Colorado and Denver health officials are emphasizing vaccinations and preparedness ahead of a flu season that could exacerbate the ongoing coronavirus pandemic and the stressed health care system fighting it.

The two diseases – influenza and COVID-19 – are both respiratory illnesses with similar symptoms: cough, fever, sore throat, fatigue. They both can be particularly deadly for the old, and the flu season begins this month, just as coronavirus cases are spiking in Colorado and elsewhere in the United States.

Mitigating the spread of flu this year serves not only to keep more Coloradoans healthy, officials said, but it’ll free up hospital space for any potential COVID surges while making it easier to identify COVID in patients with overlapping symptoms. What’s more, testing someone for both the flu and COVID takes time, stalls treatment and eats up resources – particularly testing supplies – that were scarce in the early days of the pandemic. Vaccinating will simplify all of that, officials said.

“Since the symptoms of COVID and flu are so similar, we anticipate flu-like symptoms could stress the COVID testing supplies and capacity because people will likely run to get COVID tested first,” said Karen Miller, the immunization nurses manager at Tri-County Public Health. “Which is great, we want people to get tested, we encourage that.”

But Miller said if flu can be prevented via vaccination, there would be less stress on testing resources. She pointed out that even if someone who was vaccinated got the flu, the case likely would be mild enough the person would not need to be tested for COVID-19.

At a press conference earlier this month, Dr. Eric France, chief medical officer for the state Department of Public Health and Environment, said that 3,500 Coloradoans were hospitalized last year because of influenza. 

“Having two respiratory viruses hitting us at the same time, like two hurricanes hitting us at the same time, is a big deal,” he said.

An “aggressive” approach to distributing that vaccine is underway in Denver, said Dr. Judith Shlay, the associate director of Denver Public Health, to help providers and patients avoid fighting a two-front war against a raging pandemic and a familiar foe.

She said Colorado has more flu vaccinations for uninsured and underinsured people than ever before. That’s a product of both the emphasis on the flu and the acknowledgement of how many people lost their jobs and their insurance over the past seven months.

At the press conference earlier this month, officials said that the state health department had received nearly 294,000 more doses of the vaccine than its normal order of roughly 5,000. It also had more than 313,000 pediatric doses. 

Shlay ticked off hotels, public schools, public health and business clinics, fire stations, Denver County Jail and transient shelters as locations Denver Public Health is targeting for intense vaccination efforts. Hotels are important because of the amount of people who can pass through them. Vaccinating staff there, then, can have outsized impacts. She said typically, about 45% of Denver is vaccinated against influenza, a number that’s lower within communities of color.

“What we want to do it focus on those areas that have been hard hit by COVID, communities of color in particular, go out there and vaccinate those folks, make it in their communities so they can get (the vaccine),” she said.

Dr. Margaret Huffman, the community health services director at Jefferson County Public Health, said her agency also was working to make the vaccine as “easy as possible” for people. 

Huffman and Shlay said there should be ample supply of the vaccine, even as demand has stepped up. There was an initial shortage early, Shlay said, but that’s replenished. Miller said they had placed their order back in January and that manufacturers have stepped up production. 

The distribution of these vaccines may provide a roadmap for how public health officials approach doling out a COVID-19 vaccine. Beyond the traditional settings of doctors’ offices and pharmacies, the nontraditional routes being explored now, like shelters, fire stations and schools, can all be important path-clearing for future distribution of a vaccine to underserved areas. 

“I proposed to the city an approach where we would actually use funding to actually build out an infrastructure and an approach, a mechanism to vaccinate children in schools and adults and families against flu in the community,” Shlay said. “Use that and learn from it to be more effective with the dissemination of the COVID-19 vaccine.”

It’s difficult to predict the severity of the coming season. Huffman said that if you’ve seen one flu season, “then you’ve seen one flu season.” The Southern Hemisphere had a mild flu season this year, and a flu expert from the Mayo Clinic told Scientific American he’d never seen rates so low. 

But unlike America’s flu season, which ended just as the pandemic took hold, the Southern Hemisphere’s season overlapped with the pandemic and the measures various countries had put in place to curtail its spread. It’s unclear if the measures taken in Colorado – masking and social distancing in particular – will help to keep rates low here, too.

“If we follow the precautions that we’re supposed to be doing, I think we could see less,” Shlay said. “The problem we’re seeing now is we’re seeing an uptick in COVID infections. Some of it we call COVID fatigue. People are tired of all of these restrictions, which are still necessary because a majority of our community isn’t immune, and we don’t have a vaccine. We have to continue to maintain it.”