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The influenza virus sickens millions of people every year - sometimes with deadly consequences. Learn what you can do to protect yourself and those closest to you this flu season with tips from infectious disease specialist Kristin Englund, MD.


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What To Expect During Flu Season with Dr. Kristin Englund

Podcast Transcript

Speaker 1: There's so much health advice out there. Lots of different voices and opinions. But who can you trust? Trust the experts, the world's brightest medical minds. Our very own Cleveland Clinic experts. We ask them tough intimate health questions, so you get the answers you need. This is the Health Essentials Podcast brought to you by Cleveland Clinic and Cleveland Clinic Children's. This podcast is for informational purposes only, and is not intended to replace the advice of your own physician.

John Horton: Welcome, and thank you for joining us for the Health Essentials Podcast. I'm your host, John Horton. And today, we're talking with infectious disease specialist, Dr. Kristin Englund, about the upcoming flu season. Before we look ahead though, let's take a look back. Because the last two years have been quite an up and down journey because of COVID. In year one of the pandemic, the CDC reported only 2,000 flu cases in the United States. That's a historically low number. They tied that to the fact that people were wearing masks more, they weren't going out as much. And they were even doing things like washing their hands a little more.

Then came year two. Many COVID-19 restrictions, including mask requirements started fading away. And folks started going out more. As people circulated, so did the flu bug. And the CDC reported between 8 million and 13 million cases last year. So what can we expect this flu season? That's what Dr. Englund is here to discuss with us today, as well as the importance of getting the flu vaccine and how the ongoing situation with COVID affects both the flu season and the vaccine. Dr. Englund, thank you for being with us here today.

Kristin Englund: Oh, thanks so much for having me today.

John Horton: Before we dive into talk about the flu, let's start by having you tell us a little bit about your work here at the Clinic.

Kristin Englund: Sure. I'm an infectious disease doctor here at the Cleveland Clinic down here at the main campus. And I see patients with all kinds of infections. But we've certainly had a whole lot of COVID over the last couple of years.

John Horton: Definitely. I'm sure it's kept you pretty busy.

Kristin Englund: It sure has.

John Horton: Well, let's get the conversation started now on the flu.

Kristin Englund: Sure.

John Horton: In a real basic way, can you tell us just kind of what the flu is and what it does to you if you get it?

Kristin Englund: Sure. So influenza is the broad term for a number of different types of viruses. There's influenza A and influenza B. And each of those have a number of different subtypes that circulate around at any time during any season. So it's typically spread through the air. And we breathe in influenza. And for the most part, people will have lung symptoms. They'll have a cough, they'll have fever, they're going to feel awful. They're going to feel pretty tired like they've been beaten up. And they can get pretty severe pneumonia from this. While your body is fighting off the virus itself, it can put a lot of stress on other body symptoms as well, including the heart. And people can have heart attacks and other types of symptoms throughout the rest of the body as a result.

John Horton: It's hard to believe that it goes that far. I mean, people talk about the flu like it's nothing. But it seems like it can be really, really, really serious.

Kristin Englund: Absolutely. We certainly see people dying from influenza in previous years. We've had folks dying from influenza, as much as 40,000 people every single year can die from influenza.

John Horton: Wow. As we mentioned at the start here, two years ago is historically low as far as flu cases. Why did we see such a jump last year?

Kristin Englund: Well, if we all remember back to two years ago, everyone was masking, hand hygiene was being practiced. We were socially distancing ourselves. We just weren't going out, because of COVID. Because influenza is spread just the same way. We were de facto protecting ourselves from influenza as well. But we know that things have changed over the last year. And the mandates have gone away, and people are getting out more in the world. They're tired of being cooped up. I certainly understand that. But by the same token now, we're putting ourselves more at risk, not just for COVID, but for influenza as well.

John Horton: Yeah. Yeah … well, I'm going to ask you now to get out your crystal ball. What are we looking at for this upcoming flu season?

Kristin Englund: So if we look at other countries like Australia, and we often use Australia as a way to kind of predict what we're going to have, because they're kind of a season ahead of us. They've seen a rise in the number of cases of influenza. And we are certainly going to see a significant rise in the number of cases of influenza this year as well. I mean, look around. When you go out to the grocery store, when you go out shopping anywhere, are you seeing people wearing masks? I'm not.

John Horton: No. Yeah, it's kind of ... it definitely has slowed down.

Kristin Englund: Absolutely.

