“It seems to be a more aggressive strain, and it seems to be a tougher problem,” Sam Torbati, MD, co-chair and medical director of the Cedars-Sinai Emergency Department, said of this year’s flu. “Last year, I don't recall this many patients becoming this ill.”  

Torbati cautioned that it's still very early in Los Angeles’ 2026 flu season, particularly because in the U.S., the flu tends to start along the East Coast and spread westward.  

“It may get much worse,” he said.

The Cedars-Sinai Newsroom spoke with Torbati to learn why patients are getting so sick, how to treat the flu and how to avoid a serious illness.

Who needs emergency care for the flu?

We're seeing a lot of older patients who live by themselves, and if somebody is not keeping an eye on them and they become sick, then no one is taking care of them. They could be lying in bed for two days getting very dehydrated and getting into trouble.

There are also many patients with chronic diseases who develop the flu, and two or three days later they're wiped out. When they come to the hospital, sometimes they’re dehydrated, sometimes they have a bacterial infection and sometimes it's just the flu itself.

The flu, in and of itself, can cause significant problems for patients. It can make them very sick, can make them very much out of it to the point that they can't stand, become dehydrated, and hospitalization becomes necessary to get them back on their feet.

How bad is flu season so far this year?

Around the second week of December, we started seeing a lot of influenza patients coming to the Emergency Department. That spike in flu activity was similarly seen throughout the county. We're seeing patients—the very young, the very old—everybody that gets affected by flu.

We did anticipate, based on some of the predictions from the southern hemisphere, that we were going to see a moderately severe flu season.

What are the most common flu symptoms right now?

In the early phase, we typically see fever, body ache, bone pain, runny nose, cough. The fever usually lasts anywhere from two to five days. Fever tends to stop, and then we end up having a lot of the lingering symptoms. Some patients have coughs that linger for a while. Some can have congestion that can linger for a while. But the average is a good seven to 10 days. So people should expect if they get sick, that it may take that long until they're back to normal, to the point that they feel 100%.

What is the best way to treat the flu?

If you're healthy and younger and you have a viral infection with flu-like symptoms, you basically need to take care of yourself. If you're coughing a lot, take cough medication. If you have a fever, take Tylenol or Motrin. Rest, isolate, drink a lot of fluids so you don't get dehydrated.

For patients who have shortness of breath, asthma or respiratory issues—or for older patients who are developing more severe symptoms—a doctor's visit may become important primarily to make sure that there isn't any complication.

For patients who have underlying medical illnesses—heart failure, COPD (chronic obstructive pulmonary disease), severe asthma, and transplant patients—the sicker and more complicated their medical history is, and the sicker they feel, the more likely it is that a hospital would be helpful, and coming into the ER would be helpful. For some patients, we will prescribe an antiviral called Tamiflu to reduce the risk of a more serious illness if the medication can be started early enough.

What is the best way to avoid a serious flu illness?

It's still not too late to get a vaccine. And although the vaccines are not perfect—they don't completely prevent flu—there is ample evidence to show that they can reduce the severity of what flu does.

Cedars-Sinai Stories and Insights: When to Go to the ER for the Flu

Cedars-Sinai experts recommend getting the flu shot starting in September before flu season begins as early as November. They say vaccination is the most powerful tool to avoid influenza-related hospitalizations or worse. As many as 130,000 people in the U.S. died from the flu last year, according to estimates from the Centers for Disease Control and Prevention.

“By getting the flu shot, you’re not only protecting yourself, you’re protecting your family and vulnerable members of the community who would suffer a more serious illness,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and associate professor in the Department of Medicine.

Although vaccination is the best way to prevent the flu, Grein also recommends washing hands thoroughly and often, avoiding others who are sick, and wearing a mask when not feeling well to avoid spreading an illness to others.

The Cedars-Sinai Newsroom spoke with Grein and other Cedars-Sinai specialists about this year’s flu shot recommendations, how to manage flu symptoms and where to seek care during a flu illness.

Who Should Get the Flu Shot?

There are no significant changes to flu shot recommendations this year, Grein said. The vaccine is still advised for eligible adults, teens and children more than 6 months old, according to the Centers for Disease Control and Prevention. Those 65 and older are still encouraged to get a high-dose flu vaccine if available because it elicits a stronger immune response, and older adults’ immune systems weaken with age.

“If a high-dose flu shot is not available, older individuals should receive a standard dose, rather than skipping the shot,” Grein said. “It’s critical for older adults to protect themselves.”

Children 6 months to 8 years old who have never received a flu vaccine should receive two doses, spaced four weeks apart, said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s.

“Ideally, parents should vaccinate their children before the end of October to ensure protection before peak flu season,” Soni said.

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

How to Treat Flu Symptoms

Like other upper respiratory infections, flu symptoms include nasal congestion, fever, body aches, cough, sore throat and fatigue. Most people with mild symptoms will improve at home with fluids, a pain reliever such as Tylenol and rest, Grein said. Those at high risk of more serious infection—older adults, immune-compromised individuals and others with chronic health conditions—should speak with their physician soon after symptoms appear to find out whether an antiviral medication like Tamiflu would be right for them.

Those with more severe symptoms—a very high fever, loss of appetite or inability to keep fluids down—should see their physician or visit urgent care, said Jonathan Weiner, MD, chair of the Cedars-Sinai Medical Group’s Department of Primary Care and Acute Care Medicine.

