripple effect will continue to devastate lives long after COVID settles down. Anyone experiencing unhealthy thoughts and feelings should consider whether they are coping adequately and seek professional help if not. Treating mental health issues is as important as treating heart conditions and ear infections. Please do not neglect the health of your mind.

Another major concern I have is that families have switched into “survival mode” and will neglect preventive care and existing chronic medical problems. With Oklahoma rapidly approaching 1,000 deaths, most people understand that COVID and flu are illnesses to be taken seriously. Wearing a mask, diligent public hygiene, avoiding crowded indoor places and limiting unnecessary exposures are all still great ways to be safe, but taking excellent care of your existing medical conditions and keeping up with preventive care tasks like immunizations and health screenings are equally important. Your future self will appreciate the extra efforts made to continue investing in your long-term health.

What are some of the most common myths about the flu vaccine?

  • Myth 1: The flu vaccine can give you the flu. Fact: After the flu shot people tend to get a little achy and develop mild symptoms that make them feel like they have the flu. This is a good thing! Your body’s immune system responding to the flu vaccine means it is learning to recognize the enemy and activate promptly when it encounters the real flu. The injected flu vaccine contains an inactivated version of the virus and cannot in any way cause the flu. The nasal spray vaccine contains a live virus that’s been weakened so as to stimulate the immune system but not cause an infection.
  • Myth 2: The flu shot is not effective. Fact: This is more of an overstatement than a myth. The flu vaccine is less effective than many routine immunizations of childhood, like measles and polio, but in recent years it has been around 50 percent effective if not better. 50 percent is a lot! The risks to getting the vaccine are incredibly small compared to the potential benefit.
  • Myth 3: Vaccines are not safe. Fact: Vaccines may be the most thoroughly researched health intervention of modern medicine, and time after time research demonstrates the overwhelming safety of vaccines. And there are many, many studies originating from independent labs and institutions all around the world, not just a bunch of work done by one or two groups who were paid by the company producing the vaccines. If doctors all secretly knew about major safety concerns, you would find far many more examples of doctors who would not get themselves or their children vaccinated, but that is simply not the case.

How can families best reduce spread of any virus within the household?

  • Keep hand sanitizer in key locations in the house like by the refrigerator or near the front door or door to the garage and make it a habit of using it every time you walk by. If it smells good then you’re even more likely to use it.
  • Phones are filthy, and we pick them up around 50 times per day on average. If after every time you clean your hands you then pick up your phone, your hands are just immediately re-accumulating germs. Keep your phones clean, too! There are various wipes and products created just for this purpose.
  • Keep household items separate as much as possible. Don’t share drinks, chapstick, spoons, etc. even if you are feeling well. Inevitably it’s the day after you split that smoothie with your teenager or sibling that you realize you’re coming down with something. This applies to toys for young children, too.
  • Anytime someone does get sick, whether it is COVID or flu or just a cold, as soon as they have gone 24 hours without a fever it’s time to sanitize EVERYTHING. Replace or boil toothbrushes, wash all linens and clothing on hot and with bleach if possible, wipe down TV remotes and make your 13-year-old take a shower. Germs can survive a surprisingly long time, especially on moist surfaces.

How can parents empower kids to make healthy decisions to keep themselves and others safe throughout flu season and the COVID-19 pandemic? 

School-aged children struggle most with social pressures and tendencies towards risk-taking, which means they may disregard safety practices regarding masks and social distancing. Encouraging your children to take responsibility for their own health and practice good COVID hygiene habits despite what their friends are doing can make an impact. With younger children the goal is much simpler but equally as challenging: keep hands clean and learn how to sneeze/cough into your arm. Work with little ones to break the habit of constantly touching their faces. Make mask-wearing into a superhero dress-up (PJ Masks anyone?). Make a game out of coughing into their elbows. Toddlers will respond to the same request completely differently if it becomes part of their play. Keep reinforcing the messages consistently.

Jason Onarecker, MD, pediatrics, graduated with honors from Oral Roberts University with a bachelor’s degree in biomedical engineering. He then pursued a medical degree at the University of Oklahoma Health Sciences Center, where he also completed his residency. He cares for patients from birth to 18 years across a variety of non-emergency primary care needs, including well-child checks with immunizations, sports physicals, treatment of acute symptoms, ongoing treatment of chronic concerns and more. Dr. Onarecker is located in north central OKC adjacent to the Chesapeake Energy campus. Dr. Onarecker’s office can be reached at 405-218-2500 or via

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