John Horton: Because there lower case count two years ago, does that have an impact going ahead as far as how likely you are to get it? Is it going to make it where you're more likely to because it was down and then it rebounds that hard? Or what kind of happens with that?

Kristin Englund: Well, many people probably were not getting flu vaccines over the last couple of years because they knew that they were protecting themselves wearing masks and socially distancing. So I think we see the number of people getting flu vaccines that was down. And you can get an additive benefit from having flu vaccines every year. So for not having flu vaccines for a couple of years, it may hit people a little bit harder this year.

John Horton: Yeah. Is that, too ... I mean, are there, I guess, additional complications that you're even looking at this year that might come with the flu?

Kristin Englund: Sure. Certainly, we're able to see that people are going to be admitted to the hospital not only with cases of pneumonia. But they also may be seeing other systems that are getting involved because of that. When your body gets very sick, you can get other organs involved, such as the heart, having heart attacks. You can get kidney failure. People need to be put on ventilators to help them to breathe. And that can have all sorts of complications.

John Horton: Dr. Englund, you've talked about how important the flu shot is just to prevent the flu. Are there other side benefits that you could get out of being protected?

Kristin Englund: Well, certainly we know that when people get influenza or get the flu, it's not only just the symptoms that they have of the cough and the fever, and the infection in the lungs. It taxes the body. Really puts a lot of stress on all of the other systems. So people can get side complications of say having a heart attack, or even having a stroke as a side effect from having influenza. So we want to make sure that we're keeping everybody healthy from all of these complications.

John Horton: How does that work? I mean, it seems ... you think about getting the flu and you think of it just as you're sick. I mean, how does it cascade all the way to having a heart attack or a stroke?

Kristin Englund: Yeah. So a cascade is a great word that you used with that. So we're stressing the system. So we're putting a lot of stress on the heart to be able to help the rest of the body fight off this infection. And people's blood pressures can get out of control, and that can contribute to heart disease as well. And we get these — call them kind of inflammatory responses throughout the entire body. Because it's all trying to fight off this viral infection. And they don't necessarily attack just the virus. The cascade can start to attack other organ systems in the body as well.

John Horton: Can it also move into pneumonia or other just horrible breathing situations?

Kristin Englund: Absolutely. The pneumonia is the number one complication. But if people's pneumonia gets bad enough, then they have to be put on a ventilator. They have to be put on other medications to try and control their blood pressure. And all of that can really stress the entire body.

John Horton: Well, and I'd imagine if you were already compromised with some sort of illness or a condition, it's going to make it just roll even worse.

Kristin Englund: Oh, absolutely. So we certainly know that even though perfectly healthy people can get severe complications from influenza. Those who already have some underlying disease, whether you have some heart disease, whether you have underlying asthma or COPD or emphysema. Whether you have some vascular disease that may make you more at risk for having a stroke, those can certainly occur and get worse if your body's fighting influenza as well.

John Horton: Now, let's talk about how you can prevent yourself from getting the flu. And I know the one thing that everybody talks about is, get the flu shot. I mean, you need to get that poke. Tell us why it's important to go and schedule your vaccine, and to get it?

Kristin Englund: Well, we've talked about some of the complications of getting influenza. It's not just a cold. It can be deadly. So why not protect yourself against something that could potentially kill you or one of your loved ones? It's a simple shot. It's extraordinarily safe. We do not give you the flu. You can't get the flu from a flu vaccine. I know that's always one of the big concerns. We're not giving you a live virus, so you can't get the flu from it. But you can keep yourself healthy and you can save the lives of those around you.

John Horton: It's great advice. And definitely something worthwhile to do. With COVID still around, does that make it even more important to get the flu shot? I mean, how do those relate?

Kristin Englund: Well, COVID and influenza are very different viruses, but they can both affect the lungs and lots of other organs in your body. You can get both at the same time. There's no reason why you can't get both at the same time. So it really makes sense to protect yourself from both.

John Horton: OK. I know we had talked, and as you brought it up, everybody should look to get the flu shot. But I know that there are certain groups where it's even more critical that you go and you get that protection. Can you go over some of those?

Kristin Englund: Yeah. So influenza really tends to affect most dramatically our older population. So those who are 65 and older. And the very young. So those who are really most at risk, the most vulnerable. Also for folks who have any kind of underlying diseases, any kind of problems with say asthma or emphysema, or COPD. Anyone who has heart disease. All of these can add up to having a much worse case of influenza.

John Horton: So get to the front of the line.

Kristin Englund: Absolutely.