Life-threatening symptoms like difficulty breathing should immediately be addressed in the nearest emergency department.

Flu Treatment for Children

Mild flu symptoms in children look similar to those of an adult and will likewise improve with fluids, rest, and Tylenol or ibuprofen, Soni said. She cautioned against giving children aspirin because of the risk of contracting Reye’s syndrome, a rare but serious illness linked to aspirin. Higher-risk children might need an antiviral treatment prescribed by a physician.

Soni explained that children 2 and younger run a high risk of dehydration, so their parents should make sure they drink and eat enough. She also advised parents to watch for signs that their child’s symptoms might be escalating.

“If a child is struggling to breathe, or showing signs of severe fatigue, vomiting or dehydration, they should be seen promptly by their physician or in the emergency department,” Soni said.

Where to Get Care for the Flu

For children and adults with milder symptoms, a virtual visit through a mobile app like Cedars-Sinai Connect is a great first step to get reassurance or guidance on the best treatment options, Weiner said.

“A physician or other provider can see you, assess how sick you appear and determine if you need to be seen in person or if you can manage your illness at home,” said Weiner, who treats patients in person and via Cedars-Sinai Connect. “If we determine that you need to see your Cedars-Sinai primary care physician or you need to go to urgent care for your symptoms, your provider will see the notes from your virtual visit in your chart because we all share the same Cedars-Sinai medical record.”

If a flu test is needed to rule out other illnesses or for a Tamiflu prescription, Cedars-Sinai Connect providers can order one through a streamlined visit at one of Cedars-Sinai’s urgent care locations. Patients also can get an over-the-counter test at their local pharmacy. Weiner said it’s good to know if you have the flu so you can avoid spreading the illness to others. People are contagious a day before symptoms start and up until their fever has resolved and symptoms are improving—as long as five to seven days after getting sick.

If symptoms do not improve, other causes of upper respiratory tract infections need to be ruled out, which could require in-person treatment, Weiner said. He emphasized that an in-person appointment also is recommended for patients with underlying conditions, high fever, trouble keeping food and liquids down, and for anyone who is having trouble breathing.

Read more on the Cedars-Sinai Blog: Flu and RSV: How to Protect Yourself Now

What type of flu activity are we seeing in California this year and what are the symptoms?

As of early January, flu activity in California has been increasing and is comparable to levels observed at this time last year. Influenza (flu) typically presents with sudden onset of high-grade fever, accompanied by body aches, chills, headache, nasal congestion, runny nose and occasionally sore throat or fatigue.

When should you see a doctor?

The course of the flu can vary from person to person, but if you're experiencing prolonged fevers lasting three to five days, worsening cough or shortness of breath, signs of dehydration, or if you have exacerbation of underlying respiratory conditions such as asthma, it may be a good idea to check in with your primary care provider. Additionally, if you develop a new fever after initially recovering from the flu, be aware of the possibility of a secondary bacterial infection, such as a pneumonia, which would require medical attention.

Is it too late to get the flu vaccine?

While getting the flu shot earlier in the season is ideal, vaccination at any point during the flu season can still provide significant protection. The flu vaccine reduces the severity of illness and lowers the risk of complications, especially for high-risk individuals such as young children, pregnant women, the elderly and those with chronic medical conditions.

Each year, the flu vaccine is designed to target the most likely circulating strains. Although the vaccine may not be a perfect match for all strains, it provides partial immunity, which is highly beneficial in preventing severe illness.

What is norovirus and how is it affecting Californians?

Norovirus, often referred to as the “stomach flu,” is a highly contagious virus that causes gastroenteritis. We see symptoms including nausea, vomiting, diarrhea, abdominal cramping and occasionally low-grade fever. Norovirus is one of the leading causes of foodborne illness.

What can people do to stay healthy during virus season?

The advice is always the same. We need to be really mindful of our hand washing and being careful among high-risk individuals. Wearing a mask is of utmost importance because of the fires but also to prevent the spread of respiratory infections in this critical time period during the winter. Additionally, remember to listen to your body and stay home if you’re unwell.

Read more on the Cedars-Sinai Blog: Ask a Doc | What’s Walking Pneumonia?

Officials from the Los Angeles County Department of Public Health reported that several cats tested positive for the bird flu, also called H5N1, after drinking raw milk. Shortly after, the officials reported the first confirmed local case of the illness in a human.

But how much of a threat does the bird flu actually pose to humans?

“This is not yet a threat to everyday people who are not in close contact with affected animals, such as dairy cattle, poultry and wild birds, and we have not seen any human-to-human transmission of the virus,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and head of the medical center’s Special Pathogens Response Team, which can test for bird flu and treat the most severe cases.

Though most human cases of H5N1 in the U.S. have been mild since the virus first appeared in 1997, Grein cautioned that the bird flu can be severe and is still evolving.

“We’re concerned that this virus now spreads more readily across mammals—cattle in particular—and as this virus mutates and adapts, it has the potential to spread even more easily,” he said. “We must remain vigilant.”

The Cedars-Sinai Newsroom asked Grein what everyone should know about bird flu, including how to treat it and how to avoid getting sick.

How is bird flu different from seasonal flu?

