With flu season on its way, the term "twindemic" is making its way into our lexicon. It means a surge in cases of both influenza and Covid-19 at the same time. Last year, widespread social distancing and mask-wearing lowered the spread of influenza, so cases were low; in fact, Sarasota Memorial infectious disease specialist Dr. Manuel Gordillo doesn't recall seeing a single flu case in the hospital last year.

This year, however, looser Covid-19 guidelines, vaccine hesitancy and a lack of social distancing may result in a rise in flu cases. And Sarasota Memorial Hospital's infectious disease specialist Dr. Manuel Gordillo fears that a "twindemic" could indeed sweep through our community if we don't take the right steps: getting vaccinated for Covid-19 and getting a flu shot. (And yes, it's safe to get both at the same time.)

On Wednesday, Sept. 15, via video, Gordillo answered the community's questions about what to expect this flu season.

What are your concerns as the flu season ramps up this year?

"A twindemic comes to mind. Influenza is a virus that usually kills a number of people in our community every year. I don't recall seeing a single case at the hospital [last year], and during a typical season, we'd see several cases per week, plus one or two people dying from influenza in the ICU.

"Normally at this time of year, we start looking at what happened in the Southern Hemisphere to try to predict what's going to happen to us. Last year, there were no cases in the Southern Hemisphere. Winter came in the Northern Hemisphere and the same thing happened here—no cases.

"However, this year in the Southern Hemisphere, in many places people are still adhering to social distancing guidelines and wearing masks. Influenza, which is a little less contagious than Covid, is easier to control by those measures. We'll see what happens here when we are not using masks and a larger portion of the population is at higher risk of contracting secondary diseases."

Can you get the flu vaccine and Covid-19 vaccine at the same time?

"Now you can, yes.

"Last year, the CDC was saying you could not get the vaccines together. You had to get them two weeks apart. But the CDC recently announced we can co-administer the vaccines at the same time. We just have to give them on separate anatomical sides—so one in your right arm and one in your left.

"We are still waiting to hear guidance on other vaccines. The CDC is looking at data and is going to give us advice in the next few weeks. This will apply to vaccines for children, pneumonia and shingles vaccines, for example."

Should people who are immunocompromised wait in between getting vaccines? Or is the recommendation same for everybody?

"The recommendation is going to be the same for everybody. From a practical standpoint, it is better to get it done all together. It is easier and more efficient. There are no contraindications for these two particular vaccines to be given together, and it's probably easier for the immunocompromised group we mentioned."

Is one vaccine more important than the other for this season?

"Because they can be co-administered, I would say they are equally important. I'm going to qualify that it is critical for the unvaccinated to get the Covid-19 vaccine. I would say that is the top priority.

"However, when it comes to a third dose or booster dose, that is not at the same level of importance in the grand scheme of things.

"Right underneath that, I would say the rest of us should get both influenza and Covid vaccines together. If people prefer to get them separately, there would be no problem with that. But if efficiency is important to you, you can get them together."

Will people be able to tell the difference between Covid-19 and the flu?

"No. In general, the symptoms overlap. It's going to be difficult to deal with two viruses circulating at the same time. The only way to tell the difference would be to get tested.

"At SMH, we can run a single test for both the flu and Covid, called the multiplex nucleic acid amplification test. One swab gives you the answer for both. However, these tests  are expensive and a little bit difficult to find.

"We are monitoring all the tests we do. So far, we have not seen any influenza, but we are monitoring this carefully along with other viruses, like parainfluenza and rhinoviruses, to see if anything else comes into the community."

If you develop symptoms of the flu or Covid, can you safely isolate at home? Or do you need advice from doctors?

"If you have access to a test, you should get tested, whether for Covid or the flu. There is a different approach with each virus. Taking Tamiflu is the most useful for influenza. With Covid, you want to isolate for a longer period of time. There are also home tests for Covid, which can be helpful."

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