John Horton: Let's look at timing. Is there any advantage to going and getting your flu shot early? I mean, should you wait a little? Should you just get it as soon as possible? When should you go and get that poke?

Kristin Englund: Well, as soon as the influenza vaccine is released, you can feel comfortable getting in line to get your vaccine at that point in time. There really is no benefit to waiting. We certainly know that influenza season tends to run between say October and roughly March. But we have seen in recent years that it can really stretch those boundaries and show up sooner, and last a lot longer. So it's really important to get the flu vaccine as soon as it's available for you.

John Horton: So it's not going to wear out. I know if, that's what people sometimes think, that if you get it too early, it's going to not work later.

Kristin Englund: No, we're not not going to offer you a flu vaccine, knowing that it would be wearing out on you. We just want to make sure that we're getting everybody vaccinated as soon as possible. It also takes a couple of weeks for the vaccine to fully kick in.

John Horton: Yeah.

Kristin Englund: So getting your vaccine right before the holidays, that's going to be too late. Because if you get it less than two weeks before you're getting together at Thanksgiving, then you really run the risk that you're going to be passing that virus around over the holidays.

John Horton: Right. Right. I know you had said previously that you cannot get the flu from getting the flu shot.

Kristin Englund: Right.

John Horton: But if people do get the shot, what other symptoms could you have, or kind of effects from having it?

Kristin Englund: Oh, sure. So as with many vaccines, when you get the shot, we're tricking your immune system into thinking that it has the flu, so that it makes the proteins or the antibodies against that. So that when your body really does see influenza, it's ready to attack. So you're going to get a little bit of a soreness to your arm. You may get a low-grade fever. May feel a little bit fatigued for 24 or 48 hours. But it really shouldn't be more than that. And trust me, that's a lot less than the symptoms you're going to get if you really do get influenza.

John Horton: Yeah. It seems like it's worth the little bit of discomfort for a day or so.

Kristin Englund: Absolutely.

John Horton: Dr. Englund, if you go in and you get your flu shot, I'd imagine that there are possibly some side effects that you would have just from getting the vaccine. What can somebody expect from that? And why does that happen?

Kristin Englund: So, actually, side effects are a good thing. All right? In my mind, it's telling me that your body is responding to the vaccine, and it is making those antibodies that eventually are going to protect you when you do see influenza. So you're going to have ... possibly, you're going to have a sore arm. That's to be expected. You might have a low-grade fever. You might have some body aches. Just feel pretty tired for 24 to 48 hours. But look at it this way. That's a good thing.

John Horton: I know we've talked about it a lot with ... you mentioned you can't get the flu from getting the flu shot. I know people had a lot of these same vaccination questions when it comes to COVID. Is it the same sort of feeling that you're going to get, the same sort of response that your body's given after getting the vaccine?

Kristin Englund: So, absolutely. It is very similar when you get any kind of a vaccine. Whether it be influenza or COVID, or a pneumonia vaccine, you're going to have some response, some body response from that. And that is, again, just because your immune system is starting to build up and fight against that. None of these vaccines are live virus vaccines. We're not giving you the virus. There are some live virus vaccines, such as things like yellow fever and measles, mumps and rubella. But we're very cautious about who we give those to. Influenza, I can't give you the flu. It can make you feel a little flu-like. Because again, you're going to be getting that great response that your body is now building up that immunity. But I really can't give you the flu.

John Horton: That's good news.

Kristin Englund: I will say that, sometimes, people can get an infection shortly after they have gotten the flu vaccine. And that's because it takes a couple of weeks to really build up that immune system. So if people get the flu vaccine, and then within a couple of days they get the flu, it's not because of the flu vaccine. It's because they did get exposed to it probably before they got the vaccine. And their body hasn't had enough time to build up that immunity from the flu vaccine. Which is why it's really, really important that you give yourself a two-week time period before you say, go over for Thanksgiving, or get together for any of the other winter holidays. Make sure you get your vaccine a full two weeks ahead of time so that you don't go into an environment where you could potentially catch or spread the flu.

John Horton: Let's talk about COVID-19 and the flu a little bit more.

Kristin Englund: Sure.

John Horton: I mean, COVID obviously has evolved incredibly over the last year. How are the symptoms of the coronavirus strains — how do those line up with flu symptoms? Because I think, sometimes, people have trouble telling them apart. How do you know which do you have?

Kristin Englund: Well, it's true. COVID has certainly gone through a number of different variations. But when you get down to it, the core symptoms of COVID with the fever, the chills, the body aches, the difficulty breathing, the cough. Those are very, very similar to influenza. So it can be very difficult to tell the two apart.

