In pediatrics, the stickers are the leading indicator. 

Young patients seeing Vik Mali, M.D. at Mali & Mali Pediatrics in Sterling Heights, Michigan, once ended each appointment by pawing through a stack of stickers. That’s no longer practical or safe, in light of the COVID-19 pandemic. Since March, the last medical assistant in the exam room with each patient offers a choice of stickers — Paw Patrol from one pocket, perhaps, and Dora the Explorer in the other. No patient touches a sticker that anybody else had touched previously. 

It’s just one example of the social distancing and added hygienic precautions put in place by institutions across the United States, including — but far from limited to — medical facilities. These precautions guard against the spread of COVID-19, but they also guard against the spread of more common diseases like cold and flu, too. 

“The same things we do for COVID, this is what we ought to be doing to decrease respiratory illnesses,” Dr. Mali said. 

The ubiquity of social distancing and other precautions appears to be why, according to de-identified data from the athenahealth network, symptoms more often associated with cold and flu (such as sore throat) have decreased year-over-year even as symptoms specific to COVID-19 (such as abnormal breathing and loss of taste or smell) have increased dramatically. 

(To see the athenahealth COVID-19 dashboard, click here.)

Fever and cough, major symptoms of both flu and COVID-19, are more difficult to attribute to one cause or the other. Although both of these symptoms were diagnosed at rates well above their corresponding 2019 levels during the first two waves of the COVID-19 pandemic — the first in March and April, the second in July and August — they notably fell below 2019 levels by the end of the summer.

This suggests not only lower COVID-19 rates, which mirrors a brief nationwide decline in September and October, but also lower instances of the flu-like illnesses that accounted for higher numbers in past years. 

During the first week of October in 2020, as a percentage of diagnoses recorded during patient visits, providers were diagnosing 28 percent fewer fevers, 31 percent fewer coughs, and 37 percent fewer sore throats compared to the same week the previous year. At the same time, as a percentage of patient visits, loss of taste and/or smell more than tripled as a symptom compared with the same week in 2019 — as has been the case for most of 2020, given its close association with COVID-19. 

“Wearing a mask, washing your hands, keeping your distance — that’s always been what we’ve told people when they have the flu,” said Andrew Ting, M.D. of Middleton Family Medicine, located just north of Boston. “You would think [flu cases] would go down because of that, and we’re definitely seeing that.” 

Even providers and clinical staff have experienced fewer symptoms like cough and sore throat, thanks to the precautions they’re taking. 

“I’ve been wearing an N95 mask since March, and I’ve never felt better,” Mali said. “I swab throats and have kids cough in my face — but with distance, mask wearing, and decreased duration (of exposure), we naturally have this decline in illness. We’ve definitely felt (the difference) in our office.” 

In addition to hygienic precautions, patient demand for influenza vaccinations — especially for pediatric patients — is well ahead of where it was in each of the previous two years.  

Middleton usually runs two or three flu clinics each week and depletes its stock of 2,000 flu shots by April; this year, because patient demand necessitated daily flu clinics, the practice used up its stock of flu shots by early November and had to order more. Mali & Mali Pediatrics ordered 50 percent more doses of flu vaccine than usual and so has had sufficient stock on hand to loan doses to neighboring practices, many of which have run out. 

According to athenaNet data, in the first two weeks of September 2020, twice as many pediatric visits included flu shots as had included flu shots in the same two weeks in 2019. 

As this article is published, COVID-19 case rates continue to rise to unprecedented levels across the U.S. It will be important to monitor how these diagnoses continue to trend as typical flu season ramps up alongside the pandemic. Providers are optimistic that they’ll see diminished rates of flu, at least, given the proliferation of flu vaccinations — especially among children required by their school districts to get vaccinated. 

“Families that normally wouldn’t even contemplate getting flu vaccines, despite our urging, are calling and asking for it,” Dr. Mali said. “If we do this right, this ought to be the mildest flu season on record.”