Seasonal Flu or COVID?

Sentara Martha Jefferson Infectious Disease Team Prepares for Both Illnesses

When the COVID-19 pandemic took root in March, Sentara Martha Jefferson Hospital, much like hospitals all across the world, worked tirelessly to understand the new strain of coronavirus and plan for the impact it would have on patients, healthcare workers, the hospital and surrounding communities.

This fall and winter, Sentara Martha Jefferson will face yet another challenge: treating coronavirus and seasonal flu cases at the same time. Since both are respiratory viruses with similar symptoms, distinguishing between the two could be challenging for both patients and caregivers. Depending on the diagnosis, treatment likely will take different paths. 

With more than six months of experience and data from treating COVID-19 patients, infectious disease experts at the hospital are confident in their strategies for handling both the flu and coronavirus effectively—especially since information on treating COVID-19 cases is updated continually. 

“Studies are released daily around the world,” says Keri Hall, MD, a Sentara Martha Jefferson infectious disease specialist. “One of the major challenges as an infectious disease doctor is finding the time to keep up with the unprecedented pace of new medical information. Some days it feels like drinking from a firehose, to use a common analogy, but all of this research helps to improve patient care.” 

Notable Differences 

Flu season typically peaks each year in January or February. So when doctors first started diagnosing patients with COVID-19 at Sentara Martha Jefferson in early 2020, they were still treating a few flu cases, says Andrea Chapman, infection preventionist at Sentara Martha Jefferson. 

Fever, body aches, cough, sore throat, headache, and runny or stuffy nose are all symptoms shared by the two viruses, as well as by the common cold. One of the most significant differences between COVID-19 and the flu, however, is how quickly flu symptoms appear. 

“If you’ve been exposed to the flu, you’re more likely to feel sick quicker than if you have been exposed to COVID-19,” Chapman points out. “So if, for example, you had a known exposure to a family member with the flu and then a day or two later you start to feel feverish with a sore throat, it’s probably going to be the flu.” 

With a COVID-19 infection, patients tend to feel symptomatic more gradually. 

Other differences between COVID-19 and the flu include: 

Incubation period: Symptoms usually appear one to two days after exposure to the flu virus. With COVID-19, the average time for symptoms to appear after exposure is five days, but it can range from two to 14 days. People can also spread COVID-19 to more people and for a longer period than is the case with the flu. 

Asymptomatic cases: As many as 80% of patients diagnosed with COVID-19 have a mild case, or do not experience symptoms at all. With the flu, most patients experience the telltale signs. Although asymptomatic infections can occur with the flu, they’re not as common. 

Taste/smell: Many people diagnosed with COVID-19 experience a loss of taste or smell. In fact, loss of taste and smell was the leading indicator of COVID-19 in a U.S. and British study involving 2.6 million people who reported symptoms on a smartphone app.

Populations affected: Severe cases of COVID-19 have primarily developed in the elderly, those with compromised immune systems and those with other underlying health conditions. Although young children can get COVID-19, their likelihood of developing serious illness from the virus is much lower than it is for the flu. 

Superspreading: Although flu is a contagious illness, it doesn’t have the same “superspreader” tendencies as the coronavirus. “We do see flu outbreaks in congregate living facilities,” Chapman says. “But the flu doesn’t produce the same type of ‘superspreader’ events like we’ve seen with COVID in church choirs, a scientific conference in Boston, and other parties or events where it spreads to a large number of people.” 

How Do These Viruses Spread? 

Both the seasonal flu and the coronavirus are spread due to person-to-person contact, rather than through food, blood or vectors such as insects. Both viruses spread primarily through large droplets that get expelled into the air when infected people cough, sneeze and even talk, depending on how close people are in proximity to others. 

With the flu, researchers know for sure that people also can become infected by physical contact with another person, as when shaking hands. Infection also can occur when a person touches an object or surface that someone has just sneezed or coughed on, and then touches his or her own nose, mouth or eyes. Experts believe COVID-19 can be transmitted via objects as well, but person-to-person contact is the primary method of transmission, according to the Centers for Disease Control and Prevention. 

Duration of contagiousness is another significant difference between COVID-19 and the flu. People are contagious with the flu for a shorter period of time—up to one day before the onset of symptoms through the first three to four days of the illness. The window is longer for the coronavirus. Someone with COVID-19 can be infectious up to two days before symptoms appear and remain contagious for much longer.

