This story was updated on Oct. 14 at 6:00 p.m.

The coronavirus is far from over in the D.C. region and elsewhere. And as the weather gets colder, it’s going to be joined by another, more familiar scourge: the seasonal flu.

Health experts have been warning that the confluence of the two diseases could prove a significant challenge for public health and hospital capacity. D.C.-area health officials say they want locals to stay vigilant — and get a flu shot.

“It’s coinciding with the pandemic. It will make things particularly difficult, and so we’re encouraging everyone to get a flu shot and to protect themselves from the flu,” says Dr. Jessica Boyd, the Chief Medical Officer of Unity Healthcare, which runs the largest network of federally-qualified health centers in the District. “Reducing any fever-causing viral infections will really help us to make sure that we can accurately and quickly diagnose, treat, [and] provide advice and really keep everybody healthy.”

Boyd notes that COVID-19 and flu share a lot of similar symptoms: fever, cough, fatigue, sore throat, muscle pain. That means clinicians at Unity and everywhere will face the added challenge of figuring out which illness patients are suffering from.

To that end, Boyd says Unity has chosen to invest in flu tests this year, which will help medical staff differentiate between the two diseases and treat patients accordingly. The cost outlay — $25 per flu test — is worth it, Boyd says, because it will allow clinicians to more accurately target care at the people who need it most.

“If you were to test positive for the flu and negative for COVID, that probably means that you need a little bit less follow up,” Boyd tells DCist/WAMU. “For our patients who are positive for COVID, we follow them every couple of days.”

And there are differences in treatment as well as clinical attention. A patient with the flu might benefit from a course of Tamiflu, for instance.

Health officials may also see patients who have both the coronavirus and the flu at once, according to Dr. Ankoor Shah, deputy director for programs and policy at DC Health. But he’s looking on the bright side: the same public health measures that help limit transmission of COVID-19 — like social distancing, frequent hand-washing, and self-quarantine — are all effective against the flu, too.

“When we think about the flu season, really making sure our COVID-19 pandemic is getting under better control is always a good sign,” Shah says.

Even without the added problem of an ongoing global pandemic, the flu has had serious effects locally in the past. About 36,000 District residents typically get the flu every year, Shah estimates. From 2015 and 2018, the yearly average for people in D.C. who died from the flu and pneumonia ranged from 78 to 104.

Boyd and her team at Unity Healthcare, which also provides health care to people experiencing homelessness, are concerned that the flu, like the coronavirus, will also disproportionately impact the District’s most vulnerable citizens: the unhoused, low income people, and Black people and people of color, among others.

“[If] you have more comorbidities, you may get sicker from the flu,” Boyd says. And it’s not just the illness itself, she explains. “Even the cost of days away from work may be disproportionately impactful to you.”

Boyd and others strongly encourage locals to get the flu shot this year. In fact, Boyd says flu shots are so important this year that Unity is requiring all of its staff to get them, where in the past they’ve just been strongly encouraged.

“We have a flu vaccine right now that we could get that could help us prevent us and our loved ones from getting the flu,” Shah adds. “So that is the number one thing.”

About 35% of District residents get the flu shot each year. Shah hopes to see that number increase this year.

Getting the vaccination isn’t just a matter of individual health, according to Natalie Talis, the Population Health Manager at the Alexandria Health Department. Much like social distancing or wearing a mask, flu vaccinations are a matter of community health — a way to minimize transmission of the influenza virus from person to person, and to help maintain hospital and health provider capacity for more serious COVID-19 cases.

“It’s something that we all can do to make sure that those vital hospital resources or emergency room resources, if needed, are available for what else might be going on in the world,” Talis says. “So it’s that one small action that makes a huge difference for both people individually and our community.”

But, even with the sense of urgency, there are some important barriers to community compliance with getting vaccinated for the flu. The coronavirus response has made accessing flu shots more complicated. Workers who used to get vaccinated in an office setting, perhaps at an event sponsored by their employer, don’t have that option if they’re now working remotely. Schools, a source of public health information for families, are only open virtually in most cases.

Some of the usual places that dispense flu shots are still providing vaccinations — but the experience could look a little different this year. CVS Pharmacy and Walgreens are both strongly encouraging patients to schedule an appointment to get a flu shot, and fill out relevant forms online, instead of walking in. Patients will also have to complete a series of COVID-19 screening questions. (At Walgreens, patients can expect to be temperature checked before they get the vaccine.) Grocery stores with pharmacy departments, like Safeway and Giant, are open for walk-in vaccinations, without the option to make an appointment.

Talis worries that some people may be deterred from going to a pharmacy or even a doctor’s office for a shot because of COVID-related concerns about being inside, particularly in a healthcare setting, in public.

“People might have concerns about going to get routine medical care. But we want to reassure people that it is safe to get medical care,” Talis says. “And in fact, it is crucial to helping to deal with COVID that people take care of their normal medical needs.”

Boyd also worries that people won’t get the flu vaccine because of the myth that people can get the flu from the shot

“We predominantly use inactivated vaccine. So it’s killed virus,” she says. “You really can’t get the flu from the flu shots that we’re giving.”

Where You Can Get A Flu Shot In The D.C. Region 

(A non-exhaustive list. See this handy tool for more resources, and check with your health provider or local health department, too.)

Pharmacies: CVS, Walgreens, Safeway, Giant, Harris Teeter

The District is offering flu shots at the Judiciary Square public testing site, Monday-Friday, 8 am – noon, for the month of October. Flu shots are also available at public testing sites at six fire stations around the District. More information about flu shot providers in the District, including for people who are uninsured, is available on the DC Health website.

Alexandria Health Department will host two flu shot clinics, on September 26 for drive-thru and on October 3 for walk-up.

Fairfax County Health Department will host a number of flu shot clinics, including several geared for older residents at county senior centers.

Montgomery County Health Department will host several flu shot clinics in October and November, including a drive-thru event. Residents can make appointments online or call 311 for more information.

Prince George’s County Health Department has also not yet posted information on flu shot clinics. The department has hosted them in previous years.

This story was updated to include information from DC Health’s Dr. Ankoor Shah, and to add information about public flu shot clinics.