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With COVID-19 set to complicate this year's influenza season, treating flu early remains important for vulnerable groups, and flu vaccination is more important this year than ever, experts said on Thursday.

In a press conference hosted by the National Foundation for Infectious Diseases (NFID) and the CDC, NFID medical director William Schaffner, MD, said it will be hard for physicians and other healthcare professionals to tell the difference between flu and COVID-19 based on symptoms alone during the approaching "twin-demic," since many overlap.

"This is going to be an area of diagnostic confusion this entire winter season, with these two respiratory viruses and other respiratory viruses out there," he said. "Testing will be important, but it has its limitations and challenges."

Keynote speaker Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, emphasized the importance of treating flu early among patients with underlying conditions, even while waiting for COVID test results. He discussed a scenario where you "give someone Tamiflu thinking it's influenza when it's really the beginning of a COVID-type infection."

Fauci said it was more important for the patient to "start on an influenza drug and not wait for a period of time" because it's "best to get treated within 24-48 hours" of influenza symptoms.

"We need to get the right diagnosis and eliminate what we can eliminate," he said.

Schaffner added that he wouldn't be surprised to see healthcare professionals treating especially high-risk patients "empirically" with an influenza antiviral while waiting for COVID test results, especially "if influenza is present extensively in one's community."

While the flu can be treated with antivirals if caught early, the most important prevention tool remains vaccination. Schaffner shared results of a recent NFID survey in which 28% of adults said they were more likely to get flu shots due to the COVID-19 pandemic. Yet only 59% overall said they intend to get vaccinated.

Healthcare providers will play a critical role in ensuring patients get vaccinated this year, especially patients with underlying medical conditions. Federico Asch, MD, of Georgetown University, offered his perspective as a cardiologist, having worked in a cardiac intensive care unit for many years and seeing flu complications such as myocarditis.

Risk of heart attack jumps sixfold within a week of flu infection, he said, and adults with diabetes are three times more likely to die if they contract flu.

Asch pointed out that it's not just older adults who face greater risk of hospitalization and severe complications. Younger adults with chronic health conditions do as well, and only 44% of people ages 18-49 with chronic health conditions reported being vaccinated during the previous flu season.

The NFID survey found 22% of higher risk patients said they were not planning on getting a flu shot this year. Asch said healthcare professionals still have "a lot of work to do" when it comes to ensuring this population receives their flu shots.

"Flu vaccine must be part of disease management for older adults and patients with chronic health conditions. It's just as important as eating a balanced diet, quitting smoking, getting more exercise or even being compliant with medication," Asch said.

NFID President Patricia Whitley-Williams, MD, of Rutgers Robert Wood Johnson Medical School in New Jersey, discussed another vulnerable group, namely children. The 2019-2020 flu season was record-breaking for pediatric flu deaths, totalling 189 and thus topping the 2017-2018 figure of 188.

More than 100 deaths were in patients ages 5-17, and more than half of children who died from flu were healthy, she noted.

Whitley-Williams also discussed disparities by racial and ethnic group: Black adults in the NFID survey said they were more worried about being infected with both flu and COVID-19 than were their white counterparts, but 62% of Black respondents were not sure or do not plan to get flu shots.

"This disconnect is a big concern. We do not have a vaccine for COVID-19. We do have a vaccine for flu," she said.

Nearly 40% of Black respondents also said they would not take an antiviral for flu, Whitley-Williams added.

Schaffner observed that while flu vaccine effectiveness can vary from season to season, it helps prevent tens of thousands of serious flu complications, such as heart attack and stroke, and those vaccinated are far less likely to get pneumonia, to be hospitalized, and to die.

"Hello? What's wrong with that?" he said.

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