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Flu or COVID-19? Convergence of Two Viruses Creates Risk of Diagnostic Errors

Susan Shepard, MSN, CPHRM, Senior Director, Patient Safety and Risk Management Education, The Doctors Company

The good news is that because influenza (flu) and COVID-19 are both contagious respiratory illnesses, the guidance for controlling or minimizing their spread is similar and vaccines are readily available for both illnesses. The bad news for healthcare providers is that both have similar symptoms, and testing must be performed for both to confirm a correct diagnosis. Understanding the differences between the flu and COVID-19 will help prevent misdiagnosis or delayed diagnosis of either disease.

Refer to CDC guidance on “Similarities and Differences between Flu and COVID-19,” including signs and symptoms, time periods for symptoms after exposure, length of time for spreading the viruses, how the viruses spread, individuals at higher risk for severe illness, complications, and approved treatments.

Flu Season

It is possible that the viruses causing both illnesses may spread in your community at the same time during flu season. If this happens while relaxed COVID-19 mandates are in place, people could become ill with one or both of the diseases simultaneously. To counter this possibility, it is important that appropriate screening, testing, and vaccinations are available. Refer to CDC guidance on “Frequently Asked Influenza (Flu) Questions: 2021–2022.”

Patient Safety Strategies

Enhance patient safety and conserve scarce medical resources by taking the following actions:

  • Encourage your patients (six months and older), especially those at high risk, to get an annual flu vaccine.
  • Ensure that all staff members are vaccinated for the flu. Offering it at no cost to employees increases vaccination rates.
  • Follow CDC guidance on “Information for Clinicians on Influenza Virus Testing” for patients with acute respiratory illness symptoms.
  • Prescribe flu antivirals as necessary to prevent complications.
  • Distribute or display the American Heart Association infographic “COVID-19 and the Flu: Avoiding Double Trouble.” Flu shots reduce the risk of death for people with heart disease.
  • Ensure that standard documentation relative to the possible contraction of the flu and/or COVID-19 is included in the patient’s health record.
  • Maintain, date, and document all changes in office policies related to personal protective equipment or other covered countermeasures.
  • Appoint someone in the office to maintain all COVID-19 and flu-related processes and procedures in a central location.
  • Designate a person to speak on behalf of the practice or facility with respect to the steps taken to ensure patient safety.
  • Adopt a shared decision-making approach for patients who are at high risk for flu who do not want to get the flu vaccine to ensure that the patient understands the risks of not being vaccinated. Learn more about this process with the Agency for Healthcare Research and Quality’s “The SHARE Approach: Shared Decisionmaking Tools and Training.” The same method can be used to help people understand the risks of not being vaccinated against COVID-19. The shared decision-making/consent discussion should be well documented.
  • Follow testing guidelines. Testing is the best method for determining which virus the patient may have and guiding you in decisions about the appropriate treatment.
  • Refer to pharmacies offering to provide the flu vaccine at the same time the COVID-19 vaccine is administered.
  • Offer a free video in your waiting area to educate patients about getting vaccinated. For an example, see Mayo Clinic Minute: “Why getting vaccinated for the flu is doubly important this season.”
  • Follow CDC guidelines for COVID-19 prevention to stop the spread of germs:
    • Wash hands frequently.
    • Maintain respiratory etiquette (including masking when possible).
    • Avoid touching eyes, nose, and mouth.
    • Avoid close contact.
    • Disinfect frequently touched surfaces and objects.
    • Encourage self-isolation if sick.
  • Adhere to local government or public health department recommendations for additional precautions to be taken in the context of the COVID-19 pandemic.

For additional assistance, contact the Department of Patient Safety and Risk Management at (800) 421-2368 or by email.


The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider considering the circumstances of the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

J13106 10/21

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