Getting a flu vaccination is important protection in a normal year, but it’s even more vital this flu season that includes COVID-19.

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Dr. Charles Bregier

Both influenza and COVID-19 are viruses that can lead to serious complications. Dr. Charles Bregier, Novant Health medical director of corporate health, answers some questions about this flu season that will deal with two overlapping viruses.

Some people don’t believe in flu shots, or skip years between vaccinations. Why should people not put off a flu shot, no matter what their situation is?

Flu is very contagious and it can cause severe illness and complications. The flu is prevented very well most seasons by getting a flu vaccine. It can make your arm muscle a little sore, but it’s local discomfort that all people generally get. It can protect you from the flu. More importantly, it can protect family members from the flu. If you get the flu, and you bring it home and you have a family member who has underlying asthma, emphysema, heart disease, liver disease, kidney disease, any number of chronic conditions, they could get extremely ill.

Can the flu vaccine and the upcoming (hopefully soon) COVID-19 vaccine protect me the same? Can I just wait until the COVID-19 vaccine is available, receive it, and be protected against the flu, too?

No, they're two different viruses, and you need two different vaccinations. The influenza vaccine basically protects against the four dominant strains of flu that were prevalent in the Southern Hemisphere during our summer, which is their winter. Those are the strains that typically spread to the Northern Hemisphere during our winter. It's normally two influenza A strains and two influenza B strains. The coronavirus is a totally different type of virus, and it's going to involve a different vaccine in order to provide protection. There is going to be no cross-immunity between an influenza vaccine and a COVID-19 vaccine.

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Is a flu vaccination even more important this year because of COVID-19?

Yes, for a number of reasons. First, there is always a risk of being co-infected with multiple viruses at the same time. Many authorities will say if you're sick with one virus, and your immune system is somewhat compromised or suppressed, because of the viral illness or flu that you've got, you're actually more susceptible to getting additional illnesses. So, if you have COVID-19, you could develop the flu more easily. If you have the flu, you could develop COVID-19 more easily. Having COVID-19 and influenza at the same time could be associated with much more severe outcomes than having just one alone.

Additionally, an important consideration is that typically in flu season, hospitalization rates go way up. People who get sick with pneumonia as a complication of the flu, or dehydration and other medical problems that could develop, can end up being hospitalized. Similarly, people are being hospitalized for COVID-19. It's almost like a perfect storm could develop if it turns out to be a fairly severe flu season. If COVID-19 picks up at all, as many experts are thinking, we may not be able to adequately care for all the sick people in our hospitals, and we don't want to overload our health care system.

The flu season in the Southern Hemisphere (April to October) was fairly mild compared to previous years. What might that mean for the United States?

What happens in the Southern Hemisphere is often mirrored in what we see in the Northern Hemisphere. The fact that it was relatively mild with our southern neighbors, hopefully will end up translating to a milder flu season for us. However, we don't want to be complacent about it.

One of the things that many authorities think led to a milder flu season in the Southern Hemisphere is COVID-19. People were masking well, social distancing and practicing hand hygiene, all those things helped tremendously against the spread of COVID-19. It also helps prevent the spread of the flu.

Many authorities also say that a lot of the mitigating effects that were instituted in the Southern Hemisphere were more effective than we've had here in our country. I think people didn't take some of the hand hygiene, social distancing and masking quite as seriously as what happened in the Southern Hemisphere a few months ago. So, we may not fare so well.

When is the best time to get the flu vaccine and how long is it effective?

If you get it early in September or in August, it may lose its effectiveness before the end of flu season. The flu vaccine is generally effective for about six months. Typically, flu season goes until March or April. We've had some years when it has gone into May. That is unusual, but it can happen. We don't know when flu season will peak. However, because of the COVID-19 situation, many authorities have been recommending getting immunized a little bit earlier. I think September is a good time. October is a really good time. Certainly try to get it by end of October.

Will getting a flu shot make me sick?

Flu vaccines are made from inactivated influenza viruses. They are dead particles. Because the vaccine is inactivated, it cannot make you sick.

People who say, “Oh gosh, five years ago, I got a flu shot. And three days later, I was sick with the flu.” That's really bad luck, because it wasn't the flu shot that made them sick. We are all out and about in a grocery store, in a barbershop, in Walmart or somewhere else, and one of those places is likely where that person was exposed to the flu. In previous years, while I think stores generally had good hygiene and sanitation standards, it wasn't taken to the level it's been taken now because of COVID-19.

Is the flu vaccination available in nasal spray? If so, is that an advantage?

That's still a bit of a controversial topic. Most of us think that it probably does not provide as high a degree of immunity or protection as an injection does. We are recommending people get the injection instead of the nasal spray. Where we do see that the nasal spray has more value is among small children who have needle phobias. For them, the nasal spray is likely better than nothing and should provide some protection.

What can I do to help myself if I do get the flu?

If you get a flu shot and then contract one of these strains of the flu that was part of the flu vaccine, you generally get less sick than someone who has not received the flu vaccine.

If you do get the flu, you need to take good care of yourself. Hydration is really important. Treat your fever with fever-reducing medicines. Acetominophen is generally the medication of choice. But for many people, ibuprofen might work better. You want to try to get a lot of rest and eat healthy. Get a little bit of exercise by walking around, but not too much. Don't push yourself too hard. But most importantly, you want to try to quarantine yourself from other people within your home to try to keep them from getting the flu from you. If you can keep out of the kitchen, that's good. If you can use a separate bathroom, that's good. The flu is a relatively mild-to-moderate illness from which the vast majority of people recover completely in three days to a week.

What age groups and type of patients are at higher risk for developing complications from the flu?

Anyone who has chronic medical problems like asthma, emphysema, heart disease, lung disease, immune-compromised conditions for whatever reason, or is taking medication that causes your immune system to be weakened, are at higher risk. Elderly people over 65 are at higher risk of more complications. Also, small children under age 5 are thought to be at higher risk. Additionally, pregnant women are somewhat at higher risk. It is universally recommended that all pregnant women, regardless of where you are in your pregnancy, should get a flu shot.

What other steps can you take to prevent getting the flu?

Masking is a really good idea. Keeping your hands away from your face, eyes, mouth and nose is always important. Keep hand sanitizer in your pocket and use it regularly. When you're out in public, put it on as you leave. Social distancing is important. Avoid touching things that are commonly touched. If you're coming in through a door, use your elbow to push the door open instead of touching it with your hand. If you're in a public restroom, and you're washing your hands, use a paper towel to turn off the hot and cold water faucets. Be very aware of your surroundings, of what you're doing and what you're touching.

What is the additional health risks of contracting the flu and COVID-19 at the same time?

Each of these viruses can cause significant disease. I'm very concerned about what the mortality and morbidity could be for someone who has a co-infection. We should do anything and everything we can do to protect ourselves from either of them. That should help keep ourselves and our community much healthier.