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The baddies of respiratory viral season are at your doorstep: The US is currently in the midst of a large uptick in Covid-19 cases, and flu and RSV season is just a few months away.
More than 200 viruses cause the coughs and sneezes that make so many of us miserable every fall and winter. “Respiratory infections are actually inevitable,” says Shira Doron, an infectious disease doctor and hospital epidemiologist at Tufts Medical Center in Boston.
The good news is that there are now a range of strategies available to fight them, although after years of battling a constantly shifting pandemic, many people are understandably exhausted and confused about how they should keep themselves and others safe. The bottom line is you can minimize respiratory viruses’ effects on your life by reducing your exposure to them, priming your immune system to fight them off, getting vaccinated, and making a plan to get tested and treated for an infection if you’re someone who’ll benefit.
Here’s how to think about this year’s cold, flu, and ongoing Covid-19 season, how to keep yourself healthy and safe, and how to be strategic about testing, vaccines, and medications.
Should I treat Covid like the flu? Or like the common cold?
The further we get from the OG Covid of 2020, the less likely it is that infections will translate into hospitalizations, deaths, or long-term disability. That doesn’t mean the virus doesn’t carry risk. “Covid continues to be a more dangerous virus than flu, [but] they’re becoming more similar,” said Centers for Disease Control and Prevention (CDC) director Mandy Cohen in a late August press briefing.
Last season, Covid-19 caused more hospitalizations than flu and RSV combined. However, with each successive wave of Covid, a smaller proportion of infected people are hospitalized or die as a result. That suggests the virus is less likely to cause severe illness, especially in low-risk people.
A Covid-19 infection does still carry the risk of persistent symptoms — also called long Covid — but that risk has significantly decreased over time, in large part due to Covid-19 vaccines.
“We can’t attribute characteristics to Covid 2024 that we did to Covid 2020,” Doron says.
If anything, people should be taking more care with other, non-Covid infections
Indeed, an important question when thinking about Covid risk remains, “Who are you?” says William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center in Nashville. Older, immunocompromised, pregnant, and frail people still “ought to be clearly more concerned,” he says, because the consequences of an infection are worse for them than for others.
How long should I stay away from others if I have Covid-19?
Although there are no longer any hard guidelines about how many days you should isolate if infected with Covid-19 as of this year, the CDC recommends staying home and away from others if you have respiratory symptoms, regardless of the cause. Whether you had a positive Covid test or not, don’t go back to normal activities until your symptoms are improving overall and you’ve been fever-free (without meds like Tylenol or ibuprofen) for at least 24 hours.
In conversations among infectious disease specialists, says Doron, most advocate that workers with Covid-19 infections should apply the same rules for going back to work as they do with flu or cold infections.
That doesn’t mean you should be flippant about Covid’s risks, says Doron. If anything, people should be taking more care with other, non-Covid infections. “You should stay away from people who are high-risk or immunocompromised regardless of what virus you have,” she says, “because all viruses can be dangerous to high-risk people.”
Doron recommends masking for people with any respiratory symptoms when in close contact with others, and for severely immunocompromised people (for example, people with low levels of infection-fighting cells after chemotherapy) when in public. During periods when lots of Covid-19 is circulating — like now — Schaffner suggests masking and avoiding crowded public locations for all high-risk individuals, including people 65 and up.
Should I be testing for Covid-19 if I get sick?
Since CDC and other experts say the methods for protecting others should be the same for all respiratory infections, the main reason to get tested if you’re sick is to determine whether you should take medicines directed at specific viruses.
Tamiflu (the brand name for oseltamivir) and other medications can make flu infections less lethal for high-risk people (e.g. people of all ages with asthma, heart disease, diabetes, and other conditions). Paxlovid (the brand name for nirmatrelvir-ritonavir) can have similar effects in older and immunocompromised people with Covid-19 infections.
These drugs can be lifesaving if people take them for the right infections, but neither will do much good for other viruses. If you’re sick and you’re among those who’d benefit from treatment with one of these medications, it’s smart to get tested.
The US government will once again mail free Covid-19 tests to Americans who request them starting at the end of September, and you can get tested for flu at many pharmacies, at urgent care centers, or at a health care provider’s office.
What’s the deal with all these different vaccines?
Before the pandemic, the only seasonal vaccine most people needed to think about was a flu shot each fall. Now, there’s a Covid-19 booster vaccine available at about the same time. Additionally, shots to protect babies and older adults from the pneumonia-causing RSV virus — which was in development for years before the pandemic — finally became available to the public last fall. The toolkit is bigger now than it was a few years ago. It’s a good thing, but it can feel confusing.