They’re both from the same family of influenza viruses, but H5N1 binds to different cell receptors. They both cause similar symptoms—fever, sore throat, cough, muscle aches—but conjunctivitis appears to be more common with H5N1 patients who have had close contact with dairy cattle. Both viruses can cause mild illness or more severe forms like pneumonia, but these viruses behave differently. The flu generally follows more established seasonal patterns, whereas H5N1 is more unpredictable. We largely use the same antiviral—Tamiflu—to treat H5N1 as we do to treat seasonal influenza.

How can I know which type of flu I have?

There is no way to determine which virus you’ve contracted unless you get tested. As seasonal flu activity picks up, it will be really important to understand which virus you have. From a public health perspective, we need to understand what’s happening in the community. On a personal level, you’ll want to keep those around you safe, especially if you’ve contracted something beyond the typical seasonal flu.

Will my flu shot also protect me from H5N1?

The flu shot is our most powerful tool to protect yourself and those around you from seasonal influenza. But it likely does not confer protection against bird flu. Vaccines have been developed for H5N1, but they’re not widely available at this time, although some have been stored in a strategic national stockpile to be deployed in an emergency. Drugmakers are developing additional vaccines, and their development process would likely pick up if we began seeing H5N1 spread between humans.

How can I avoid bird flu?

Nearly all cases in humans have been in people who had close contact with dairy cattle, poultry or wild birds. Individuals who must be in contact with these animals should avoid cattle and birds if they appear sick. Also avoid drinking raw milk, which the virus can easily infect.

Read more from the Cedars-Sinai Blog: Flu and RSV—How to Protect Yourself Now

“It’s not just sniffles or cold-like symptoms. It can turn into pneumonia or an even more severe illness for older adults that can lead to hospitalization and, unfortunately, sometimes their demise,” said Leslie Ramirez, MD, a physician with Cedars-Sinai’s Senior Advantage program, which specializes in caring for medically complex Medicare Advantage patients 65 and older.

Because the body’s immune system weakens with age, Ramirez said, viruses like influenza can cause more serious illness in older adults. Once hospitalized, they’re at even higher risk for developing bedsores and skin infections from lack of movement. And unlike younger people whose condition rapidly improves once an illness passes, it can take weeks for older adults to regain their strength.

“If they’ve been in the hospital for a while, when they return home, they can struggle getting in and out of bed, getting to the bathroom or sitting down and standing up,” Ramirez said. “It complicates their care and increases the burden on the family members trying to help them.”

The Cedars-Sinai Newsroom talked with Ramirez about the most effective ways to help older adults avoid a hospital stay altogether.

What can cause an older adult with the flu to need hospital care?

The flu can trigger a huge inflammatory response in the lungs of older adults who may not be able to continue breathing on their own. They might need supplemental oxygen and fluids because we tend to eat and drink less when we’re ill. Dehydration can be very harmful in older patients, causing their blood pressure to drop, as well as respiratory distress.

Older adults also are more likely to have multiple chronic health issues—heart, lung and kidney conditions—and an influenza infection can make all of those worse.

If an older adult gets the flu, how can they avoid a severe illness?

They should contact their provider as soon as they experience flu-like symptoms—fever, chills, body aches, maybe a sore throat or diarrhea—or get tested for the flu at a nearby urgent care. With a confirmed diagnosis, patients might be eligible for Tamiflu, an antiviral treatment that can help shorten the length of illness and decrease severity. But the medication must be started within five days of symptom onset.

It's also important to rest and drink plenty of water. Chicken noodle soup or broth also can help with hydration. Acetaminophen can help reduce a fever, ibuprofen can ease body aches and over-the-counter cough suppressants can help ease a cough. But always check with a provider before taking a new drug to ensure it won’t interact with your current medications or chronic conditions.

Do you have any advice for caregivers or loved ones of older adults?

It’s important to identify flu symptoms early—a fever above 100.4 degrees, chills, fatigue, body aches, an itchy throat. If you notice that an older loved one with the flu is starting to become more lethargic, very weak or confused—they don’t know where they are or who they are, and they’re usually very aware of their surroundings—those are big flags that the severity of their illness is increasing. Take them to the emergency department or call their provider immediately.

If they start complaining that they haven’t gone to the restroom as much as they normally do, that could be a sign they’re not drinking enough, or their kidneys aren’t functioning well. If their cough worsens and they’re having difficulty breathing or they’re short of breath or they can’t walk to the bathroom—those are all red flags.

How can older adults avoid the flu?

Wash your hands, especially if you’re going to be eating or you’ve been in an environment that might not be clean. You might want to avoid crowded places like giant sporting events during flu season. I’m not advocating that people skip important life events like a wedding or gathering with family, but take precautions, such as masking or keeping your distance. Some people still choose not to shake hands.

And, of course, get the flu shot. The flu vaccine is available at local pharmacies and in our clinic at Cedars-Sinai. For those 65 and older, there is a high-dose flu shot because their immune system isn’t as reactive as it used to be, and they need a stronger dose to mount a successful immune response. Younger family members also should consider getting vaccinated to reduce their risk of contracting influenza and passing it on to their older relatives. But remember, it takes two weeks to become fully protected. Keep that in mind if you want to time your flu shot ahead of Thanksgiving, the holidays or major travel.

Read more on the Cedars-Sinai Blog: Care Coordination for the Sandwich Generation

Antibiotics are often prescribed for patients experiencing a respiratory illness. But when tests reveal that a virus—such as influenza—is causing the illness, antibiotics should be stopped, Cedars-Sinai investigators say. That’s because antibiotics are not meant to treat a viral illness; they are only effective against bacterial infections.

