COVID-19 Vs. Flu: A Facebook Live Q&A

COVID-19 versus the flu. Do you know how to tell the two apart? Join us for a discussion with Jared Eddy, MD, infectious disease specialist at National Jewish Health, to find out.


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Molly Casey: Good afternoon. My name is Molly Casey, and I will be the host today for our interview with Dr. Jared Eddy, an infectious disease specialist Here at National Jewish Health, regarding COVID-19 and the flu. Thanks for joining us.

Jared J. Eddy, MD: You're welcome. Thanks, Molly.

Molly Casey: Typically, during this fall period and into the winter, we would be focusing on the flu. It's kind of what comes up during this fall season. Right now, we're also dealing with the COVID pandemic and we're just going to be talking through what the differences are between COVID-19 and the flu. We'll just jump right in. Is the flu related to COVID-19?

Jared J. Eddy, MD: Influenza and COVID-19 are viral respiratory infections that are caused by different viruses and different viral families. They're not very closely related, but many respiratory viruses have a lot of overlap between each other and they've become certain ways for evolutionary reasons and they mimic one another. I think that probably leads into your next question, Molly.

Molly Casey: Yeah, I was going to say, our next question is what are the difference between the symptoms of the flu and COVID-19, and the similarities?

Jared J. Eddy, MD: There's definitely more similarity between COVID-19 and influenza in terms of symptoms. Things like runny nose, congestion, muscle aches, headaches, fever, shortness of breath, these are all things that you can get with many respiratory viruses, not just COVID-19 and influenza. Number one, it's very difficult to tell the difference between them. One symptom that has had more attention called to in this pandemic has been the new loss of taste or smell, which perhaps is more prominent with COVID-19, but again, that is possible to have with influenza and other viruses as well. It is just very difficult to tell.

Jared J. Eddy, MD: One thing I can say is that with influenza, typically, you're sick right off the bat. With COVID-19, you can have more of a mild case at first and then, about a week's time, you can suddenly develop that viral pneumonia and get sicker. That is probably a more typical pattern for COVID-19. You can see that in influenza as well, because you may actually get a secondary bacterial infection about a week into influenza. So more similarities than differences, Molly.

Molly Casey: Interesting. Can you get the flu and COVID-19 at the same time?

Jared J. Eddy, MD: Yes, you can. You can get a number of viruses and other microorganisms with COVID-19, or with SARS-CoV-2, the virus that causes COVID-19. Basically, sometimes we test for that and sometimes we don't. I think if we tested for that more often, we would see it more often. In fact, here at National Jewish, we were doing that testing in the beginning of the pandemic and then, as COVID became more predominant, we were testing more just for COVID-19. But I think that we have seen people get flu and COVID at the same time, that's very possible.

Molly Casey: Interesting. How will getting the flu help protect you against COVID-19, or how will it help the pandemic?

Jared J. Eddy, MD: Right. I'd say there's a direct effects and indirect effects, and I think the more important really is the indirect effects. What I mean by that is that influenza exerts a tremendous burden on the healthcare system in the United States every year. Last year there were 500,000 hospitalizations for influenza and only about 50%, at most, of people who can get the flu vaccine, get the flu vaccine. What we really want to do is want to protect our health care system by having people who may get flu not get flu, or if they do get flu, they're protected, they don't need to go to the hospital and to put that burden on our already pressed hospital system.

Jared J. Eddy, MD: The other thing that's particularly relevant right now is that in the beginning phase of the pandemic, we had more space in the hospital because a lot of other procedures or a lot of other conditions, people weren't coming in. Now, those things are happening along with COVID-19 so there's even less capacity in the system than there was in the spring. If we add a whole influenza season on top of that, then we'll really be in trouble. It's also, again, very difficult to know if your symptoms are influenza or COVID, so we need to address both of those things.

Molly Casey: With the flu, obviously you can take Tamiflu if you've got, I guess, the beginning of the flu symptoms and you haven't progressed too far into the flu itself. With COVID, are there any, I guess, vaccinations or treatments right now that you can really say are specifically for COVID-19?

Jared J. Eddy, MD: Are you talking to prevent COVID, Molly, or for

Molly Casey: Yeah, we'll start with prevention.

Jared J. Eddy, MD: There are no treatments, certainly no FDA-authorized treatments that I know of to prevent COVID-19, but there are certainly are vaccines. There are a number that have been in development and several that are now developed. We do have a lot of data from tens of thousands of people on several of these vaccines, and they do appear to be safe and preliminary data seems that they're effective. In fact, quite effective, up to 90%. However, those are small numbers that give that percent effect size, so we won't really know until they're rolled out and used. But in terms of prevention, not getting COVID-19 or the flu by your behavior is most important, and secondly would be vaccines.

Molly Casey: Speaking of that, what are the best ways to prevent yourself or to help prevent getting the flu and COVID-19?

