The Flu vs. COVID-19: How to Navigate the Differences and Stay Healthy During Flu Season

Cold and flu season has been complicated by the coronavirus pandemic, but we can help you go forth armed with knowledge. Here, experts answer your biggest questions about navigating symptoms in the time of COVID-19.

little girl in bed with kleenex box blowing her nose
Photo: Priscilla Gragg

The fall and winter seasons normally usher in a great flurry of activity from holidays to travel. They also unfortunately bring those all-too-familiar runny noses and coughs. Cold and flu season has become a little more worrisome with the arrival of the coronavirus and the COVID-19 pandemic. If your anxiety is spiking, let us help by answering a few of your burning questions.

Which Is Worse for Kids: The Flu or COVID-19?

COVID-19's effect on kids is not yet entirely understood. Early in the pandemic, experts believed that the flu virus presented a greater danger to kids than the coronavirus that causes COVID-19. Initial reports even suggested that the very young were merely carriers of the coronavirus, but the numerous pediatric COVID-19 cases that followed disproved that claim. In fact, children appear to get the virus in ways adults don't.

While the majority of COVID-19 cases in children are not severe, children have been hospitalized for COVID-19, and there have been some deaths. There have also been some children who have presented with symptoms similar to Kawasaki disease (an inflammation of the blood vessels) and toxic shock syndrome (a bacterial infection) resulting in an umbrella diagnosis of multisystem inflammatory syndrome in children (MIS-C), a post-COVID syndrome that has not been observed in adults.

Doctors have also been surprised to note that kids who were asymptomatic or who experienced only mild COVID-19 symptoms have reported bruise-like blisters and bumps on their toes, a condition dubbed "COVID toes." In other words, the medical community's understanding of how COVID-19 affects kids is incomplete, but what we do know is enough for many parents to be worried.

Each year, the influenza virus typically infects between 9 million and 45 million people. Kids who catch it usually experience the sudden onset of fever, aches, fatigue, cough, sore throat, and congestion. On rare occasions, the flu can cause more serious health concerns, particularly in infants.

Ultimately, it's difficult to say which respiratory illness is worse for kids. Both are typically mild in children but can present with severe symptoms and complications. Though rare, they can also be fatal.

Unlike COVID-19, however, the flu is mostly a known foe, which means that even if we can't prevent it entirely, we do know more about how to treat it, says Charlene Wong, M.D., associate professor of pediatrics at Duke University School of Medicine in Durham, North Carolina. That said, the science is starting to catch up with regard to our understanding of COVID-19.

Though media outlets like to simplify this discussion by comparing statistics like hospitalization and death rates, these comparisons present an incomplete picture. As experts learn more about COVID-19, the coronavirus continues to evolve, and more children develop some immunity either through exposure or vaccination, it is difficult to predict what these statistics and outcomes will look like in the future.

It's also important to acknowledge that death, while arguably the most devastating outcome, is not the only metric to consider when determining which illness is "worse." Short- and long-term complications also take a substantial toll.

Is the Flu or COVID-19 Worse for Adults?

As with children, severe illness and complications related to influenza and COVID-19 are also possible for adults. But overall, COVID-19 appears to be more serious for adults than the flu, according to the Centers for Disease Control and Prevention (CDC).

Some adults who have had COVID-19 also later develop post-COVID conditions including symptoms that are collectively being referred to as "long COVID" or "long-haul COVID." While anyone can develop a post-COVID condition, they appear to be more common in adults than children or adolescents.

Experts say that it's important to bear in mind that one of COVID-19's more worrisome characteristics is its unpredictability: Some people who don't have any underlying medical conditions nonetheless experience severe symptoms, while others have only mild or even entirely asymptomatic cases. There is no way to predict how it might affect you.

That said, with the introduction of multiple COVID-19 vaccines for adults, people can now reduce their personal level of risk of severe illness.

Can You Get COVID-19 and the Flu at the Same Time?

Though casually referred to as "flurona," the medical term for having the flu and COVID-19 at the same time is coinfection—and it is possible. Because of historically low flu activity during the 2020–2021 flu season (thanks in part to prevention measures like social distancing and the use of face masks), flu and COVID-19 coinfections were rare. But it's difficult to say how common it may become in the future, the CDC says.

For reasons still largely unknown, coinfections of flu and other respiratory viruses are relatively rare. It's even been hypothesized that having certain types of flu can reduce the chances of contracting a rhinovirus (the most common type of cold).

Then again, getting the flu can make you susceptible to other infections, says Byron Whyte, M.D., a pediatrician in Washington, D.C. He recalls a patient with asthma who got the flu, then caught pneumonia. "That's pretty typical," he says. The same might end up being true for the flu and COVID-19 but more data is needed.

What Should I Do If My Child Develops Cold or Flu Symptoms?

With both at-home and clinic-based testing more readily available and accessible now than earlier in the pandemic, the CDC recommends getting your child tested if they develop symptoms of COVID-19. It is also recommended that you follow quarantine guidelines while awaiting the test results.

It can be very difficult to differentiate between a cold, the flu, and COVID-19 in children, especially in those who have received their COVID-19 vaccine. Testing is one of the only reliable ways to determine whether your child's symptoms are the result of COVID-19 or another respiratory virus.

That said, if you're unsure, don't hesitate to call your child's doctor. They can make a recommendation based on symptoms, the number of cases in your area, and your family's risk. "You don't need to go through all these mental acrobatics," says Dr. Whyte. "Let the experts make the call."

If your child is struggling to breathe, however, call 911 immediately or go to the emergency room. It's a serious symptom, regardless of its cause.

Is There Anything Else I Can Do to Prepare?

Yes—and you're likely already doing at least some of it. First and foremost, make sure you and your kids get vaccinated and stay up-to-date on your vaccines. The annual flu vaccine is approved for use in people over 6 months old, and babies under 6 months who can't be vaccinated themselves can still benefit from the people around them being vaccinated.

As of April 2022, there are safe and effective COVID-19 vaccines available for children and adults over 5 years old, and approval of a vaccine for kids under 5 is on the horizon. According to the CDC, "getting a flu vaccine is the best protection against flu and its potentially serious complications, and getting a COVID-19 vaccine is the best protection against COVID-19."

Second, try to stick to regular bedtimes. Prolonged lack of sleep can depress the immune system and make it harder for the body to fight off infections. Turn off electronics at least an hour before bed to help your kids fall asleep more easily. Third, do what you can to keep your kids moving. Habitual exercise improves the immune system's ability to regulate itself and increase production of cells critical to immune function and metabolic health.

And finally, continue doing what you've likely already been doing to stave off the coronavirus: Wear a mask when recommended and keep up with the all-important task of regular handwashing. Sing it with us now: Kids should wash their hands for at least 20 seconds and avoid touching their face.

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