COVID-19 or the flu? Kansas, Missouri prepare for confusion, testing demand this winter

Everyone’s felt the tell-tale signs: the cough that lingers, the fever and chills, the aches and overall fatigue. Often, there was no doubt about what it was. You had the flu, plain and simple.

It’s not going to be so simple this winter. Instead, many people who feel ill will be asking a new question: Is it the flu or COVID-19?

“The concern, obviously, is it’s going to be maybe potentially difficult to distinguish between flu and COVID just based on symptoms,” said Cindy Prins, an infectious disease epidemiologist at the University of Florida.

The pandemic has upended nearly every facet of life and flu season is next. Doctors, public health officials and epidemiologists are bracing for a possible winter of confusion as people unsure of what ails them seek out care. It likely means more stress on a healthcare system already in the middle of an extraordinary period.

The demand for COVID-19 testing will rise as health providers and patients seek definitive answers, experts say. Flu tests, which usually don’t attract much attention, will become more frequent because of the important role they will play in diagnosing patients.

Quickly determining whether someone has the flu or COVID-19 is vital to how patients and doctors proceed. Doctors can prescribe anti-viral drugs, such as Tamiflu, to reduce the severity of the flu. But few outpatient treatments exist for the coronavirus and those with it must isolate.

Public health agencies are placing extra emphasis on the importance of the flu vaccine this year. The flu shot also presents a chance to build trust and confidence in vaccines ahead of an anticipated COVID-19 vaccine in 2021.

“To ensure our state has the capacity to care for COVID-19 patients, we need to do whatever we can to prevent strain on our health care system and keep Missourians healthy,” Randall Williams, director of the Missouri Department of Health and Senior Services, said in a statement emphasizing the importance of the flu vaccine.

But health officials fear the opportunity will be wasted because the trust between local health departments and communities has been strained by restrictions to slow the spread of the virus.

Doctors and other medical professionals are holding onto hope that this year’s flu season will be mild. They point to a relatively light season in the southern hemisphere this year, where winter is coming to an end. Precautions to fight COVID-19, such as masks and social distancing, may slow the spread of flu.

“Most years, whatever the activity was in the southern hemisphere portends what’s going to happen in the northern hemisphere,” said Lee Norman, director of the Kansas Department of Health and Environment.

Resistance to masks and a lack of mandatory rules in some areas could undercut whatever natural advantage is gained from a mild flu season, however.

As temperatures cool and the flu awaits, nothing is certain.

Many shared symptoms

Flu and COVID-19 share a remarkable number of symptoms. Both can cause fever, cough, body aches, vomiting and diarrhea, according to Johns Hopkins Medicine. They can both lead to pneumonia and severe illness, even death.

“The majority of these symptoms are going to be very similar,” said Darrin D’Agostino, executive dean of the College of Osteopathic Medicine and vice provost for health affairs at Kansas City University. He estimated the overlap at more than 80 percent.

There are sometimes differences. The biggest giveaway is the loss of taste and smell, a symptom of COVID-19 but not common in flu.

Still, retaining taste and smell doesn’t mean you don’t have COVID-19. Studies conflict on what percentage of people with the virus lose those senses. Findings range from a large minority to an overwhelming majority.

Without a fool-proof way to differentiate between COVID-19 and the flu in all cases based on symptoms alone, those who feel ill are expected to seek out testing. At that point, where people go and the kind of testing they receive can make all the difference.

COVID-19 tests where a swab is sent away to a lab can take days to produce a result. Even if the analysis is done relatively quickly, sample backlogs and transport time can add up to long waits, especially for people who are ill.

State labs can often produce results much more quickly. Kansas officials have said the state’s lab can turn around a test in a day or less.

Finally, rapid tests offer results in a matter of minutes, but with lower accuracy. When someone is already ill, however, it can be a gamechanger.

“You’ll have an answer before you leave the office, which way you need to go,” said Mary Devers, market medical director of CareNow urgent care clinics in the Kansas City metro area.

Her clinics this past week received numerous rapid coronavirus tests with the capacity to run flu tests if needed. The tests will be put into use next week.

Chad Johanning, a doctor at Lawrence Family Practice and president of the Kansas Academy of Family Physicians, said his clinic just received a rapid test that can produce a result in 15 minutes. He acknowledged the test is less sensitive than slower tests on samples sent to labs.

Concerns have been raised about the accuracy of antigen tests and especially the rate of false negatives. But the rapid result can still be very valuable, especially if it produces a positive result

“That’s a whole different ball game to a five-day wait time, whatever it may be,” Johanning said.

