UNC Health Talk

High Risk for COVID-19 and Flu? How to Stay Well This Winter

Winter has arrived, and in addition to the usual seasonal health concerns, such as influenza and icy sidewalks, we’re facing another winter in the midst of the COVID-19 pandemic. Some people are at a higher risk of complications from COVID-19 or the flu—or both—and need to take precautions to stay well.

We talked to UNC Health family medicine physician Sarah Ruff, MD, to learn what those who are considered high risk can do to stay safe and healthy this winter.

Who Is at High Risk of Complications from COVID-19?

While anyone of any age can have severe illness from COVID-19, older adults face the highest risk.

“Those who are most vulnerable to complications are older than 65,” Dr. Ruff says. COVID-19 can cause lung damage and breathing problems that require supplemental oxygen or, in very severe cases, mechanical ventilation. COVID-19 also can impair other organs and result in long-term symptoms, including fatigue and shortness of breath.

If you have a serious underlying medical condition or comorbidity, such as high blood pressure, cancer, asthma, lung disease, diabetes or heart disease, you are also considered high risk. You are considered high risk if you are pregnant or immediately postpartum, or if you’re a resident of a nursing home. People with obesity (a body mass index of 30 or higher) also appear to be at greater risk.

“Those with a BMI over 30 tend to get sicker, and those with a BMI over 25 can be at a little higher risk, too,” Dr. Ruff says.

Who Is at High Risk of Complications from the Flu?

Flu cases are steadily increasing. Experts expect this flu season to be worse than last year’s, when many people were still in some version of lockdown to prevent the spread of COVID-19.

“We’ve been talking a lot about COVID-19, but the flu also can cause pneumonia and lead to hospitalization,” Dr. Ruff says. Tens of thousands of people die of complications from the flu each year in the United States.

People at higher risk of complications from the flu include children younger than 2, adults 65 and older, pregnant and immediately postpartum women, residents of nursing homes, people with chronic illnesses such as asthma, lung disease and heart disease, and those with chronic immune-suppressing conditions such as diabetes and cancer.

How to Stay Safe from COVID-19 and the Flu

The most important ways you can protect yourself and others from COVID-19 are to get vaccinated, get a booster shot when you’re eligible and wear a mask in public. COVID-19 vaccines are now available to everyone age 5 and older.

The flu vaccine is critical, too, and anyone age 6 months and older can get it, typically at your doctor’s office or a pharmacy. During the 2018-2019 flu season, the flu vaccine prevented an estimated 7.52 million flu illnesses and 6,300 flu-related deaths. That’s with only about half of the U.S. population getting the vaccine.

The flu vaccine can reduce your risk of flu by 40 to 60 percent, “and even if you get the flu after getting a flu shot, you typically get a milder form of the illness and are sick for fewer days,” Dr. Ruff says.

Also, be aware of your health and wellness on days when you have an activity planned. Make sure that you’re only going out when you feel well.

Because they have such similar symptoms, you could have the flu and think it’s COVID-19 or vice versa. If you have any cold or flu-like symptoms, you need to be tested for COVID-19. This is especially important because a positive COVID-19 test means you need to isolate to protect others.

A positive test can be important for treatment, too. If you’re at high risk for complications from COVID-19, you also may be eligible for monoclonal antibody therapies, which are very effective at reducing the risk of severe disease and hospitalization from COVID-19.

Many locations offer drive-thru COVID-19 tests, or you can buy a rapid test from a pharmacy

“The rapid ones are getting better and better as far as accuracy goes. And they’re better than nothing, especially on a weekend if you don’t have any other choices,” Dr. Ruff says. “I recommend everyone stock up.”

In addition, if you are at high risk for complications from COVID-19 or the flu, take extra steps to stay safe. Limit visitors, keep at least 6 feet from other people while in public and clean your hands often.


Not feeling well or need your flu shot? Call your primary care doctor or find one near you. For a COVID-19 vaccine or booster, visit unchealthcare.org/vaccine.