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Last year, as Americans facing the threat of covid-19 hunkered down and masked up, the flu seemed to go into hibernation.

At the height of a typical flu season, up to 1 visit in 20 to emergency departments is for the illness. But during the most recent flu season, it accounted for less than 1 of every 1,000 emergency room visits.

Experts expect that the flu will make a comeback this winter, circulating along with other seasonal respiratory viruses as well as the coronavirus. Here’s what you need to know to protect yourself and your family.

What to expect

Influenza is a notoriously difficult virus to predict. The past year with fewer cases means there may be a lower level of immunity in the general population, says Lynnette Brammer, an epidemiologist in the influenza division at the Centers for Disease Control and Prevention. This may affect children more than adults, because adult immune systems have had decades of exposure to different flu viruses.

On top of that, covid-19 will still be with us, especially because new and more contagious variants of the coronavirus that causes covid-19 are continually emerging. So it’s possible we may see both the flu and covid-19 spreading at the same time, a situation feared by some scientists last year.

“It really comes down again to behavior” and whether people continue taking the steps to avoid respiratory diseases that so effectively limited the spread of flu last season, says Sarah Cobey, an associate professor of ecology and evolution at the University of Chicago.

Your vaccine checklist

Consider vaccines as your first line of defense. They’re not available for all seasonal respiratory viruses, including many that cause the common cold. But you can be vaccinated against two of the riskiest viruses that will be circulating: influenza and the coronavirus.

In a May 2021 study published by the CDC, researchers found that the Pfizer and Moderna vaccines were 94 percent effective at preventing hospitalizations for covid-19 among people 65 and older. In comparison, the flu vaccine’s strength may seem low: The shot was 39 percent effective at keeping people from needing to see a doctor for a case of the flu during the 2019-2020 flu season, the last year for which CDC data is available. But just as with the coronavirus vaccines, flu shots also reduce your risk of serious illness or hospitalization if you do get sick. For example, the CDC estimates that in the 2019-2020 flu season, vaccinations averted about 61,000 hospitalizations among those 65 and older and 105,000 hospitalizations overall. So take these steps now:

Get a coronavirus vaccine. If you haven’t had a shot yet, get one as soon as you can. The CDC says you can even get a covid-19 shot and a flu vaccine during the same visit. And millions of people are now eligible for a booster shot. Get one if you are.

65 or older? Seek out the best flu vaccines. Two have been shown to provide better protection for older adults compared with the standard vaccine, and they’re available only for those 65 and older. The Fluzone High-Dose contains four times the amount of viral antigen (the molecule that stimulates an immune response) as the standard shot. The other vaccine, Fluad, is made with an additive that’s designed to prompt a stronger response from the immune system. If you can’t get one of those shots, a standard flu vaccine is still better than none at all.

Time your flu jab right. Flu vaccine effectiveness wanes over the course of the season, especially for older adults. Get your shot as soon as you can if you haven’t yet, and remember that it takes a couple weeks for protection to kick in.

If you’re over 65, go for a pneumococcal vaccine if you haven’t yet. The bacteria Streptococcus pneumoniae is one of the most common causes of bacterial pneumonia. Vaccines are available against this bacteria, which can also cause sinus infections and meningitis. The CDC recommends that everyone 65 and older receive a dose of PPSV23 (Pneumovax 23).

Other important steps

With covid-19, the flu and colds likely to circulate together this winter, you’ll need to practice some additional virus-fighting habits.

Hang on to your mask. Whatever the current rules are where you live, remember that wearing a mask can help protect you from covid-19 — including breakthrough infections — and may shield you from other respiratory viruses. (Even with a mask, keep a distance from anyone coughing or sniffling.)

While the flu can spread through surfaces and large droplets (as from a sneeze), it can also be transmitted via small particles in the air, just like the novel coronavirus. The CDC doesn’t actively recommend mask use for preventing the flu, but if you have any respiratory symptoms or are headed into a crowded environment — an airplane, a busy store, a big event — wearing a mask is a reasonable precaution to take, says Seema Lakdawala, an assistant professor in microbiology and molecular genetics at the University of Pittsburgh School of Medicine, who studies flu transmission. That’s especially true if you’re at higher risk for severe disease because of your age or an underlying condition.

Wash your hands. Cleaning your hands regularly with soap and water for at least 20 seconds helps prevent a wide range of diseases, not only those caused by respiratory viruses. When you don’t have access to a sink, use hand sanitizer with at least 60 percent alcohol.

Stay home when you’re sick. Many people developed at least one good habit during the pandemic: staying home the minute they had any respiratory symptoms, Lakdawala says. That meant not going to work, visiting friends or even stopping in a store. This probably helped limit the transmission of many viruses in addition to the coronavirus, she adds.

If you get sick

If you start to notice symptoms of any viral illness — fever, cough, chills, sore throat, runny nose, congestion — seek out testing, for the novel coronavirus at least. The flu, covid-19 and colds can cause symptoms that make telling one disease from the others difficult. That’s one reason it’s important to get tested early and take precautions such as isolating yourself from others.

Early testing can also help facilitate prompt treatment, which is critical for the flu and covid-19. If you have the flu and are at an increased risk of complications (because of age or an underlying illness such as asthma or diabetes), antiviral medications are recommended. These can help reduce the severity of symptoms, but meds are most effective if you start taking them within two days of noticing the first signs.

Early treatment with monoclonal antibodies and other medication may improve your prognosis if you have covid-19.

 Copyright 2021, Consumer Reports Inc.

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