Disease determines treatment

Whether someone has the flu or COVID-19 helps determine the course of treatment. Tamiflu and other drugs can be used on flu patients. The flu isn’t a new disease and doctors have more experience dealing with it.

For coronavirus patients, fewer treatment options are available. But the sooner a case is identified, the sooner contact tracing efforts can get underway to bring close contacts into quarantine and, hopefully, limit the virus’s spread.

Johanning predicted clinics will each take their own approach to handling possible flu or COVID-19 cases. Some will see patients in person initially, others will emphasize telemedicine and virtual visits.

“We’re evaluating them through telehealth first to minimize the risk and then deciding from there based on their presentation, how they look, what we need to do at that point,” he said of his clinic.

If testing is needed, patients will be sent to either a drive-thru location or have a drive-up test performed at the clinic so there’s no exposure to others.

At that point, a flu test could also be performed. Often, the same swab can be used for both, Johanning said.

While most coronavirus testing is still being done through samples sent away to labs, most flu testing is done through a rapid test performed within 15 minutes, according to the Centers for Disease Control and Prevention.

The CDC has developed a test that can check for both the flu and coronavirus and initial supplies were sent to public health labs in August. It’s unclear how many tests and supplies states will ultimately receive.

In Kansas, Wichita State University is using federal aid to add testing capacity for both coronavirus and the flu. Eventually, the school’s lab will be able to run more than 22,000 tests a week.

“We will be able to provide saliva, nasal and most importantly also, given the next few months that will pop up, flu,” WSU President Jay Golden told lawmakers earlier this month. “Many people will think they have COVID, when in fact it could be flu or cold.”

Labs are no longer experiencing the kinds of shortages that crippled testing in the first months of the pandemic. But they still report trouble securing needed supplies.

An August survey by the American Association for Clinical Chemistry found 52 percent of labs unable to obtain supplies needed to run COVID-19 tests the previous week. Nearly a third of labs said they couldn’t get supplies needed for non-COVID testing during that same period.

“Laboratories continue to have supply chain issues,” AACC president David Grenache said.

For instance, Grenache said, his lab in New Mexico is experiencing supply chain problems with plastics, specifically tips for pipettes, a tool used to transfer liquids from one container to another.

“It’s a new problem. At the beginning of the pandemic, access to those types of disposables were plentiful,” Grenache said.

Can flu prepare us for COVID-19 vaccine?

While the medical community has little hope of totally heading off the impending flu season, doctors and public health officials are begging people to get vaccinated.

A few health departments have gone as far as asking the Kansas Department of Health and Environment to aid with contact tracing COVID-19 cases in order to free up staff for flu vaccine clinics, said Dennis Kriesel, director of the Kansas Association of Local Health Departments.

The flu vaccine this year likely represents the last mass vaccination campaign in the United States before the anticipated rollout of a COVID-19 vaccine sometime in 2021. Government and health leaders have a potentially valuable opportunity to build trust, which they’ll need to convince people to line up for a new shot.

Kansas Gov. Laura Kelly has been emphatic about the need to get vaccinated, calling it “vital.”

“Flu season is just around the corner, and it’s more important now than ever before that Kansans get a flu shot,” Kelly said at a recent news conference.

Williams, the Missouri DHSS director, said preventing flu “means fewer unnecessary medical visits and hospitalizations. Preventing flu also reduces disruptions to our daily lives – at home, at work, at school.”

D’Agostino, the vice provost at Kansas City University, said the school is working with Missouri officials on vaccine messaging and will be speaking with Kansas officials about how it can help, too.

KCU will tap into its existing Score 1 for Health network, which provides health screenings to elementary-aged children, to provide education about the challenges communities face without vaccines.

“Much of that is in preparation for the COVID vaccine initiatives,” D’Agostino said.

But concerns exist that health leaders won’t be able to use the flu vaccine to lay the groundwork for a coronavirus vaccine.

“I think part of the issue is with COVID there’s a huge trust gap right now,” Kriesel said.

Kriesel said “in theory” there’s a good opportunity, but at the local level there is pushback against departments over quarantine orders and rules to curb the spread of the virus.

Kelly issued a mask order over the summer, but most counties opted out. Missouri Gov. Mike Parson, who tested positive along with his wife for COVID-19 on Wednesday, has declined to order mask use.

In both states, mask orders and other restrictions have largely been decided by local officials. Kriesel said that while looking at the flu vaccine as a possible dry run isn’t a terrible concept, the rollout of the COVID-19 vaccine will be massive and little is currently known at the local level.

“A lot of that is being dictated by HHS (federal Health and Human Services) and we don’t really know what the plan is,” he said.