US recommendations aim to keep things simple for most people: The CDC recommends everyone over 6 months old get a Covid-19 booster and a flu shot for this fall (more below on how to time your shots).
When it comes to RSV, three categories of people should be getting a vaccine: older people, pregnant people, and babies. For now, this is a one-and-done shot — people who get it don’t need to worry about an annual booster. If you’re 75 or over, 60 or older with an underlying illness, pregnant, or have a newborn baby, talk to a health care provider about getting an RSV vaccine.
How should I time the flu and Covid vaccines to give myself the best protection?
Getting the flu shot and the Covid-19 vaccine at the same time is perfectly fine, and you can even get them in the same arm a few inches apart. Any time before New Year’s is good protection, although you can be strategic with the timing if you need to.
Experts have landed on Halloween as optimal vaccination time for both to avoid the worst of the winter flu season and whatever Covid might also be bouncing around in late winter.
The main benefit of Covid-19 vaccination is protection from severe infection and hospitalization, not protection from infection altogether. However, there is a short-lived period after vaccination when antibody levels are so high that even infection is unlikely. If you have an important life event planned — say, a big overseas trip or a wedding — it’s not unreasonable to try to time your vaccine for about a month before that event in order to make it less likely you’ll be sick during your big moment, says Doron.
Experts have landed on Halloween as optimal vaccination time to avoid the worst of the winter flu season and whatever Covid might also be bouncing around in late winter
If you’re at risk for a severe Covid-19 infection, get a Covid booster as soon as you can, says Schaffner. His reasoning: There’s a lot of Covid circulating right now, and in any case, people who need extra protection can get an extra dose of the updated vaccine midwinter.
If you’re someone who’d benefit from the RSV vaccine, the best time to get it is in the late summer or early fall, before the virus starts spreading. Vaccination for pregnant people in particular should happen between September and January.
Seriously, do I really need to get another Covid vaccine?
“You betcha,” says Schaffner, echoing the CDC’s broad recommendation. Experts have determined that in the US, the benefit of getting the vaccine exceeds the risk for all age groups.
That said, it’s more crucial for some than others. “The more high-risk you are, the more you’ll stand to benefit from the updated vaccine,” says Doron. That includes older people (65 and up) and those who are severely immunocompromised, like those actively receiving chemotherapy.
All three Covid-19 vaccines expected to be offered this fall are safe and effective at preventing hospitalization. Novavax is less likely to cause side effects than the Pfizer and Moderna mRNA vaccines; in her latest newsletter, epidemiologist Katelyn Jetelina noted that’s a major reason she’ll be waiting to get a Novavax booster.
Despite the vaccines’ safety record, a recent survey by the Annenberg Public Policy Center at the University of Pennsylvania suggests false Covid beliefs are on the rise, with one in five Americans believing Covid infection is safer than vaccination. “The level of messaging on one side didn’t change. On the other side, it did change,” director Kathleen Hall Jamieson told me. “There’s less pro-vaccination messaging that you’re routinely hearing, and you’ve still got the same amount of anti-vaccination messaging out there.”
Do I need to get the Covid-19 vaccine if I recently had Covid?
Wastewater measurements suggest we’re in the midst of a big Covid-19 uptick nationwide, with infections likely continuing to climb upward in the Midwest and Northeast. That means many Americans have recently been infected with the virus.
There’s not much benefit to receiving a Covid-19 vaccine in the three months after a Covid-19 infection. Holding out for longer gets you more bang for your vaccine buck and allows the immunity produced by a Covid-19 infection to mature and solidify, says Doron. Studies of vaccine timing have borne this out: In one study, for example, antibody levels (which are protective against infection) were 11 times higher in people vaccinated eight months after infection than in people who only waited three months.
On the flip side, the longer you wait to get vaccinated after a Covid-19 infection, the more likely you’ll get infected in the interim. (However, most people are not reinfected in the first nine to 12 months after an infection, says Doron.)
What else can I do to stay healthy this season?
If you’re not sick, several familiar strategies can help keep you healthy: Wash your hands before touching your face or preparing food and after touching shared surfaces or using the bathroom; use a mask in crowded places; ventilate shared spaces by opening a window and turning on a fan if possible, and consider using an air purifier when gathering with others.
“During the height of Covid, we forgot about reinforcing how important sleep, exercise, nutrition, stress reduction, all of those things impact the immune system,” says Doron. Optimizing those factors — while also maintaining a healthy weight and controlling underlying medical conditions — makes it more likely you’ll stay healthy if and when you get a respiratory infection.
