Flu cases typically peak in the fall and winter – which means now is a good time for people who are interested to get vaccinations. As the number of flu and Respiratory Syncytial Virus, or RSV, emergency room visits and hospitalizations increase across Texas, here’s what providers and health experts want people to know:
What all is included in “cold and flu” season?
There are four infections that experts expect to start increasing during winter: colds, influenza, COVID-19 and Respiratory Syncytial Virus, or RSV.
“Respiratory viruses love the winter,” said Catherine Troisi, a professor who focuses on infectious disease at UT Health Houston’s School of Public Health. “People in colder climates…are more likely to be inside so they can exchange viruses easier. Plus, the lower humidity dries your nose out.”
Dr. Varun Shetty, chief state epidemiologist at the Texas Department of State Health Services, says changes in the weather and environment aren’t the only reason respiratory viruses spread this time of year.
“There's holiday time, a lot of travel,” Shetty said. “This is a time that Texans really need to take steps to protect themselves.”
While experts generally agree that COVID-19 cases are likely to spike during the winter, it still isn’t clear if COVID-19 will ever be “seasonal” like the flu.
“The final answer to that is still out there,” Shetty said. “We're still watching to see how COVID will behave over time. One thing that we did notice is that we've started to see activity in the summer months as well.”
What’s the difference between colds, influenza, RSV and COVID-19?
All four fall under what are called influenza-like illnesses, meaning they spread in similar ways and typically have the same types of symptoms.
But there are a few differences:
- Flu is caused by the influenza virus. One of the differences Troisi highlights is how quickly the flu causes people to feel sick, going from fine in the morning to sick in the afternoon.
- Respiratory syncytial virus or RSV is very common, but infants and older adults are more likely to develop severe RSV and need hospitalization.
- COVID-19 is caused by the SARS-CoV-2 virus, and can infect anyone. Similar to flu and RSV, certain populations are at an increased risk of severe symptoms and health outcomes.
- Colds are the odd one out. There are a lot of different viruses that result in what people think of as a cold, which is why it doesn’t have a vaccine. Colds also tend to be milder and have a much lower risk of hospitalization.
“You can't distinguish them without testing – fever, running nose, sore throat, that kind of thing,” Troisi said.
I want to avoid getting sick. What should I do?
There are several steps you can take to minimize your risk of illness, like washing your hands often and avoiding touching your mouth and nose. But experts agree: The best way to reduce your risk of infection is vaccinations.
Dr. John Carlo, infectious disease expert and CEO of Prism Health North Texas and, said vaccines are incredibly safe and effective.
“The best public health accomplishments of our time are contained in these vaccines,” he said.
Vaccines don’t eliminate the risk of infection, but they can lower the possibility of hospitalizations and deaths, said Troisi.
“A vaccine works by…presenting part of the virus to your immune system so that it makes antibodies,” she said. “If you were exposed to the real virus, [your immune system] would say ‘I remember that’ and make those antibodies and protect you.”
Because of how quickly the influenza virus mutates, some years the flu shot is less effective, but it’s still the best tool available.
Who are the vaccines recommended for?
The Centers for Disease Control and Prevention still recommends the flu shot for people over six months old – especially for people at a higher risk of infection or severe outcomes due to age or other health factors.
The recommendations also haven’t changed for the RSV vaccine.
“That's not recommended for all age groups because of who's at risk,” Troisi said. “The recommendations are 75 and older – or younger if you have an underlying condition like asthma or heart disease, something that would put you at higher risk.”
There is also an RSV vaccine for pregnant people in their last trimester.
“Not so much to protect them, but because those antibodies are passed on to the baby,” Troisi said.
Federal recommendations on who should – or can – get the COVID-19 vaccine is less clear.
The Food and Drug Administration approved the COVID booster earlier this year for anyone who is over 65 or has an underlying condition. The CDC’s recommendations said anyone older than six months can get the vaccine – they just need to complete what’s called the shared-clinical decision-making process by talking to a medical professional.
The FDA approval establishes who the vaccine is recommended to based on the label, but the CDC’s recommendations inform insurance coverage. Troisi said it still isn’t clear how the recommendations will work in practice.
