What to Expect This Cold and Flu Season

Cool weather may come as a relief after a long, hot summer, but fall has its own challenges. As the temperature drops, we spend more time indoors, in dry, heated spaces. Last month’s outdoor barbecue becomes an indoor potluck, with people congregating in small spaces, chatting, laughing, and trading germs. Allergens such as dust or mold proliferate, affecting those with asthma or allergic rhinitis. Next thing we know, cold and flu season is back.

About Those Winter Illnesses

The Common Cold is a mild viral infection. Symptoms include sneezing, nasal congestion, sore throat, and cough. Some colds may lead to sinusitis or ear infections.

Influenza (Flu) is a viral infection of the upper respiratory tract. Every year, between 5% and 20% of Americans get the flu with symptoms such as high fever, body aches, sore throat, cough, and fatigue. The flu can be deadly for young children, the elderly, pregnant women, or those with weakened immune systems. Even if you have a mild case of the flu, others may not be so lucky. Protect them by waiting at least five days after onset of symptoms and 24 hours after your fever breaks before going out in public.

Respiratory Syncytial Virus (RSV) is a viral infection of the lungs and respiratory tract. It is especially dangerous for children, seniors, people with heart and/or lung problems or weakened immune systems, and infants, preemies in particular. The symptoms include runny nose, cough, wheezing, and difficulty breathing, and can lead to pneumonia. RSV is extremely common, with about 90% of babies and toddlers getting RSV at least once by age two.

COVID-19 (SARS-CoV-2) is a viral infection whose symptoms vary greatly in range and severity. Some may test positive but have few or even no symptoms. Others may have cold or flu symptoms. Many report losing their sense of smell and taste. Body aches, headaches, shortness of breath, vomiting, and diarrhea are also possible. As we learned during the pandemic, COVID-19 is highly contagious and can be life-threatening or even fatal. Post-COVID, a lingering cough, fatigue, memory issues, and a diminished sense of smell or taste can persist for weeks or even months. If you experience difficulty breathing, chest pain, confusion, blueish lips, or trouble waking up and staying awake, see a doctor right away. You may be prescribed the antiviral medication Paxlovid to reduce the virus’ duration, severity and risk of complications.

Pneumonia affects the air sacs in the lungs. Its causes may be viral, bacterial, or even fungal. Symptoms, which range from mild to life-threatening, include confusion, fever, a cough with mucous, sweats, chills, shaking, rapid breathing and pulse, shortness of breath, and chest pain. While there are drugs to treat bacterial or fungal pneumonia, there are no effective drugs for viral pneumonia. If you have a persistent fever over 102, your cough does not improve and is causing chest pain, or you have chills and shakes, see a doctor right away.

Acute Bronchitis is usually viral and often develops after a cold or flu. In bronchitis, the bronchi are inflamed and produce too much mucous, leading to chest pain and a persistent cough. Aches and pains, chills, headache, runny nose, sore throat, watery eyes, shortness of breath, and wheezing are all common symptoms. Bronchitis usually clears up on its own unless it progresses to pneumonia.

Pertussis, or Whooping Cough is caused by a bacterium called Bordetella pertussis and can be treated with antibiotics. Whooping cough starts out like a lingering cold but severe coughing develops after a week or two. The rapid, powerful cough persists until all air has left the lungs and the person is forced to “whoop” for air. The cough may be accompanied by watery eyes and a blueish tinge to the lips, tongue, and nailbeds. Infants six months or younger may experience apnea, a pause in their breathing, instead of coughing. This is very serious and requires emergency treatment.

Croup is a viral illness that mainly affects young children. In croup, the larynx, trachea, and bronchi are inflamed, causing hoarseness, wheezing, and a distinctive bark-like cough. Get immediate medical attention if your child is drooling, wheezing, having trouble breathing or swallowing, is lethargic and has a high fever, or if their skin takes on a pale or blueish color.

CDC Predictions for Fall and Winter, 2025 -2026

The CDC issues yearly predictions for three common respiratory illnesses: COVID-19, influenza, and RSV. This fall and winter, they expect similar levels of disease and hospitalizations as last year. Overall, they anticipate that the combined peak hospitalization rate will be within 20% of last season’s, 19.3 hospitalizations per 100,000 people in the weeks ending February 1 and 8, 2025.

COVID-19 hospitalizations are expected to be similar or higher than last year’s. If no new variant appears, the prediction is 3.8–5.9 hospitalizations per 100,000 people. If a new variant emerges that does not trigger antibodies from previous infections, that number should rise to 6.7–9.5 hospitalizations per 100,000 people. Waning population immunity and lower vaccine rates could contribute to an increase in hospitalizations. A peak in COVID cases is expected in January 2026.

Last season (2024-2025) was a high-severity flu season. Experts expect a moderately severe one this time around because bad flu seasons rarely occur back-to-back. In addition, flu vaccines have gotten more effective and more people are getting them.

Hospitalization rates for RSV are expected to remain similar to last year. New RSV immunizations for infants and older adults are helping to keep people out of the hospital. If you were vaccinated against RSV last year, you should still have strong immunity.

Protect Yourself and Your Household

While there’s no way to completely avoid infection during cold and flu season, you can do a lot to reduce your chances of getting sick.

• Wash your hands with soap and water. Spend at least 20 seconds washing your hands–one way to time this is to sing happy birthday to yourself twice. If soap is not available use hand sanitizer with an alcohol content of at least 60%.
• Stay away from people who are sick as much as you can.
• Stay home if you are sick and keep your distance from others in your household so you don’t infect them.
• Cover your mouth and nose when you sneeze or cough.
• Clean and disinfect frequently touched surfaces such as handrails, kitchen counters, light switches, etc.
• Refresh the air indoors–open windows and use portable HEPA filters and fans. Use a humidifier to add moisture to dry air.
• Wear a mask when you go out, whether you are sick or not, especially in public places like grocery stores, airports, public transportation, etc.
• Get your flu shot. If you are immunocompromised, are over 50, or have other high-risk factors, talk to your doctor about RSV and Covid vaccines. If you don’t have a doctor, click here to find one that meets your needs.

This article first appeared in the October 2025 edition of the HealthPerks newsletter.