This year’s looming flu season, thanks to the COVID-19 pandemic, is going to present a new range of challenges, one of the leading pharmacy quality experts in the country said late last week. 

“We expect the flu season, whether mild or robust, to be like nothing we’ve seen before,” said Nancy Losben, R.Ph., CCP, CG, a consultant pharmacist for Omnicare, a CVS Health company. She delivered an array of insightful observations  during a McKnight’s Long-Term Care News webinar on Thursday called “When COVID-19 and Flu Season Converge: What to Anticipate and How to Prepare.” The presentation will remain available at no cost in archived format.

Among the biggest difficulties of the flu-COVID-19 double-punch, first and foremost, Losben said: Knowing the differences between the two. Both share certain symptoms, such as fever, shortness of breath, fatigue, sore throat, runny nose and muscle pain or body aches. Other common symptoms are possible vomiting and diarrhea, intensity ranging from none to severe, and a comparable high-risk patient population. But there are notable distinctions as well.

COVID-19 includes a possible change in or loss of taste or smell, which is not characteristic of the flu. Also, symptoms of COVID-19 can appear as early as two days and as late as 14 days after infection. With the flu, most people develop symptoms within one to four days after infection. In addition, COVID-19 has more “superspreading events than the flu,” meaning it can result in more contagion spreading. 

Losben recommended interviewing residents and staff members who have had COVID-19 to learn more about their specific symptoms. Such stories “are well worth learning and listening to” to further identification differences, she advised.  

Among those 65 and older who were hospitalized with COVID-19, researchers have found that most had fever, cough and shortness of breath. And shortness of breath more commonly was reported among hospitalized adults than non-hospitalized adults. This symptom is “your trigger to dial 911 and get that resident the acute care that they need,” she said. 

The modes of transmission also overlap between the two viruses: both can spread from person to person and within six feet, and both are spread mainly by droplets when people cough, sneeze or talk. And some potential complications are common to both, such as viral pneumonia, respiratory failure and sepsis. 

COVID-19 flu shot exception

Losben encouraged providers to drive home the need for all residents and staff members, including everyone from care workers to those in the kitchen, to get a flu shot. 

“Everybody on the nursing home staff needs to receive their vaccination,” she said. 

One of the exceptions for flu shots is those who are in isolation as a result of COVID-19. In these cases, vaccination should be deferred until isolation has been completed. 

Providers need to educate residents, staff members and families about the importance of vaccinations, she stressed. Misconceptions about vaccines abound, including the incorrect belief that flu shots lead to Alzheimer’s disease, Losben said. She noted that the flu vaccine contains dead or weakened germs that cannot make someone sick, and they stimulate the immune system just enough to produce antibodies. Long-term care faces a natural challenge in terms of vaccination because of the traditionally low vaccine rates — about 65% — among workers, she pointed out.

To help encourage residents to get vaccinated, Losben suggested reminding those who are old enough about 1954, when President Dwight Eisenhower mandated that every child receive the polio vaccine. Residents may remember standing in line to get the vaccine, which was administered on a sugar cube. Such a memory might entice a resident to spread the good word about the flu vaccine, she noted.