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

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

This season normally ushers in a great flurry of activity—holidays, travel—and, unfortunately, those familiar runny noses and coughs that hop from kid to kid. But this year’s flu season is like no other in recent memory, coinciding with an unprecedented global 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 remains somewhat mysterious. Initial reports stated that the very young were mere carriers, not sufferers, of the disease, before numerous cases disproved this belief. In fact, children appear to get the virus in ways adults don’t. Some pediatric cases presented with symptoms similar to Kawasaki disease, an inflammation of the blood vessels, or toxic shock syndrome, a bacterial infection resulting in an umbrella diagnosis of multisystem inflammatory syndrome in children (MIS-C). And doctors have 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, we don’t know a lot yet about how COVID-19 affects kids, but we know enough 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 a fever, aches, fatigue, a cough, a sore throat, and congestion. However, on rare occasions, flu can cause more serious health concerns.

Ultimately, the flu virus is a greater danger for kids than COVID-19, says Nava Yeganeh, M.D., visiting assistant professor in the Department of Pediatrics, Division of Infectious Disease at the David Geffen School of Medicine at UCLA. That said, it is also mostly a known foe, which means that even if we can’t prevent it entirely, we do know how to treat it, says Charlene Wong, M.D., associate professor of pediatrics at Duke University School of Medicine, in Durham, North Carolina.

Is the flu or COVID-19 worse for adults?

In general, COVID-19 appears to be more serious for adults than the flu. In addition, the flu is often preventable with a vaccine. And bear in mind that one of COVID-19’s scariest characteristics is its unpredictability: Some people without underlying conditions experience severe symptoms, while others have only mild or even entirely asymptomatic cases. There is no way to predict how it might affect you.

What kind of flu season are epidemiologists predicting? 

Fortunately, this year’s flu season may be milder than usual, thanks to widespread social-distancing practices. Mask wearing, washing your hands, and avoiding proximity to people do just as great a job of halting the spread of the flu as they do of reducing exposure to COVID-19. In an article published in Science, researchers in South Africa, Australia, and New Zealand reported a decrease in flu cases during their cold and flu season, which arrives over our summer. Australia logged 33 cases between April and mid-August; South Africa logged just six. 

But, says Dr. Yeganeh, “we’re not Australia or New Zealand.” There, people largely complied with social distancing; in this country, much less so. It’s hard to predict what will happen in the United States as schools reopen and cases continue to surge in some areas. 

Can you get COVID-19 and the flu at the same time?

Technically, the answer is yes, since the viruses use different receptors on our cells to access, and infect, our bodies. But preliminary reports suggest that it’s pretty unlikely. For reasons still largely unknown, coinfections of flu and other respiratory viruses (which is what the coronavirus is) 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 seeing a patient last year with asthma who got the flu, then caught pneumonia. “That’s pretty typical,” he says. Unfortunately, the limited studies conducted so far aren’t conclusive. The bottom line is that we just don’t know yet.

What should I do if my child develops cold or flu symptoms?

The experts all agree: Call your doctor, who will make the determination about whether your child should be tested for COVID-19 based on symptoms, the number of cases in your area, and your family’s risk. “The people you pay to take care of your kids should decide the next step,” says Dr. Whyte. “You don’t need to go through all these mental acrobatics—let the experts make the call.” Furthermore, if your child is struggling to breathe, call a medical professional or 911 immediately, or go to the emergency room. It’s a serious symptom, regardless of its cause.

Could stress put my child’s health at risk? 

It’s definitely possible. With school having started amid the free-floating anxiety of a global pandemic, kids are bound to experience some worry and woe right now, and long periods of stress and anxiety have been shown to weaken immune response. Meditation, walks, journaling, and talking with friends and family are all good ways to lower the internal boil. Whenever it’s possible to do so, give your kids a break. This is a tough time for folks of all ages.

Could vitamins or supplements help with prevention?

Possibly. A recent study published in the Journal of the American Medical Association’s online network analyzed 489 patients and found that those who might be deficient in vitamin D were 1.77 times as likely to test positive for COVID-19. Not all that surprising, since vitamin D treatment has been found to decrease other viral respiratory infections. More research on the connection between vitamin D and the virus is needed, so if you’re considering a supplement for your child, talk to a pediatrician first.

We also know that a balanced diet plays a huge role in immune response. Many nutrients in fruits and vegetables make up the essential building blocks of your body’s immune system, so make sure your child is getting a decent dose of produce. In addition, a large proportion of our body’s immune system lives in our digestive organs. Studies show that a diverse and balanced microbiome in the gut helps regulate immunity. Encourage your kids to eat foods that are high in fiber (raspberries and black beans are two that kids often eat willingly) and probiotics (like yogurt). 

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 the flu vaccine. Not only does it protect from flu, but getting vaccinated can also help parents and health-care professionals rule out the flu if you or your child do get sick, says Dr. Whyte. Second, try to stick to regular bedtimes. Schedules are all over the place these days, since everyone is spending so much time at home, says Dr. Wong. But 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, practice social distancing, 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. 

This article originally appeared in Parents magazine's December 2020 issue as “Cold and Flu in Anxious Times.” Want more from the magazine? Sign up for a monthly print subscription here

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