As respiratory season approaches, the COVID-19 Delta variant is still widely circulating, resulting in increased cases, hospitalizations, and deaths. This recent surge has also led to greater vaccine urgency and a renewed focus on mitigation measures—including masking and social distancing.

The original COVID-19 strain infected older adults at higher rates, but with many in this age group now fully vaccinated, infections are now surging among younger adults and children. According to the Centers for Disease Control and Prevention (CDC) as of Tuesday, Sep. 14, young adults ages 18 to 29 account for 22.4% of COVID-19 cases with 11.6% of cases in children ages five to 17.

“The Delta variant is a lot more transmissible than previous variants and is causing roughly three to four times more infection,” says Dr. Kristin Englund, Staff Physician, in the Infectious Disease department at Cleveland Clinic. “The original COVID-19 virus had an infection quotient of two, which meant that someone infected with the virus was expected to infect two other people at one time. With the Delta variant, we are seeing an infection quotient of six to eight, which roughly means three to four times more infection transmission per infected individual.”

Other respiratory viruses such as Influenza, Respiratory Syncytial Virus (RSV), and Human Parainfluenza Viruses (HPIVs) are also beginning to emerge, so preventative measures are more important than ever.

“The Delta variant is likely to continue for several months so we now face the threat of dual respiratory viruses that could put additional strain on our health care system,” cautions Dr. Englund. “Wearing masks and keeping up a lot of the other preventative measures to control the spread of viruses can be helpful in many ways.”

Is It Covid-19 or is it the Flu? 
Both COVID-19 and Influenza attack the respiratory system. While they are caused by two very different viruses, the symptoms—which include fever, body aches, cough, runny nose, and shortness of breath—can be very similar. “For the most part, it would be very difficult to tell the difference between COVID-19 and Influenza based on the symptoms alone” says Dr. Englund. “The only way to clearly distinguish between them is through testing.”  

Testing for COVID-19 is now widely available. “If you are having any symptoms, it is going to be critically important to know if you have COVID-19 or the flu,” says Dr. Englund. “First call your doctor’s office before going to get tested. If it is COVID-19, you will be required to isolate much more than you would with the flu.”

Last year’s flu season was the mildest on record with only a few thousand cases for the entire year. “As we entered last year’s respiratory season, we didn’t have the benefit of the COVID-19 vaccine,” says Dr. Englund. “Everything we did last year to cut down on the transmission of COVID-19 also cut down dramatically on the transmission of influenza. If we can get more people vaccinated and keep up masking, social distancing, and hand sanitizing, we can hopefully keep influenza down to last year’s levels while keeping COVID-19 numbers down as well.”

As of Sep. 14, 52.96% of all Ohioans have been fully vaccinated against the COVID-19 virus, but Dr. Englund stresses that it is important that everyone get both the COVID-19 vaccine and the Influenza vaccine. “The COVID-19 vaccine and the Flu vaccine protect us against very different viruses,” she says. “One vaccine is not going to protect you against both viruses.”  

Cleveland Clinic continues to offer COVID-19 vaccinations to those ages 12 and up at several locations including at almost all primary care locations. Patients scheduling an appointment for their COVID-19 vaccine can also get their Influenza vaccine at the same time.

“The Delta variant has shown that it can mutate very rapidly and will likely continue to surge for several months,” says Dr. Englund. “It is also possible that we’ll see another variant that could be more infectious and cause more severe disease. Only if more people get vaccinated and wear masks will we be able to cut down on the amount of virus and stop the virus from mutating.”

Back to School
After the challenges of last year, the return of in-person learning remains a concern during the COVID-19 surge. As school districts work through their COVID-19 safety protocols, parents are also trying to decide what’s best for their family. “We all want children to be safe, but also know that it is better and more effective for them to be around other children socially and educationally,” says Dr. Kendalle Cobb, Family Physician and Associate Chief of Staff at Cleveland Clinic.

Cobb says the beginning of the school year is often tough as children often struggle to get into a daily routine. “Parents need to speak with their children and help them understand that some things may be different, but we are doing these things to help keep ourselves and others safe. It is important to help them build a routine around those differences,” she explains. 

While everyone 12 years and older is eligible to receive a COVID-19 vaccine, vaccination rates among children 12 to 17 years old is lower than in older age groups. “Unfortunately, many people have not been having their children 12 years and older vaccinated,” says Dr. Cobb. According to the CDC, only 40.6% of children ages 12 to 15 and 49.1% of teens ages 16-17 have been fully vaccinated. 

“I strongly recommend that parents get their eligible children vaccinated as soon as possible,” advises Dr. Cobb, “as full protection is not reached until five weeks after the first vaccine. Because we don’t have a vaccine yet for those under 12 years of age, masking, social distancing, and frequent hand washing are still very important in helping to keep our children safe.” 

Even though masks have been proven to help prevent disease, there continues to be a lot of discussion around whether they should be optional or mandatory in schools. “Some people are concerned that wearing a mask will cause their child to not get enough oxygen,” says Dr. Cobb. “Yet we know from people who have used masks for many years, including those in the medical profession, that kids with asthma or any other condition can wear a mask safely. It is not going to interfere with their breathing, and it is going to help to keep them safe.”  

Dr. Cobb also encourages parents to check in regularly with their child and ask how they are doing with masking and if they feel safe, and to make sure they are not being teased or bullied around mask wearing.

Dr. Cobb says she sees many parents also questioning the safety of their children participating in various school activities. “Parents need to consider the risk-benefit of each activity,” she advises. “The closer the contact, the more risk there is. If your child has been vaccinated and is outdoors, that allows for a certain amount of freedom. If they are going to participate in an inside activity, then wearing a mask is preferable even if they have been vaccinated.” 

Perhaps everybody is tired of the protocols and safety issues in place because of COVID-19, but unfortunately, it is still necessary to take precautions.

“We all want to be safe and want things to be like they were pre-pandemic,” says Dr. Cobb.” It is not yet time to go back to the way things were. Even though we are all tired of living with COVID-19, it is not tired and continues to change. We all need to continue to do everything that we can to protect ourselves and our loved ones.”

This story is part of a five-part series on the Cleveland Clinic’s response to the COVID-19 pandemic and efforts toward recovery. To view the full series, click here.