You’re feeling cruddy. Is it flu? COVID? Here’s why it matters

If you’re feeling really cruddy right now, join the crowd. Yes, you might have COVID. Yet again, this time it might be the flu — or just a really bad cold that is making the rounds.

Figuring out why you’re sick is a bit more complicated this fall amid myriad circulating viruses.

Flu season is off to an early start. And as we head toward a third winter of the COVID pandemic, experts say the trend that has emerged in the first two years is likely to continue: The weather gets colder, preparations for the holidays ramp up, and COVID cases will start to rise, too.

So in our always-complicated shifting effort to stay healthy, here are some answers to your latest questions.

Q. We hear about “flu season” every winter. Is there also a “COVID season” now?

A. Influenza transmission follows strong seasonal patterns — in the Bay Area, that typically happens between November and April — tracked carefully by public health experts well before the current pandemic. Now COVID might be falling into a similar, though less-predictable, seasonal pattern as well.

During the first winter of the pandemic, in January 2021, California recorded what was then an all-time-high case rate. The next year, in late 2021 and early 2022, we had the worst surge we have seen so far, in large part because of the omicron variant’s increased transmissibility.

“It was the perfect storm,” said Dr. Peter Chin-Hong, a UCSF professor of medicine who specializes in infectious diseases.

And this year might follow suit. “Right now we have the right time of year,” Chin-Hong cautions, “and we may have variants that have legs.”

Q. How concerned should we be about another winter COVID surge?

A. Chin-Hong said he is most worried about a variant that is showing rapid growth in Europe, commonly referred to as BF.7. “It may be the most immune-invasive of the lot,” he said, but a large surge is far from certain, and there are other variants of concern that could emerge.

Dr. Bob Wachter, chair of UCSF’s Department of Medicine, also expects a surge. “It almost certainly will go up this winter for one of the reasons that flu goes up,” he said. “People go inside more, and there is more opportunity for spread.” He points out that while we may have seen our worst surges so far in the winter, “counting on seasonality is dicier than it is with the flu.”

Cases in the United States have yet to start spiking, but COVID testing is also at new lows, and the switch to weekly rather than daily reporting by the Centers for Disease Control and Prevention and many local and state health departments might give us less of a warning than we had during previous winter surges.

But Wachter is optimistic the surge won’t break records. “It feels unlikely to be a huge surge, given the population immunity,” but he’s also wary to make predictions at all. “As far as I can tell, it’s all pretty unpredictable at this point.”

Q. Should I worry about catching the flu this year?

A. Simply put: Yes! The flu is heading for an early rise, with positivity rates for flu testing increasing fivefold from mid-August to early October in the country. New York is showing signs of an early and rough flu season, according to Chin-Hong. “It’s coming earlier,” he said, “and there is already much more than last year at this time.”

Chin-Hong says that while the population seems to be getting stronger when it comes to COVID, two years of lower-than-normal flu activity means our population, especially the very young and the very old, are even more susceptible than before to getting very sick with influenza this year.

Q. Isn’t COVID more dangerous than the flu?

A. COVID killed more Americans in 2020 than the flu killed during the entire decade of flu seasons before that, and 2021 COVID deaths were even higher.

But this winter, for those who are up to date on COVID vaccinations, flu might be a worse bug to kick.

“At this point COVID is not any more severe than the flu,” Wachter said. “When people said that two years ago, it was a lie meant to minimize the impact of COVID.” But now? “As a reasonably healthy guy, with five (COVID) vaccine shots, the chances of me dying of the flu are greater.”

New vaccinations, current variants that typically cause less severe illness and new successful therapeutics have all dropped the case fatality rate for COVID in the past three years.

But even with a lower mortality rate, COVID is likely to still have a higher death toll than the flu, especially if case rates rival previous years. Most of our immunity has waned from previous omicron surges, and many people are not up to date on their vaccinations.

Q. What should I do if I start to feel sick?

A. If you start feeling extra run down, a cough or a tickle in your throat, the confluence of COVID and flu season might complicate your path to recovery. “Symptoms are merging more and more,” Chin-Hong said.

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It can be harder to tell if you have COVID right away, so testing is important, especially because early detection means you can get prescribed more effective treatments such as the antiviral Paxlovid, if you are eligible.

Wachter said if he starts feeling sick, he will first take a COVID test right away. If that’s negative, he would get tested for influenza and again for COVID in a few days.

Reach out to your medical provider for the best treatment options.

And whether you have COVID, influenza or another virus, you can help prevent transmission by wearing a mask, washing hands and isolating.

One thing we know for certain: Vaccination helps prevent the worst outcomes for both influenza and COVID-19. So don’t put off getting your annual flu shot and the latest COVID boosters.

“In a different world, if everyone went out to get the booster, we might have a really mild COVID season,” Wachter said, but with fewer than 1 in 10 people getting the newest booster, “that doesn’t seem like its going to be the case.”