Some flu patients continue taking antibiotics out of concern that they will also develop a bacterial pneumonia—a common “secondary” infection often seen in vulnerable patients with influenza and a leading cause of death in flu patients.

A team of investigators led by Cedars-Sinai found that when influenza patients take antibiotics, the drugs disturb the gut’s fungal microbiome. This results in an increase in immune cells called eosinophils in the lungs that hinder the function of alveolar macrophages—important immune cells that clear out pathogens from the lungs.

This chain of events actually makes it more likely that a flu patient taking antibiotics will develop a bacterial pneumonia rather than avoid one. The investigators also showed that increased levels of eosinophils are associated with poor clinical outcomes and more systemic inflammation. The results of the experimental study were published in The Journal of Clinical Investigation. 

“We need to be aware that antibiotics are not innocuous and can have harmful side effects,” said the study’s corresponding author, Peter Chen, MD, the Medallion Chair in Molecular Medicine and the interim chair of the Department of Medicine at Cedars-Sinai. “To be clear: When a flu patient has a confirmed bacterial infection, you definitely need to prescribe antibiotics. But when there is no direct evidence of such an infection, antibiotics should not be prescribed because they will not help, and could, in fact, be harmful.”

To conduct the study, investigators examined laboratory mice that had been infected with influenza followed by a bacterial infection caused by MRSA (methicillin-resistant Staphylococcus aureus), one of the most common causes of a secondary bacterial pneumonia. One group of mice received antibiotics prior to the onset of a bacterial infection; the control group did not receive any medication.

Compared with the control group, those treated with antibiotics experienced greater weight loss and showed evidence of greater lung damage after MRSA infection. The mice that were given antibiotics also had higher levels of MRSA bacteria in their lungs and higher levels of immune cells (macrophages and eosinophils). In other words, this data suggests that antibiotic treatment during an influenza infection actually impaired the body’s efforts to clear the MRSA bacteria rather than helping the body heal.

The investigators also evaluated a cohort of influenza patients at Cedars-Sinai and critically ill patients at Northwestern University and the University of Pittsburgh. They found that eosinophils increase with antibiotic use and are associated with a higher length of stay and systemic inflammation.

“Altogether, this research demonstrates that prescribing antibiotics during influenza infections may do more harm than good. This research also sheds light on the role that eosinophils play in regulating lung immunity,” said co-author David Underhill, PhD, chair of the Department of Biomedical Sciences and the Janis and William Wetsman Family Chair in Inflammatory Bowel Disease. “These results also support clinical trials using eosinophil-depleting strategies as a therapy to improve outcomes in patients admitted with influenza and other viral illnesses.”

Additional authors include Marilia Sanches Santos Rizzo Zuttion, Tanyalak Parimon, Stephanie A. Bora, Changfu Yao, Katherine Lagree, Catherine A. Gao, Richard G. Wunderink, Georgios D. Kitsios, Alison Morris, Yingze Zhang, Bryan J. McVerry, Matthew E. Modes, Alberto M. Marchevsky, Barry R. Stripp, Christopher M. Soto, Ying Wang, Kimberly Merene, Silvia Cho, Blandine L. Victor, Ivan Vujkovic-Cvijin, Suman Gupta, Suzanne L. Cassel, Fayyaz S. Sutterwala and Suzanne Devkota.

This work was supported by grants from the NIH (TP: K08HL1411590; CAG: F32HL162377; RGW: U19AI135964, U01TR003528,P01HL154998, R01HL14988, and R01LM013337; GDK: R03HL162655; AM: R01HL163646, R01HL164177; BJM: P01HL114453; PC: R01HL159953, R01HL155759). This research was also supported by NIH National Center for Advancing Translational Science (NCATS) UCLA CTSI Grant Number UL1TR001881.

Follow Cedars-Sinai Academic Medicine on LinkedIn for more on the latest basic science and clinical research from Cedars-Sinai.

Vaccination clinics begin Sept. 9 and are scheduled through November across Los Angeles County.

“Cedars-Sinai is committed to keeping our community as healthy as possible during this upcoming flu season,” said Jonathan Vickburg, LMFT, associate director of Community Health Improvement at Cedars-Sinai. “Influenza is a serious disease, especially for young children and older adults. If you haven’t gotten your vaccination yet, please come see us at one of our clinics.”

Influenza can cause severe illness that can lead to hospitalization and even death. Symptoms include fever, chills, cough, sore throat, fatigue, nausea, diarrhea, runny nose and muscle aches. Flu activity often accelerates in October, making it critical to get vaccinated now. Infectious disease experts  from Cedars-Sinai strongly urge adults, children and infants to get the flu vaccine.

“You think it will never happen to your family, but every year, thousands of people in the U.S. die from flu complications,” said Jonathan Grein, MD, Cedars-Sinai’s director of Hospital Epidemiology and associate professor in the Department of Medicine. “It takes only a couple of seconds to get a shot and protect yourself and everyone in your family who is eligible for the shot, including babies 6 months and older and pregnant women.”

The flu vaccines formulated for the 2024-25 flu season protect against three different flu viruses that are circulating this year. Infectious disease experts recommend that everyone 6 months old and up get vaccinated. All ages are welcome at the community flu shot clinics, and children must be accompanied by a parent or guardian.