“On the other hand, insurance companies know it's a whole lot cheaper to have people vaccinated and not get hospitalized with serious illnesses then have to pay for that,” Troisi said. “I don't think we've had enough people ask for the vaccine yet to know if the insurance company payment is going to be a big issue or not.”
When should I get my COVID-19 shot and my flu shot?
The best time to get a flu shot is typically around the end of October, but that doesn’t mean people who haven’t gotten it yet have missed out.
“Now's a great time to get the flu vaccine,” Troisi said. “But if you forget, if your schedule is too busy and it's December, get it then. Even in January or February, if the virus is circulating then, and usually it is, it'll still protect you. Don't think it's now or never.”
For the COVID-19 shot, people should wait about three months since their last booster.
“I doubt that that's an issue for most people,” Troisi said. “Get your COVID shot now. You can get it the same time you get your flu vaccine. One trip, you know, one in each arm and you're done.”
While COVID-19 doesn’t behave exactly like the flu, experts said keeping an eye on COVID-19 infections and hospitalizations can help people decide when to get a vaccine. However, it takes about two weeks for a vaccine to be most effective, so getting a vaccine at the beginning of a COVID-19 wave or spike may not provide enough protection quickly enough. But it does start to offer some protection, at least.
“It’s not like at two weeks, suddenly you have protection,” Troisi said. “It ramps up during that time to optimal protection at two.”
Dr. Philip Huang, director of Dallas County Health and Human Services, said despite challenges, the COVID-19 vaccine is still one of the best ways to protect yourself.
“Getting the vaccine up front, and now, when the numbers are still low is the thing that people can do to protect through the whole season,” Huang said.
He also said confusion created by misinformation, disinformation and unclear recommendations can lead to fewer people being protected, which is what can make this cold and flu season harder on communities.
I’ve been hearing a lot about the COVID-19 vaccine. Is it available? Where should I go to get it?
The COVID-19 vaccine is available, just not everywhere that it had been in previous years. Due to confusion created by the new federal vaccine recommendations, some pharmacies and clinics were hesitant to order or ordered fewer doses.
The COVID-19 vaccine was not included in Texas’ “adult safety net” program, which means the state doesn’t provide those vaccines to adult safety net clinics for free. However, many providers and organizations are finding ways to take on that cost for the patient.
For example, Prism Health North Texas has absorbed the costs for its patients. Dallas County Health and Human Services also created a plan to cover the additional cost.
Huang said he wants to prioritize breaking down barriers to preventive care, like costs and insurance coverage.
“Typically…it's easy for us to provide them as part of our services,” Huang said. “When we have to then buy them or not get reimbursed, then that becomes difficult for us to offer them as readily as we would like.”
He said the county is utilizing charity care, or the uncompensated care program, to get reimbursement for the services that can no longer be provided by the adult safety net program. That way his department is still able to provide care to patients without insurance – which Huang said benefits everyone in the community.
Providers at Prism Health said patients can seek affordable care through Federally Qualified Health Centers, also known as community health clinics. They also said if the care isn’t available for a patient at one of these clinics, they are able to help people figure out how to access that care.
Shetty, with DSHS, said people can speak with their doctor, nurse, pharmacist or local health authority to figure out where to go to get a vaccine.
Why are experts worried about this season?
In addition to the confusion created by the conversations around vaccines this year, experts and providers are worried about a repeat of last year’s flu season.
“We had a large number of, unfortunately, pediatric deaths last year, the most in a number of years.,” Troisi said. “It was a bad flu year. Even children, healthy children, can die from flu.”
Flu deaths in the adult population don’t have to be reported to the state health department, but pediatric deaths do. Troisi said that indicates it was a particularly rough year for the whole population.
Shetty said the CDC has a method to predict what each season may look like.
“Their prediction is that this season is going to be similar to last season, which is to say that a number of people are going to become sick with these viruses,” Shetty said. “That's going to cause stress on people, stress on healthcare systems, and it can also lead to really severe illness.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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