John Horton: Is there a point where do you need to tell them apart? I know that sounds silly, but is there ... for treatment, is there a benefit to knowing?

Kristin Englund: No, there's definitely a benefit to knowing which one you have. Because treatments are very different. So when I test somebody for COVID, I'm usually testing them for influenza A and B as well, because I usually can't tell apart just by the symptoms themselves.

John Horton: OK, OK — one thing — could you be, I guess, unlucky enough to get COVID and the flu at the exact same time?

Kristin Englund: Could you get them both at the same time? You would be terribly unlucky, but there's no reason why you can't. They're two totally separate viruses. And there's really no ... the way that you're going to protect yourself from one is the way you're going to protect yourself from the other. So if you're not being careful and masking when you need to, and washing your hands, and doing your social distancing from people, you could get them both.

John Horton: Well, actually that leads perfectly into the next question. We were talking about protecting yourself from both. If you got the COVID-19 vaccine, will that do anything to protect you from the flu? And I guess, in vice versa. If you get the flu shot, will that protect you against COVID?

Kristin Englund: I wish. Unfortunately…

John Horton: We all do.

Kristin Englund: …Unfortunately, being two totally separate viruses, there is no way that one can protect against the other. It's like getting a pneumonia vaccine and getting a meningitis vaccine. They're very different. All of our vaccines are quite specific to one virus or bacteria. So at this point in time, we need to get both. So you're going to need to get a flu vaccine this fall, as well as likely an updated COVID-19 vaccine as well.

John Horton: OK. And just so people don't worry, if you get one or the other, I mean, they're not going to interfere with each other, correct?

Kristin Englund: Absolutely not. You can get both vaccines, frankly at the same time.

John Horton: Oh, wow. That was going to be the next question. You could one-stop-shop it. So you can get them both. You could make an appointment, come in and just both of them, boom. Right away.

Kristin Englund: Absolutely. Why not? Why not get them both at the same time? That way you can save yourself some time. And if you're going to have a sore arm and maybe a low-grade fever for a couple of days from either one of them, why not have them together?

John Horton: Definitely.

Kristin Englund: It's not going to interact. You're not going to get less of a response to one because you've gotten two at the same.

John Horton: That is very good to know. As far as, if you're an adult or a child, is there any difference in the timing of getting those? I mean, do you have to stagger them, or is it the same?

Kristin Englund: You should be able to get both vaccines whether you're an adult or a child.

John Horton: OK. In addition to getting the flu shot, which, as we said, is probably one of the best ways you can protect yourself. What other things could you do just to kind of prevent yourself from getting the flu?

Kristin Englund: Well, as we know going back into the fall, when we tend to see most of the viral infections floating around anyway because people are going more indoors, kids are going back to school. People are getting into much more enclosed spaces together. We see a lot of viruses running around. So trying to do the things that we've been doing during the time of COVID is going to be very important. So I think people need to be very comfortable wearing masks, making sure that they stay a safe distance away from other people. Hand hygiene, for goodness sakes. We've all gotten used to using the hand sanitizer. Keep it up. It's so important. That's never going to go away. We're always going to need to continue using that.

But thankfully, we've now all gotten into the habit of doing that. But I still wear my mask when I go out grocery shopping, or go to any of the different stores. And I think it's important that we maintain that ability to have people feel free to wear masks if they want to. I doubt we're ever going to get back to a mandated type of a stage anymore. But I think it's important that if you want to wear a mask, feel comfortable, wear it. It's important for you and your own health. And you know what's going on in your body, your own health and those around you, you need to feel comfortable wearing it.

John Horton: So keep yourself safe.

Kristin Englund: Absolutely. Keep those around you safe. Keep your loved ones safe. You're not just doing it for yourself. You're doing it for everyone in your family.

John Horton: That's great advice. We have covered a lot of ground here. Is there anything that we haven't discussed that you think we should bring up?

Kristin Englund: I think it's important to know that influenza vaccines are exceptionally safe. They have been around for so many, many decades. And we know that they save lives. So it's tremendously important to make sure that you're getting your flu vaccine.

John Horton: Perfectly said, Dr. Englund. So, thank you so much for being with us here today.

Kristin Englund: Of course.

John Horton: If you have any questions about the flu or the flu shot, talk to your doctor. Or call Cleveland Clinic at 216.444.2200. You can find more information online too at clevelandclinic.org\flu. Thank you for being with us today.

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