Scheduled Clinics:

Monday, Sept. 9
10 a.m.–1 p.m.
Roxbury Park 
471 S. Roxbury Dr. 
Beverly Hills, CA 90212

Sunday, Sept. 15
11 a.m.–2 p.m.
Saint Basil's Church
3611 Wilshire Blvd.
Los Angeles, CA 90005

Thursday, Sept.19
7:30–10 a.m.
Hope on Union – United University Church
2208 S. Union Ave. 
Los Angeles, CA 90007

Sunday, Sept. 29
8–11 a.m.
St. Kevin Catholic Church
4072 Beverly Blvd.
Los Angeles, CA 90004

Tuesday, Oct. 1
10 a.m.–1 p.m.
Plummer Park Community Center
7377 Santa Monica Blvd. 
West Hollywood, CA 90046

Friday, Oct. 4
9 a.m.–noon
Immanuel Presbyterian Church
3300 Wilshire Blvd.
Los Angeles, CA 90010

Sunday, Oct. 6
9 a.m.–noon
Cedars-Sinai Medical Center – Steven Spielberg Parking Lot
8723 Alden Dr.
Los Angeles, CA 90048

Saturday, Oct.19
7 a.m.–noon
Children's Institute Inc. – Otis Booth Campus
2121 W. Temple St.
Los Angeles, CA 90026

Wednesday, Oct. 23
10 a.m.–noon
Watts Labor Community Action Committee (WLCAC)
2528 West Blvd. 
Los Angeles, CA 90016

Saturday, Nov. 2
7 a.m.–noon
Michelle and Barack Obama Recreation Center
5001 Obama Blvd.
Los Angeles, CA 90016

Sunday, Nov. 10
9–11 a.m.
Young Israel of Century City
9317 W. Pico Blvd.
Los Angeles, CA 90035

Tuesday, Nov. 12
Noon–2 p.m.
Fairfax Senior Citizens Center 
7929 Melrose Ave.
Los Angeles, CA 90046

Read more on the Cedars-Sinai Blog: Flu and RSV: How to Protect Yourself Now

Flu shots are available now at Cedars-Sinai medical offices—even as much of the U.S. continues to cope with unusually high levels of COVID-19 infections from that virus’ summer surge.

Though COVID-19 tends to taper off in the autumn—when flu and RSV (respiratory syncytial virus) are beginning to set in—whether the U.S. will have a tough virus season is unpredictable at this point.

“Only one thing is certain,” said Jonathan Grein, MD, director of Hospital Epidemiology at Cedars-Sinai and associate professor in the Department of Medicine. “We will definitely see influenza, COVID-19 and RSV circulating at the same time this winter.”

The most important advice Grein has for surviving this year’s respiratory virus season: Get vaccinated.

“The flu shot is still our most powerful tool to avoid influenza-related hospitalizations and deaths and keep our community safe,” Grein said. “The flu is linked to tens of thousands of deaths every year in the U.S. in addition to hospitalizations and clinic visits.”

The Cedars-Sinai Newsroom spoke with Grein for more information on vaccines, where to get medical care and other helpful advice for getting through flu season.

If someone gets sick, how can they tell which virus they have, and does it matter?

It can be tricky to tell these three illnesses apart because the flu, COVID-19 and RSV all can share similar symptoms—nasal congestion, headaches, fatigue, muscle aches, sore throat, cough and fever, and shortness of breath in more severe cases. Vomiting and diarrhea also can occur with COVID-19 or the flu. Only loss of taste and smell is more specific to COVID-19, though that occurs less often than it did early in the pandemic.

It’s important to get tested quickly to determine which illness—or illnesses—are causing your symptoms. Depending on which virus you have, you might need to start a particular treatment soon after symptoms appeared. If you’re considered high-risk—an older adult, someone who is immune-compromised or has a chronic health condition—your provider might recommend Paxlovid if you have COVID-19 or Tamiflu if you have the flu. To have the most benefit, Paxlovid should be taken within five days of symptom onset and Tamiflu within 48 hours, so it’s important to act quickly.

Who should get vaccinated against the flu, COVID-19 and RSV?

We strongly encourage adults and children older than 6 months to get the flu and COVID-19 vaccines. Ideally, you would get the flu shot in September or October and the updated COVID-19 vaccine when it becomes available shortly. Remember that it takes a couple of weeks for your immune response to develop after getting a shot.

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment through My CS-Link at locations in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

To make an appointment for a COVID-19 vaccination, visit the My Turn website from the California Department of Public Health.

We also now have an RSV vaccine for older adults, a shot for pregnant people and an immunization for babies. If you or a loved one is in one of these groups, we recommend speaking with your physician to determine if the immunization or the vaccines are appropriate. 

When should someone seek treatment for flu-like symptoms?

Most mild symptoms can be managed at home with supportive care—fluids, Tylenol, rest. A humidifier can help with congestion and a saline nasal rinse can help clear mucus. Little kids might also benefit from a nasal suction device.

If you’re not sure if your symptoms are more serious, a virtual appointment is an easy way to get an expert opinion. Cedars-Sinai Connect offers quick access to Cedars-Sinai providers—available 24/7 for urgent issues—for those in California, including kids aged 3 and older, Spanish-speaking adults and patients new to Cedars-Sinai. Individuals with immediate concerns that are not life threatening—prolonged dizziness, not tolerating food or fluids—should visit urgent care. If symptoms truly are life threatening—difficulty breathing, pain or pressure in the chest or abdomen—go to the nearest emergency department. 

