That’s bad news, according to health experts who warn the illnesses could circulate together. That scenario could make this winter more challenging than years past, and threaten chances of returning to life—and school—the way it was before the pandemic hit.

An Unprecedented Flu Season Approaches

“This year’s flu season is unlike any other because it is expected to peak alongside the ongoing COVID-19 pandemic,” says Kevin Ban, MD, chief medical officer at Walgreens. “As parents navigate the uncertainties of daycare or school, flu immunizations are more critical than ever to help ensure the health of their families and community, as well as reduce the burden on the healthcare system amidst COVID-19.” Parental fear of the flu shot has long been a barrier to high rates of vaccination for the flu, confounding health experts who continue to tout its safety and benefits, especially in a pandemic. “The flu vaccine is extremely well studied and has many years of research behind it,” says Margaret Aldrich, MD, pediatric infectious disease specialist at the Children’s Hospital at Montefiore. “It is a safe preventative measure.”

Flu Shot Fears Unfounded

Any questions about side effects from the vaccine have long been quelled by scientific studies that prove the safety and efficacy of the flu shot, even for children as young as 6 months, older people, and those who are pregnant. Any risks associated with the flu shot are exponentially smaller than the risks the flu itself presents in a given year. According to estimates from the Centers for Disease Control and Prevention (CDC), “influenza has resulted in between 9 million and 45 million illnesses, between 140,000 and 810,000 hospitalizations, and between 12,000 and 61,000 deaths annually since 2010."

Similar Symptoms Could Lead to Added Confusion

And when you combine this with the COVID-19 pandemic, especially considering symptoms of the two illnesses are very similar, it could become a problematic situation. “It is going to be very difficult clinically to differentiate between flu and COVID,” says Aldrich. “In addition, we don’t know if one infection could worsen the other and if people might get a co-infection.” Schools across the country are fervently trying to salvage the 2020-21 school year, welcoming students back in waves even in districts that began the year using a distance learning approach. Many schools have implemented COVID safety measures like daily temperature checks, mask wearing, and physical distancing in order to prevent outbreaks. But the incoming flu season will pose a challenge when it comes to determining whether kids are potentially sick with COVID-19 or a more common illness, like the flu or even a cold that may also present with a fever, cough, and fatigue. “While they share some similarities, the flu and COVID-19 are caused by different viruses,” says Ban. “Because some of the symptoms of flu and COVID-19 are similar, it may be hard to tell the difference between them based on symptoms alone, and testing may be needed to help confirm a diagnosis.” Aldrich agrees it could become an extremely complicated season, “Schools and respective health departments will likely err on the side of caution, and any childhood illness will need to be considered as COVID positive until proven otherwise," she says. “This will be a real challenge for schools, families and community pediatricians.” While it’s true that the flu and COVID-19 are both viruses that the majority of children will overcome, the possibility of COVID-19 outbreaks in schools has health experts more concerned due to how easily the virus is transmitted, and because of the way it can affect older individuals much more severely than younger ones. While kids may be at less risk for severe symptoms, studies suggest they may carry high viral loads and be “silent spreaders.” That makes testing critical in order to contain the spread and implement contact tracing measures as much as possible. It’s a tall order for the United States, which has lagged behind much of the world when it comes to implementing widespread testing protocols.