Seasonal Flu or COVID-19?

Sentara RMH Infectious Disease Team Prepares for Both Illnesses

When the COVID-19 pandemic took root in March, Sentara RMH Medical Center, much like hospitals all across the world, worked tirelessly to understand the new strain of coronavirus and plan for the impact it would have on patients, healthcare workers, the hospital and surrounding communities.

This fall and winter, Sentara RMH will face yet another challenge: treating coronavirus and seasonal flu cases at the same time. Since both are respiratory viruses with similar symptoms, distinguishing between the two could be challenging for both patients and caregivers. Depending on the diagnosis, treatment likely will take different paths. 

With more than six months of experience in and data from treating COVID-19 patients, infectious disease experts at the hospital are confident in their strategies for handling both the flu and coronavirus effectively.

“The difficult part of the pandemic was that when we started seeing cases, we didn’t know much about the virus,” says Parag Patel, MD, an infectious disease specialist at Sentara RMH. “We didn’t know how it behaved, how it spread, what kind of symptoms it produced and what kind of testing we needed to do. There were so many unanswered questions to address in a short period of time.” 

With new medical data shared frequently not just within the Sentara Healthcare system, but throughout the world, Dr. Patel is confident they have the systems and protocols in place to tackle both illnesses. 

“Compared to last year, the flu season will be more challenging due to COVID-19,” Dr. Patel says. “But hopefully we will have more medications available for the coronavirus. Having plenty of personal protective equipment on hand will help, too.”

Notable Differences 

Flu season typically peaks each year in January or February. So when doctors first started diagnosing patients at Sentara RMH with COVID-19 in March, they were still seeing a small amount of seasonal flu, according to Becky Brubaker, Sentara RMH infection control practitioner.

Fever, body aches, cough, headache, sore throat, and runny or stuffy nose are all symptoms shared by the two viruses, as well as by the common cold. One of the most significant differences between COVID-19 and the flu, however, is how quickly flu symptoms appear. 

“With the flu, you can feel OK one minute, and the next moment you have developed a fever and feel terrible,” Brubaker says. “You’ve got a temperature of 102, you’re feeling bad and you’re wondering what in the world is going on—because when you got up in the morning, you felt fine.”

With a COVID-19 infection, patients tend to feel symptomatic more gradually. 

Other differences between COVID-19 and the flu include: 

Incubation period: Symptoms appear one to two days after exposure with the flu. With COVID, the average time for symptoms to appear after exposure is five days, but this period can range from two to 14 days. People also can spread COVID-19 to more people and for a longer period than is the case with the flu.

Asymptomatic cases: As many as 80% of patients diagnosed with COVID-19 have a mild case, or do not experience symptoms at all, Dr. Patel says. With the flu, most patients experience the telltale signs. 

Taste/smell: Many people diagnosed with COVID-19 experience a loss of taste or smell. In fact, loss of taste and smell was the leading indicator of COVID-19 in a U.S. and British study involving 2.6 million people who reported symptoms on a smartphone app. Flu typically does not cause this loss. 

Populations affected: Severe cases of COVID-19 have developed primarily in the elderly, people with compromised immune systems and those with other health problems. Children have had much milder cases overall, Dr. Patel says. That’s not true of the flu, which affects younger age groups more often. 

Superspreading: Although the flu is a contagious illness, it doesn’t have the same “superspreader” tendencies as the coronavirus. 

How Do These Viruses Spread? 

Both the seasonal flu and the coronavirus are spread through droplets in the air. 

“These droplets get injected into the air when infected people sneeze, cough or talk,” Brubaker explains. “Then others can inhale them, or the droplets can get deposited on the mucous membranes in our mouth, nose or eyes some other way, such as by touch.” 

With the flu, researchers know for sure that people also can become infected by touching an object that someone has just sneezed or coughed on, and then touching their own nose, mouth or eyes. Although experts believe COVID-19 can spread via objects as well, it’s actually transmitted primarily from person to person, according to the Centers for Disease Control and Prevention. 

However, COVID-19 is more contagious than the flu, according to Dr. Patel. 

“With the flu, each person can pass it on to one or two people,” he says. “With COVID, you can spread it to two to three people. So that’s almost double the rate of spreading.” 