How long is someone contagious after getting sick with a virus?

Every virus is a little different, but in general people start becoming infectious with a respiratory virus shortly before their symptoms start, and then remain infectious for several days afterward when their symptoms are improving. With the flu, you’re infectious a day before symptoms start and until after a fever has resolved and symptoms are improving, as long as five to seven days after getting sick. It’s helpful to think of infectiousness as more of a gradient than an on or off switch. It’s also not unexpected for a cough to linger for many days or weeks after you’ve recovered, but it does not always imply you’re infectious for that period of time.

Is there anything unusual about this year’s flu season?

We should keep a close eye on what happens with the “bird flu,” the avian influenza A(H5N1) virus. Multiple outbreaks in cattle and poultry since the spring have been connected to more than a dozen infections in humans in the U.S. Even if you don’t work on a farm, it’s still relevant information. Families tend to visit farms in the autumn, and raw milk—which is sold in some health food stores—is another potential risk factor.

The good news is that we haven’t seen any human-to-human transmission of H5N1 with these recent cases in the U.S., but public health authorities are watching these outbreaks closely. If you’re someone who has been in close contact with cattle or poultry—even if it’s at a petting zoo or county fair—and you develop flu-like symptoms, alert your physician about your exposure to animals. I’d recommend washing your hands after being in contact with these animals and avoiding raw milk.

Read more on the Cedars-Sinai Blog: Tips to Survive Peak Flu Season from a Cedars-Sinai Expert

“We’ve had patients come into our clinics testing positive for both COVID and flu,” said Caroline Goldzweig, MD, chief medical officer of the Cedars-Sinai Medical Network. “Having one doesn’t protect you from the other.”

Goldzweig said Cedars-Sinai’s primary care and urgent care offices have seen a steady rise in respiratory viruses since November. Their percentage of positive COVID-19 tests has doubled since then, rising to 14% of tested patients by the end of December.

The percentage of positive influenza tests in Los Angeles County more than doubled to almost 23% by the end of December. RSV, which mostly affects younger and older patients, peaked late in November, but 10% of tests for the virus in Los Angeles County are still positive.

Cedars-Sinai Medical Center also has seen a steady rise of COVID-19 patients since Thanksgiving, although these patients still remain a fraction of those cared for in the hospital’s 915 beds. Flu has followed a similar pattern.

Priya Soni, MD, a pediatric infectious disease specialist with Cedars-Sinai Guerin Children’s, has treated many young children and infants who have not yet been vaccinated against COVID-19 and come to the hospital needing oxygen. She recommends that babies get the COVID-19 vaccine when they’re eligible, starting at 6 months of age.

RSV also is dangerous for young infants. Expectant mothers should consider getting not only the updated COVID-19 vaccine but the newly available RSV vaccine as well, Soni said, if they’re going to deliver during respiratory virus season “so that the antibodies can protect your infant during their youngest and most vulnerable few months of life.” This is especially important because a new RSV immunization for infants is in short supply.

Soni added that it’s not too late for people of all ages to get the updated COVID-19 vaccine, especially with the further increase in cases experts are predicting over the next couple of weeks. It’s also not too late to get the flu shot. This year’s formulation is very effective against circulating influenza strains. A new RSV vaccine is also available for adults over 60, with the greatest benefit for those who are at higher risk because of chronic medical conditions.

“Remember to mask,” Soni said. “It’s a really effective way to protect yourself in very crowded situations and when you have a vulnerable family member.”

But Wait, There’s More

If a tripledemic weren’t bad enough, a fourth illness—superimposed bacterial infection—has been exacerbating an already challenging virus season, landing vulnerable patients in the hospital, said Soniya Gandhi, MD, associate chief medical officer at Cedars-Sinai.

“When you have these viral infections, there is a risk of superimposed bacterial infection,” said Gandhi, an infectious disease specialist. “And we have seen a rise in pneumococcal pneumonia as a superimposed bacterial infection on top of the viral illness.” 

Still another culprit has been appearing in Cedars-Sinai’s outpatient clinics. Goldzweig said the staff members have seen many patients with viral gastroenteritis, a stomach bug causing nausea, vomiting and diarrhea. The virus spreads through contact, likely making the rounds at holiday meals. Avoid it by not sharing food and washing hands after eating or visiting the bathroom.

Get Tested, Get Treatment

Flu, RSV and COVID-19 all share similar cold-like symptoms—nasal congestion, headaches, fatigue—plus muscle aches and fever. But it’s important to get tested to determine which virus, or viruses, might be causing symptoms.

“There's no way to tell specifically what you have without getting tested, so it's incredibly important to get tested early on during your illness because there may be specific treatment options depending on what you have, as well as specific recommendations regarding isolation and keeping you and your loved ones safe,” Gandhi said.

Gandhi said patients with COVID-19 may qualify for Paxlovid, which needs to be taken within five days of symptom onset or as soon as possible to be effective. Similarly, those with the flu might be prescribed Tamiflu, which must be taken within 72 hours of diagnosis to be effective.