Jared J. Eddy, MD: Well, we think that we cut the flu short in the spring and we're having a slow flu season so far, thank God. That's because of the behavior that we do that addresses many different viruses. That is socially distancing, you staying at least six feet apart, but you can spread COVID-19 if you are further than six feet apart so as distanced as you can be, essentially. Wearing a mask, we know there's now evidence that that is very effective, we didn't know that early on, so trying to stay masked as much as possible. Using regular hand hygiene so that you don't actually touch something infected and then touch your eyes or touch your face and infect yourself. Finally, if you do have the symptoms of COVID-19 or flu, staying away from others and isolating so that you don't spread it.

Molly Casey: What's the best thing to do if you think you have the flu?

Jared J. Eddy, MD: Well, if you think you have the flu, you might have COVID-19, or you could even have both, so the best thing I would say to do is that you need to get on the phone and talk to your healthcare provider for some guidance, because again, it's not appropriate for everyone to go to the emergency room, that will overburden the healthcare system. If you do have certain symptoms, like your lips are turning blue and you're really having difficulty breathing, you're having bad chest pain, then those are more obvious things that you would seek emergency care for. But I think having that guidance from your provider is key, and they may be able to direct you to places like the outside tent testing that we have at National Jewish where you can get tested, not necessarily need to be seen in the clinic.

Molly Casey: I guess that kind of leads into the next question of what do you do if you think you have COVID-19?

Jared J. Eddy, MD: Mm-hmm (affirmative), I think we've covered a lot of those things already, but essentially if you think you have COVID-19, you need to isolate yourself from your family members or others. If you're having the symptoms that would suggest COVID-19, you do not go into work. You will need to essentially isolate yourself and not spread the infection. Again, you need to have some sense of what next steps are for how severe the disease is, and that's where you can have a lot of help by talking to your healthcare provider about whether you need to go to a clinic or go to the emergency room or simply come in for a test.

Molly Casey: I actually have a question of my own. What does it mean to isolate?

Jared J. Eddy, MD: To isolate means, and there are some great references that you can find online from the CDC and also Colorado Public Health about how to do that, but essentially it means that you're living separately as much as possible from others, so you're using a separate bathroom, you're not using the same utensils to eat or cups to drink. Typically, if you have the symptoms of COVID-19 and you have what we call a mild case, you'll need to isolate for 10 days. That may be a bit longer than other viral infections. If you have a more severe case or you're someone who might be immunocompromised, you may have to isolate for up to two weeks or even longer, potentially.

Molly Casey: Yes, we have one question. What's that?

Alyssa Paschke: Yes. There's been some questions coming in from the audience. Leah M. asks, "Once you get COVID-19 and recover, how long do you carry the antibodies? Can I still ..." I think she means, "Can I still be infectious with COVID-19 after I've had it and have recovered?"

Jared J. Eddy, MD: Some people actually don't make antibodies or they don't make them in levels that can be detected. That's more common with people who have asymptomatic infection, which means maybe they were exposed, they never got symptoms themselves, but they were tested positive or they had a very mild case. There's actually quite a bit of variability in terms of antibody detection. That would be the answer to the first question.

Jared J. Eddy, MD: The second question was are you going to be infectious to someone else afterwards. We know that some people who have had COVID-19 actually can get COVID-19 again. The cases where that's happened has happened several months afterwards. The official CDC guidance is that if you're in a 90-day period, you should not need to be tested and you should have some protection from COVID-19, but after that 90-day period is over then you could have COVID-19 again.

Jared J. Eddy, MD: I should say that even before those 90 days, if you develop new symptoms and it looks like COVID-19 and you can't explain them by some other illness process, then you should act as if you are reinfected.

Alyssa Paschke: Thank you very much. Cyndy asks, "Will we need to have the COVID vaccine every year, like we do for the flu vaccine?"

Jared J. Eddy, MD: That's a great question, and I would think that that is quite possible. We don't know yet how much immunity or how much protection the COVID vaccine does give to people, so stay tuned, essentially.

Alyssa Paschke: Great. Then one last question that has come in, "Should the testing sites for COVID-19 also include testing for the flu, or is that something that you've heard around the medical community?"

Jared J. Eddy, MD: Personally, I would like for testing sites to test for influenza as well as COVID-19. Again, we haven't seen a lot of influenza thus far in the season. There's some, but again, if we don't test for it, we may not see it. There is something that you can do for influenza, which is to give something like Tamiflu. Now, typically you have to be early in your infection to benefit from Tamiflu, but if you're someone who has particular health conditions, then you can get it at a later stage as well. So I think, yes, there is a role for testing for both.

Alyssa Paschke: Perfect, great. Another question has come in from Jane. She's asking, "Is it okay to take Tylenol or ibuprofen if you have COVID?"

Jared J. Eddy, MD: There was some worry about that earlier in the pandemic. As far as I know, from the latest or the updates on that, that it is fine to take those medications.

Molly Casey: Interesting.

Alyssa Paschke: Great.

Molly Casey: All right. Well, I think we've covered just about everything that we came prepared today with. If you have any other questions, feel free to submit them both to the video that we'll be posting or to our page, we'll be happy to look into the answers that we can find for you. Thank you again, Dr. Eddy for joining us today. I feel like I've learned quite a bit and hopefully you, our viewers, have as well. Thank you very much and have a great afternoon.

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