COVID-19 is also more deadly for certain patient populations, in part because with a new virus, people have no built-up immunities to fight it. What makes COVID-19 so challenging to treat is that it has mutated and can attach to the lung surface, causing inflammation, Dr. Patel says.

The mortality rate for people who contract the flu is 0.2%, Dr. Patel says. Right now, statistics show the mortality rate for COVID-19 at 2-3%. Due to the high number of unreported asymptomatic cases, that number will drop, but likely will remain higher than the mortality rate for the flu, he adds. 

Living in a “hot spot” with a relatively high infection rate increases a person’s chance of contracting the coronavirus, Dr. Patel notes. 

Slowing the Spread of Both Viruses

The good news is that the precautions people are taking to slow the spread of COVID-19—such as wearing a covering over the nose and mouth, practicing social distancing, avoiding large crowds, and frequently washing hands with soap and water—also can limit the flu from spreading. 

Another precaution people are taking more often now, likely due to the COVID-19 pandemic, is staying home when they feel sick. 

“We’ve gotten accustomed to running errands and going to work even when we feel bad,” Brubaker says. “Now we’re being asked to stay home when we don’t feel well, and that should help stop the spread of the flu, too.”

Unlike during the H1N1 “swine flu” outbreak in 2009, today people can more easily avoid crowded places like stores and workplaces, thanks to increased options for online shopping, curbside pickup and working from home.

“I’m hoping all these steps will lead to a reduction in flu cases this year,” Brubaker says. 

Flu Vaccine Key to Staying Healthy

Of course, the No. 1 defense against flu is the annual flu vaccine. 

“Whether it protects you from getting the flu entirely or lowers the severity of symptoms, the vaccine definitely reduces hospitalizations and deaths from flu-related illnesses every year,” says Brubaker. 

During the 2019–2020 flu season, the flu virus infected 11,964 people in Virginia, according to the Virginia Department of Health. Each flu season, the vaccination is modified to combat the strains of the virus researchers predict will be in circulation. 

After receiving the flu vaccine, it takes about two weeks for antibodies to develop in the body that can fight off a flu infection. That’s why doctors recommend getting vaccinated well before the virus is active in your area.

“It’s important to put a flu shot reminder on your calendar, just as you do for a seasonal event,” Brubaker says. 

Flu patients also can benefit from antiviral medications like Tamiflu that can shorten the duration of illness, health experts say. Similar medicines for coronavirus are still under development. 


While researchers are working tirelessly to develop a vaccine for COVID-19, Dr. Patel says the knowledge healthcare teams have gained from treating coronavirus patients has improved the effectiveness of care. 

At the beginning of the pandemic, screening policies, instructions for isolating patients and guidelines for treating patients changed every few days as hospitals made adjustments. Now hospitals have standard procedures in place that have been developed and tested over time. 

Medications used to treat COVID-19 patients also have evolved as the pandemic progressed. That knowledge will make a difference in the readiness of healthcare teams to face the concurrent flu and COVID season, Dr. Patel adds. 

“I’m hopeful we’ll have a mild seasonal flu season,” Brubaker says. “And if we can get a safe, effective coronavirus vaccine by wintertime, we should be looking pretty good. Time will tell, but I’m optimistic.”


How Sentara RMH Hospital is Keeping You Safe 

  • Everyone entering the hospital—staff, patients and visitors—is screened for COVID-19 with a temperature check. Staff, patients and visitors must wear a mask that covers the nose and mouth.
  • In the Emergency Department, patients suspected of having COVID-19 are immediately separated from other patients.
  • If you have a surgery scheduled, you’ll likely be required to take a COVID-19 screening test to prepare for surgery.
  • Fewer chairs are available in waiting rooms, and magazines have been removed to avoid transmission via high-touch objects
  • Housekeeping uses enhanced cleaning protocols recommended by the Centers for Disease Control and Prevention for cleaning and disinfecting high-touch surfaces in patient rooms and common areas. 
  • Besides using disinfectant products, the hospital also uses ultraviolet light disinfectant technology. 
  • To reduce congregating traffic in the cafeteria, fewer tables are now open for seating, and more grab- and-go food options are available.

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