How to protect yourself against a flu and Covid ‘twindemic’

During the last two winters, there was at least one silver lining to the gruelling Covid pandemic: decreased social mixing, and other protective measures taken to limit the spread of the virus, had the knock-on effect of reducing the spread of flu. But now that most of us have returned to living more or less as we did pre-2020, health services are bracing themselves for a difficult winter ahead, with flu and Covid both circulating widely to create a so-called “twindemic”.

On Wednesday, the UK Health Security Agency (UKHSA) urged everyone eligible for a free flu vaccine and Covid booster to take up the offers as soon as possible. It is feared the downside of having kept flu at bay since 2019 is a population with increased vulnerability this year. In particular, because we largely avoided flu in 2021, we now have lower levels of natural immunity to the H3N2 strain that circulated to only a limited extent last year but is currently the most commonly detected flu virus worldwide.

Steve Russell, NHS director for vaccinations and screening, said this winter could be “the first time we see the effects of the so-called ‘twindemic’, with both Covid-19 and flu in full circulation”.

“There are strong indications we could be facing the threat of widely-circulating flu, lower levels of natural immunity due to less exposure over the last three winters and an increase in Covid-19 circulating, with lots of variants that can evade the immune response,” warned Dr Susan Hopkins, chief medical adviser at UKHSA. “This combination poses a serious risk to our health, particularly those in high-risk groups.”

Here’s what you need to know about protecting yourself against Covid and flu this winter.

Who is eligible for a Covid booster?

Everyone aged 50 and over will be offered a Covid booster this autumn. The jabs will also be offered to those aged five to 49 in clinical risk groups, including pregnant women, and to other groups such as household contacts of people with immunosuppression, carers and frontline health and social care workers.

When and how can I book my Covid booster?

The National Booking Service went live on September 7 and can be accessed here. As with previous campaigns, those deemed most vulnerable will be called forward first, with those eligible able to book online or through 119 as long as it has been three months since their last dose.

What is the Covid jab this autumn? Which variants does it cover?

The autumn booster will give you a dose of a vaccine made by Pfizer or Moderna. You may be offered an updated combination version of these booster vaccines, including a half-dose of the previous vaccine combined with a half-dose of a vaccine against the Omicron variant.

How effective is it?

According to the UKHSA, both the previous and the combination vaccines boost protection very effectively, but the combination vaccines produce slightly higher levels of antibody against some strains of Omicron.

What are the side effects of the Covid jab?

The NHS stresses that millions of people have had the Covid jab and serious side effects are very rare. But common side effects include a sore arm from the injection, tiredness, headache, achiness, nausea and vomiting. Some people may experience a high temperature or feel hot or shivery one or two days after their vaccination.

Can you – and should you – have Covid and flu jabs at the same time? Which is most important?

You can – the NHS says it is safe to have the Covid booster and flu vaccination at the same time. It would involve having two separate jabs, but you may be able to book one appointment for both if your GP is offering the two.

Covid vaccine centres will only be offering the Covid vaccine; if you’re getting your booster at a dedicated centre, you’d need to go elsewhere for your flu jab.

As for which is most important, if you’re in a higher risk group or working around people who are, then both are important and you should take up your offer of both. At-risk groups will be offered a free flu jab but younger, healthy adults can pay for a flu jab in a pharmacy, as in previous years. This demographic will not currently be called for a Covid booster.

How do I know if I have Covid, the flu or a cold?

The only way to know if you have Covid is to take a Covid test, although official guidance no longer advises you to do this. Some people are still eligible for free Covid tests; for instance if you work in healthcare or adult social care. The rest of us now have to buy them. Rapid lateral flow tests are available for purchase from some pharmacies and retailers, in person and online.

There are several key differences between flu and a cold. According to the NHS, flu appears quickly (within a few hours), while a cold comes on more gradually; flu affects more than just your nose and throat, whereas a cold mainly affects those areas; and while flu leaves you feeling exhausted and incapable of carrying on with normal activities, a cold may make you feel unwell but you’ll still be able to perform your normal activities.

What are the most common symptoms of Covid now?

According to ZOE Health Study tracker app data, the current top five symptoms that have emerged in recent weeks in those who had had two Covid vaccinations are: runny nose, headache, sneezing, sore throat and persistent cough. The symptoms that were previously strongly associated with the virus – loss of sense of smell, shortness of breath and fever – are now much less common in those who are fully vaccinated.

What are the most common symptoms of flu?

Flu symptoms can include: a sudden high temperature; an aching body; feeling tired or exhausted; a dry cough; a sore throat; a headache; difficulty sleeping; loss of appetite; diarrhoea or stomach pain; nausea and vomiting.

Can you get Covid and flu simultaneously?

Yes – and this is not a good combination to have. Research suggests that patients in hospital with both Covid and flu simultaneously are at far higher risk of severe disease and death. A study carried out by the universities of Edinburgh, Liverpool and Leiden and Imperial College London showed patients who were infected with SARS-CoV-2 (the virus that causes Covid) and flu at the same time were over four times more likely to require ventilation support and 2.4 times more likely to die than if they only had Covid.

How can I book a flu jab?

Anyone can book a flu jab at a pharmacy if they’re willing to pay the £16.99 cost. But at-risk groups can receive an NHS flu jab for free. You can book your free flu jab at a pharmacy if you’re 65 or over, have certain medical conditions, you are pregnant or you’re a frontline adult social care worker. From mid-October, people aged 50 and over can also receive their flu jab for free.

If you’re entitled to a free flu jab, you can also have this at your GP surgery but, if you’re struggling to book one at your practice, it may be easier to book online with a pharmacy.

All primary school children and some secondary school children are eligible for the flu nasal spray, which is usually administered at school. GP surgeries are also inviting two- and three-year-olds to receive the nasal spray vaccination at their practices.

When does flu season start and how long does it last?

Flu season falls between December and March, but the illness can start to spread from October onwards and some cases have already been detected in the UK this autumn. Although cases are concentrated in the winter months, it’s possible to catch flu at any time and sometimes outbreaks can occur as late as mid-spring.

How else can I protect myself against colds, flu and Covid this year?

The UKHSA is encouraging everyone to help stop the spread of respiratory viruses this winter by practising good hand hygiene, wearing masks in crowded or enclosed public spaces and covering their nose and mouth when they cough and sneeze.

Other than that, experts suggest a number of ways to boost your immune system naturally. These include: eating a Mediterranean diet rich in different-coloured fruit and vegetables to maximise the number of nutrients; getting a good night’s sleep (on average, adults need seven to nine hours a night); taking regular exercise; and considering topping up your vitamin D with a supplement as the days grow shorter. The Government advises everyone should consider taking a daily vitamin D supplement during autumn and winter to support their general health.