If you’ve been lucky, you were not affected by the COVID upsurge this summer, and perhaps the Flu and RSV have not been on your radar since last year’s vaccination push. But now is the time to check in to see whether you need to be revaccinated for any of these circulating viruses and to strategize about the best timing for whatever vaccinations you may need. As a review, respiratory viral infections are common all year round, but especially in the fall into the winter. While there are more than 200 viruses that can cause illness, we primarily concentrate at this time on 4: the common “cold” (which is itself an upper respiratory virus), along with the Flu (influenza), COVID, and RSV. For a review of each of these viruses, their symptoms, and treatment approaches, grab your tissues and click here.

This year, as in past years, there will be available vaccines to help lower your risk of serious infection with both COVID-19 and the Flu. While you may not consider either of these to cause serious illness at this point, it makes sense to understand how you can lower your risk of infection and serious illness, and why it’s valuable to be vaccinated for each. In case you didn’t know, last winter COVID caused more hospitalizations than the Flu and RSV combined, and as we’ve made clear, older adults (65+), especially those with underlying chronic illness, and those who are immunocompromised stand the biggest chance of hospitalization and serious illness from COVID. While vaccinations may not prevent you from becoming infected, they will lower your risk of serious illness when and if you do become infected. Those who are unvaccinated also have a greater risk of long COVID should they become infected and brand new research published in JAMA Psychiatry reports that the unvaccinated who become sick with COVID have an elevated risk of mental health problems as a result.

So when should you arrange for a COVID-19 vaccine and a Flu shot this fall? The CDC recommends that everyone over the age of 6 months receive a COVID booster and Flu shot this fall. While you can arrange to get both shots at the same time on the same day (and even in the same arm), whether that makes sense for you depends upon many factors. First, if you think you only have the ability or inclination to schedule one appointment with your local pharmacy or physician, then get both together, which is better than not getting them at all. 

With the Flu vaccine, the ideal recommendation is to postpone your receipt of the vaccine until sometime in October. The CDC starts flu surveillance on October 5th and it recommends you receive your vaccine by the end of October at the latest, so that the 5-6 month protection it affords should then see you through the entire flu season for this year into next. If by chance you don’t get it by the end of October, then get it whenever you can after that, so at least you’ll get some protection. And if you’re 65 or older, make sure to ask for the vaccine formulated as a higher dose for older adults.

Concerning the COVID-19 booster, the CDC has approved 3 new boosters from Pfizer, Moderna, and Novavax. If you fall into a high-risk category for COVID-19 (older, underlying illnesses, or immunosuppressed), you may not want to wait until late October for the booster, and you may want to get the shot as soon as possible. However, it’s complicated this year given that COVID has been surging all summer.  Experts generally recommend that you wait at least 3 months after a previous COVID infection before getting a booster and wait at least 4 months from your last shot before you get a new one.  Since the protection afforded by the vaccines begins to wane after a few months, if you take the shot too soon you may not be sufficiently protected if there’s a winter surge at the beginning of the new year. There is not one right answer for when you should get a COVID shot this year- the only “right” answer is that as an older adult, you should try to get a booster at some point to lessen your risk of serious illness, hospitalization, or even death. And if you’re worried about becoming sick from the side effects of a COVID booster? That’s just a good indication that the vaccine is doing its job and building up your antibodies.

Another question is whether you should even bother testing yourself if you feel sick this year. Whether you have the Flu, COVID, RSV, or the common cold, does it really matter if you know which one? Many experts argue yes it does, for several reasons. Regarding COVID, knowing whether it’s COVID is important (and necessary) if you need to start Paxlovid to avoid serious illness (you can only get a Paxlovid prescription if you have a confirmed positive test). It’s also important to know if it’s COVID because that will affect when you can receive a new booster shot and get the most benefit from that shot. And if instead, you have the Flu, that too is valuable to know so that you can potentially access valuable flu antiviral drugs. Concerning the at-home tests for COVID, soon you will once again be eligible to receive 4 free COVID tests from the US government. If you already have tests at home, you can find out here whether their expiration date has been extended and whether you can still use them even if the expiration date has passed. It’s thought that a negative test result from an expired test may not be reliable but if the test is positive, then the result is likely valid even if the test has expired.

Finally, when it comes to the RSV vaccine, the picture is a little less clear. It is not yet known how often people will need to be revaccinated once they’ve had one RSV vaccine. The current thinking is you won’t need the RSV vaccine annually, so if you got one last year, you won’t need to go back this year for a second shot. But there is evidence of the value of RSV vaccines for both individuals and society at large, so if you didn’t get an RSV vaccine last year, the CDC recommends you get one if you’re 75 or older, or if you’re 60-74 with underlying health conditions such as diabetes, heart disease or a weakened immune system. Since RSV usually peaks in the winter, it’s advised to get this vaccination in the early fall.