Colorado, as of now, is faring well in the fight against coronavirus. Just 3 percent of available hospital beds are currently occupied by confirmed and suspected COVID-19 patients, and the seven-day average death rate is down 90 percent from its peak in April, according to the data from the Colorado Department of Public Health and Environment (CDPHE).

But all of that could change in the months ahead. As the weather turns colder, experts worry the U.S. (and other parts of the world) may see a surge of COVID-19 cases combined with a severe flu season, a frightening “twindemic” scenario that could increase people’s risk of fatal illness and overwhelm hospitals. Others, however, predict low influenza transmission this year given the public health precautions already in place.

So how concerned should Coloradans be about what’s to come? And what can we do to stay healthy this fall and winter? We posed these questions—and others—to local epidemiologists. From the best time to get a flu shot and the risks of contracting both viruses at the same time to the likelihood of another lockdown this year and more, here’s what we learned:

There have been conflicting predictions about the upcoming flu season. Some experts warn of a possible “twindemic” if a surge of COVID-19 cases converge with a serious flu season, while others theorize that influenza won’t be as severe since many people are already taking extra precautions, like staying home and frequently washing hands. How worried should Coloradans be about the coming fall and winter?
Epidemics, by their very nature, are unpredictable, so we can’t say what this year’s flu season will look like, explains May Chu, PhD, clinical professor in the department of epidemiology at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus. We do know, however, that the​ formula for this year’s influenza virus vaccine contains three to four different influenza strains ​selected based on their prevalence in the Northern Hemisphere this year. ​This includ​es strains based on the H1N1 virus, which has been around since 2009, plus two to three other variants. The good news: “It looks like we are not getting surprises and new strains of influenza this year,” says Chu. The caveat: That doesn’t mean flu season won’t be severe. Also important: Certain behavior (like social distancing and hand-washing) can reduce the transmission of influenza, but it does not predict its seriousness, she says.

With all that in mind, “we still need to be concerned about influenza,” warns Thomas Jaenisch, MD, PhD, infectious disease epidemiologist, clinical scientist, and associate professor at the Colorado School of Public Health at the University of Colorado Anschutz Medical Campus. The flu, he points out, can cause severe illness. Last year, 3,544 Coloradans were hospitalized with influenza and three children died, according to data from the CDPHE. (The state does not report adult deaths.)

How important is it to get a flu shot this year?
Very. A flu vaccination not only protects you from the flu, but it also supports Colorado’s bigger battle against COVID-19. “We all know that [coronavirus] testing supplies are limited, and that the major instrument we have to fight COVID is testing more” and reducing testing turnaround times, explains Jaenisch. “The more unnecessary mild episodes there are of influenza triggering people to go to their health provider and get tested, the less we can concentrate on the core business” of coronavirus testing.

Getting a flu shot can also help doctors narrow down a diagnosis if you do get sick with respiratory symptoms, adds Chu. Additionally, it increases the likelihood that we’ll have more hospital beds available for COVID-19 patients in the event of a rise in cases. Bottom line: Just get vaccinated. “Even if this season might not be the most powerful or epidemic influenza season, it’s just the right thing to do,” says Jaenisch.

So when is the best time to get a flu shot?
Now through October is a good time, says Jaenisch. This follows current guidelines from the Centers for Disease Control & Prevention, which warn that vaccination in July or August is too early, especially for older people, because of the likelihood of reduced protection later in the flu season. If, for some reason, you don’t get vaccinated this month or next, it’s not too late. “As long as flu viruses are circulating, vaccination should continue, even in January or later,” states the CDC.

Where can Coloradans without health insurance get a flu shot?
Nearly all local public health agencies and some Federally Qualified Health Centers (FQHC) and Rural Health Clinics (RHC) in Colorado offer vaccines for both uninsured children and adults at no or low cost, a spokesperson with the CDPHE tells 5280 via email.

Find your local agency here. Uninsured children can also get flu shots for free through the state’s Vaccines for Children (VFC) program, the spokesperson says—see participating providers here. And, CDPHE is currently compiling a list of clinics (including drive-thru options) where uninsured Coloradans can get vaccinated. Check the CDPHE website next week to learn more.

COVID-19 and the flu share many symptoms. If people start to feel sick, will there be any way to know which virus (if either) they are ill with?
Clinically, you can’t distinguish between the two, says Jaenisch. Loss of smell and taste might be more pronounced with COVID-19, and “there might be a little bit more likelihood of other symptoms,” he adds, but the only way to confirm infection is to get tested.

The CDC recently developed a test that will check for both A and B type seasonal flu viruses and SARS CoV-2, the virus that causes COVID-19, and will be used in public health laboratories.

What would you say to Coloradans who are hesitant to get a flu shot?
The influenza vaccine has been proven very safe and efficacious for several decades, says Chu, and Coloradans—especially those at high risk for serious flu complications, including pregnant women, children, the elderly, and folks with chronic conditions like asthma, diabetes, and heart disease—shouldn’t hesitate to get vaccinated. The CDC recommends an annual flu shot for all people 6 months and older.

What poses a greater threat to Colorado this year: COVID-19 or the flu?
Definitely COVID-19, says Janesich. “We’re still learning about this disease,” says Chu, whereas influenza has been around for over a century and thus much more is known about flu viruses and how they behave. Also important: There is both a vaccine and an FDA-approved antiviral treatment for the flu—neither of which exist for coronavirus, Chu points out.

At the same time, the flu can cause serious illness and influence our fight against COVID-19. If we don’t have to deal with the added disease burden and testing burden of the flu, explains Jaenisch, we can concentrate our resources on the coronavirus.

What are the health risks of getting both COVID-19 and the flu at the same time?
There isn’t evidence on the topic, says Jaenisch, but theoretically and from a general medical perspective, getting simultaneously infected with COVID-19 and the flu—two respiratory viruses that target the lungs—would increase the likelihood of more severe disease, he says.

Aside from getting the flu vaccination, what steps can Coloradans take this fall and winter to protect themselves from both flu and COVID-19?
We should all continue following public health precautions, says Chu, like wearing a mask in public, social distancing, washing your hands frequently, and not touching your face.

What is the likelihood that Colorado will have another lockdown this fall or winter?
“We don’t know,” says Chu. Just because Colorado is faring well right now in the fight against the coronavirus doesn’t mean we won’t have another wave. “All it takes is somebody coming in from Texas for grandmother’s party, and we could start again,” warns Chu. “If we have lots of flare ups or flare ups go unreported, we’ll just be back to where we were in May and June.”

So until we’ve conquered COVID-19, we need to keep following public health guidelines. “It’s not a time to let your foot off the brake,” says Chu.