“With COVID, even if you’re asymptomatic, you can remain contagious for at least 10 days after testing positive,” Chapman says. “We’re seeing that sometimes people continue to test positive for weeks or months after that. We are still learning more about how long patients with COVID can transmit the virus to others. This period varies, depending on the severity of illness and the patient’s immune status—people who are severely immunocompromised or have severe disease can be infectious for longer periods of time.” 

COVID-19 is also more deadly for certain patient populations, in part because with a new virus, people have no built-up immunities to fight it. The virus can cause inflammation in the lungs that, in severe cases, may require a patient to go on a ventilator.

“Most of us have an immune system that’s encountered flu in the past, and many of us receive an annual vaccine that boosts our immune response against flu—so we have some protection or immunity,” Chapman explains. “When our body encounters a similar virus, we’re more able to fend it off. But COVID is completely new, so our immune systems are more vulnerable.” 

Living in a “hot spot” area with a relatively high infection rate increases a person’s odds of contracting the coronavirus. 

Slowing the Spread of Both Viruses

The good news is that the precautions people are taking to slow the spread of COVID-19—such as wearing a covering over the nose and mouth, practicing social distancing, avoiding large crowds, and frequently washing hands with soap and water—also can limit the flu from spreading.

People have become more knowledgeable on how to wash hands properly, and to wash or sanitize them often, Chapman says. In addition, for many of us, our mindset has shifted to staying home when we feel sick. 

“If people stay home when they aren’t feeling well, that will prevent opportunities for disease to circulate, which will be helpful with the flu as well as COVID,” Chapman points out. 

Unlike during the H1N1 “swine flu” outbreak in 2009, today people can more easily avoid crowded places like stores and workplaces, thanks to increased options for online shopping, curbside pickup and working from home. 

Flu Vaccine Key to Staying Healthy

Of course, the No. 1 defense against flu is the annual flu vaccine. 

“Even if the vaccine doesn’t totally prevent a person from contracting flu, the flu shot will help reduce the severity of symptoms and prevent many hospitalizations,” Chapman notes.

During the 2019-2020 flu season, the flu infected 11,964 people in Virginia, according to the Virginia Department of Health. Each flu season, the vaccination is modified to combat the strains of the virus researchers predict will be in circulation. 

After receiving the flu vaccine, it takes about two weeks for antibodies to develop in the body to fight a flu infection. That’s why doctors recommend getting vaccinated well before the virus is active in your area.

Flu patients also can benefit from antiviral medications like Tamiflu that can shorten the duration of illness or even prevent a person from getting the flu. Similar medicines for coronavirus are still under development. 


While researchers are working around the clock to develop a vaccine for COVID-19, Dr. Hall says healthcare teams now are much more prepared to care for patients than they were in March. 

At the beginning of the pandemic, screening policies, instructions for isolating patients and guidelines for treating patients changed every few days as hospitals made adjustments. Now they have standard procedures in place that have been developed and tested over time. 

“For example, at the beginning of the pandemic, it was recommended that patients be placed on mechanical breathing machines, known as ventilators, as soon as they showed signs of deterioration,” Dr. Hall recalls. “To improve patient outcomes, that practice has been adjusted, with a focus on not putting patients on ventilators until absolutely necessary.” 

Medications used to treat COVID-19 patients also have evolved as the pandemic has progressed. For example, the use of steroids was discouraged early during the outbreak, but data now shows steroids—which are commonly available and inexpensive—actually should be used in many cases, Dr. Hall explains.

“Physicians and scientists around the world have been working tirelessly to learn how to prevent the spread of the coronavirus infection and how to treat it,” Dr. Hall adds. “The scale and rapidity of the research is unprecedented and should be celebrated as an example of what human beings can do when they unite around a common goal.”

How Sentara Martha Jefferson Hospital is Keeping You Safe

  • Everyone entering the hospital—staff, patients and visitors—is screened for COVID-19 and required to wear a mask.
  • In the Emergency Department, patients suspected of having COVID-19 are immediately separated from other patients.
  • If you have a surgery scheduled, you’ll likely be required to take a COVID-19 screening test prior to surgery. 
  • Fewer chairs are available in waiting rooms, and magazines have been removed to avoid transmission via high-touch objects.
  • Housekeeping uses enhanced cleaning protocols recommended by the Centers for Disease Control and Prevention for sanitizing high-touch surfaces in patient rooms and common areas. 
  • Besides using disinfectant products, the hospital also employs ultraviolet light disinfectant technology. 
  • To reduce congregating traffic in the cafeteria, fewer tables are now open for seating, and more grab-and-go food options are available.

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