For those who don’t know whether their sniffles or sore throat require a trip to the doctor, a virtual appointment can be a convenient first step. Adult patients in California can use Cedars-Sinai Connect, a new mobile app that provides quick access to Cedars-Sinai experts, who are available 24/7 for urgent issues. Same-day appointments also are available on the platform for primary care 

Mild symptoms can be managed virtually, Goldzweig said. Providers might recommend using a self-testing kit for COVID-19 or refer a patient for in-person testing or labs. Or they can follow up with a prescription if needed or advise on supportive care (fluids, Tylenol) to help patients manage symptoms at home. Goldzweig said patients with more serious symptoms—ongoing inability to tolerate food or fluids or prolonged dizziness—should visit urgent care.

For parents who want to prepare ahead of time for the possibility of a sick child, Soni recommends keeping a few things on hand: a humidifier to ease congestion and cold-like symptoms and a nasal suction device and saline solution to help clear mucus from a viral infection.

And all season long, she says, we should all “hydrate, hydrate, hydrate.”

Read more on the Cedars-Sinai Blog: COVID-19 and Flu Shots Provide a Double Dose of Protection

“We urge everyone in our community to get vaccinated because it’s so important for everyone’s health,” said Jonathan Vickburg, LMFT, associate director of Community Health Improvement at Cedars-Sinai. “Holding free flu vaccine clinics is the best way to demonstrate our commitment to our community’s health and wellbeing.”

The Oct. 8 clinics are part of a series of more than 40 free, Cedars-Sinai Health System flu vaccination clinics throughout the community. A list of upcoming clinics is below.

Influenza can cause severe illness that can lead to hospitalization and even death. During the 2022-2023 flu season in the U.S., the flu was linked with as many as 650,000 hospitalizations and as many as 58,000 deaths, according to the Centers for Disease Control and Prevention.

Flu activity often accelerates in October, making it critical to get vaccinated now if individuals haven’t already received their shots. Infectious disease experts from Cedars-Sinai and its affiliates strongly urge adults and children 6 months and older to get the flu vaccine.

“The flu shot is the best tool we have to protect ourselves from the flu,” said Kimberly Shriner, MD, medical director of Infection Prevention and Control at Huntington Health. “Make sure everyone in your home is vaccinated against the flu and also up to date on COVID-19 vaccinations as we approach the holiday season when people will be gathering.”

People especially vulnerable to the flu include adults 65 and older, patients with certain chronic medical conditions (asthma, diabetes, heart disease), those who are pregnant and children younger than 5.

“We hope that the public will take advantage of these free flu clinics to protect themselves and others in their community who are vulnerable to the flu,” said Torrance Memorial infectious disease specialist David D. Rand, MD.

The complete list of flu vaccination clinics includes:

• Cedars-Sinai Medical Center–Spielberg Building
  Oct. 8, 9 a.m.–12 p.m.
  8723 Alden Drive, Los Angeles 90048
   
• Huntington Health–Light of Love Mission Church
  Oct. 8, 9:30–11:30 a.m.
  2801 E. Colorado Boulevard, Pasadena 91107
   
• Torrance Memorial–Richard B. Hoffman Health Conference Center
  Oct. 8, 9:30–11:30 a.m.
  3315 Medical Center Drive, Torrance 90505
   
• Huntington Health–Friends In Deed
  Oct. 10, 9–11 a.m.
  444 E. Washington Boulevard, Pasadena 91104
   
• Huntington Health–Jefferson Public Library
  Oct. 10, 10 a.m.–12 p.m.
  1500 E. Villa Street, Pasadena 91106
   
• Huntington Hospital–Cafeteria
  Oct. 11, 11 a.m.–1 p.m.
  100 W. California Boulevard, Pasadena 91105
   
• Huntington Health–South Pasadena Farmer’s Market
  Oct. 12, 4–6 p.m.
  905 Meridian Avenue, South Pasadena 91030
   
• Huntington Health–Living Rock Church
  Oct. 14, 9–11 a.m.
  2181 E. Washington Boulevard, Pasadena 91104
   
• Cedars-Sinai–St. Kevin Catholic Church
  Oct. 15, 8–11 a.m.
  4072 Beverly Boulevard, Los Angeles 90004
   
• Huntington Health–St. Elizabeth Parish School
  Oct. 15, 9–11 a.m.
  1840 N. Lake Avenue, Altadena 91001
   
• Huntington Health–St. Joseph Center (Holy Family Giving Bank)
  Oct. 16, 8–10 a.m.
  1524 Fremont Avenue, Pasadena 91030
   
• Huntington Health–Villa Parke Farmer’s Market
  Oct. 17, 9–11 a.m.
  363 E. Villa Street, Pasadena 91101
   
• Cedars-Sinai–Plummer Park
  Oct. 17, 10 a.m.–1 p.m.
  7377 Santa Monica Boulevard, West Hollywood 90046
   
• Huntington Health–Hastings Branch Public Library
  Oct. 18, 10 a.m.–12 p.m.
  3325 E. Orange Grove Boulevard, Pasadena 91107
   
• Cedars-Sinai–Taste of Soul Event
  Oct. 21, 10 a.m.–7 p.m.
  Crenshaw Boulevard (between Stocker and Obama)
   
• Huntington Health–Community Church (Dream Church)
  Oct. 22, 9–11 a.m.
  1305 E. Colorado Boulevard, Pasadena 91106
   
• Huntington Hospital–Emergency Department
  Oct. 24, 4–6 p.m.
  100 W. California Boulevard, Pasadena 91105 (Fairmount Courtyard Entrance)
   
• Huntington Health–Sacred Heart Church
  Oct. 29, 10 a.m.–12 p.m.
  2835 N. Lincoln Avenue, Altadena 91001
   
• Cedars-Sinai–Young Israel of Century City
  Nov. 5, 9 a.m.–12 p.m.
  9317 W. Pico Boulevard, Los Angeles 90035

Visit Cedars-Sinai’s events page and Huntington Health’s flu page to find a nearby location.

Read more on the Cedars-Sinai Blog: Cold vs. Flu Symptoms

Flu season started early in the Southern Hemisphere, which typically gives experts some clues as to what we’ll experience here in the U.S. To avoid getting caught off guard, it’s important to get the flu shot in September or October, said infectious disease specialist Soniya Gandhi, MD, MPH, associate chief medical officer at Cedars-Sinai.

“Even a typical flu season can be deadly and can cause significant hospitalization,” Gandhi said, pointing to 58,000 deaths in the U.S. and more than half a million hospitalizations—all caused by last year’s flu. “We should do what we can to protect ourselves—and others—with the best tool we have: the flu vaccine.”

Cedars-Sinai primary care physicians and pediatricians are now offering flu shots to patients during regularly scheduled visits. Patients who have been treated by a Cedars-Sinai primary care provider in the past 16 months can schedule a vaccination appointment online through My CS-Link at clinics in Beverly Hills, Marina del Rey, Santa Monica, Los Feliz, Playa Vista and Tarzana.

In addition to the flu, COVID-19 and the respiratory syncytial virus (RSV) could again spike at the same time, triggering a “tripledemic,” Gandhi said. Last year, that same triple punch filled emergency departments across the country and strained children’s hospitals with young patients, who are vulnerable to RSV—a virus that can be serious, if not deadly, for infants and older adults.

But there’s a silver lining this year. In addition to the flu vaccine, new RSV shots are available for babies and adults over 60, and a new COVID-19 booster is coming this fall.

“These new shots and vaccines could really help protect us and our community during the upcoming season,” Gandhi said. “We need to preserve capacity in hospitals for those patients who really need that care.”

Help for Youngest and Oldest

RSV causes mild cold-like symptoms in most people, but it’s the leading cause for hospitalization among infants in the U.S. In babies, the virus can cause mild illness or it can cause dangerous inflammation in a child’s tiny airways.

“There's really no way to predict how your child would do even if they're completely healthy,” said Priya Soni, MD, a pediatric infectious disease specialist at Cedars-Sinai Guerin Children’s. “If they do end up having a horrible course with RSV, they will likely need to be hospitalized for oxygen support, fluids and other supportive measures.”

Most children in the U.S. will be infected with RSV within the first year of their life, and almost all infants will have been exposed to the virus by the time they're 2 years old.

But parents of infants have a new way to protect their children. The U.S. Food and Drug Administration (FDA) recently approved an immunization—a monoclonal antibody treatment called nirsevimab-alip (Beyfortus)—that can be given as a single-dose shot to newborns and infants during their first RSV season. Children up to 19 months old who remain vulnerable to severe disease in their second RSV season also can get the shot.

Soni said she “100%” recommends the immunization because of strong clinical trials that yielded positive results.

The FDA also recently approved a Pfizer RSV vaccine for women who are 32-36 weeks pregnant to protect their infants at birth. The same vaccine also was approved for adults 60 and older, as was another vaccine from pharmaceutical company GSK.

For older adults, the Centers for Disease Control and Prevention (CDC) recommended these new vaccines only for those who are at highest risk of severe RSV, such as patients with asthma, diabetes or heart failure. Although both vaccines are considered safe, a very small number of cases of Guillain-Barre syndrome—a condition in which a person’s immune system attacks their peripheral nerves—were reported after vaccination.

More data is needed to determine whether these episodes may have been unrelated to the vaccine, according to the CDC. But the significant risk RSV poses to some older adults could outweigh the very low risk of developing potential side effects.

Sonja Rosen, MD, section chief of Geriatric Medicine at Cedars-Sinai, said that for now,  she recommends the RSV vaccine for older patients with lung disease, or for those who are otherwise immunosuppressed and therefore at higher risk for severe illness. “Patients should speak with their physician and make an informed decision about whether this shot is right for them,” Rosen said.

New Twist on the COVID-19 Booster

The new COVID-19 booster has been updated to include a sub-variant of Omicron called XBB, which was the predominant strain at the time the shot was approved by the FDA this summer.  The vaccine should provide protection from all the strains circulating in the U.S. right now, Gandhi said.

Thanks to the new booster, antiviral medications like Paxlovid and at-home tests, Gandhi is grateful that “we're in a very different position in 2023.” She encouraged the public to take advantage of the booster when it becomes available this fall, to keep themselves and their loved ones safe, especially when gathering throughout the fall and winter holidays.

“We know immunity wanes after the administration of the booster and that many individuals may not have had a booster for quite some time,” Gandhi said. “I think it will be incredibly important, particularly in those populations that are vulnerable to COVID illness, hospitalization and potentially even death, to ensure that they get the updated booster in a timely fashion.”

She said it’s safe to get the COVID-19 and flu vaccines together. For older adults who determine with their physician that the RSV shot is right for them, they should get that immunization alone and two weeks apart from the other vaccines, if possible, Gandhi said. 

Read more on the Cedars-Sinai Blog: Flu—When to Go to the ER