Up and down the country people are looking forward to gathering for Christmas, but it appears many may end up with an unwanted gift: flu. According to data from the UK Health Security Agency (UKHSA), there has been a sharp increase in flu levels in England, with analysis of the latest data from sentinel laboratories – based on samples collected from primary and secondary care – revealing a rise in influenza positivity from 2.4% to 5.6% in the space of a week. So what should we do, and where does that leave our festivities? What is the current situation with flu? Influenza, better known as flu, is on the rise in England. According to the latest report by the UKHSA, which covers 4-10 December, there was a rise in influenza-like-illness consultations in primary care from 4.6 to 5.3 per 100,000, compared with the previous week. There has also been an increase in influenza hospitalisations, and emergency department attendances and flu admissions to intensive care have both risen. However, the report suggests that while rising, such activity currently remains within baseline or low-impact ranges. “Influenza infections always rise in the winter, usually peaking some time about December to February. The only uncertainty is how high infections will rise and exactly when the peak will happen,” said Prof Paul Hunter of the University of East Anglia. “At present, flu trends look like most years prior to Covid.” What about Covid? Covid levels are also on the rise. While the UKHSA has delayed the release of its winter Covid infection survey results for England and Scotland, the national influenza and Covid-19 surveillance report reveals an increase in case rates and positivity in pillar one (largely hospital testing), with a small increase in Covid hospitalisations. How can I tell whether I have flu or Covid? To know for sure you’d need to have a test, as both can make you feel terrible and they share some common symptoms, including fatigue and fever. “It is increasingly difficult to distinguish the symptoms of flu and Covid,” said Hunter. “Problems with sense of smell are more common in Covid and muscle aches and pains are more common in flu but the difference is not sufficient to be diagnostic.” What should I do? Public health experts have urged all those eligible for Covid or flu jabs on the NHS to make sure they get vaccinated to protect themselves from serious illness. Dr Mary Ramsay, the director for immunisation and programmes at the UKHSA, said while the NHS national booking system had now closed, those eligible for jabs could still talk to their GP or pharmacist about getting vaccinated. “Also if you have been offered the pneumonia (pneumococcal) vaccine, take up that,” said Hunter. “Often flu doesn’t kill directly but triggers people into developing pneumococcal pneumonia, which is what kills.” If you do not qualify for a flu jab on the NHS but wish to be vaccinated, they are available privately – unlike Covid jabs – for a cost of about £10-£20 depending on the pharmacy and whether a loyalty scheme is involved. However, access varies: Boots says it is not currently taking further online bookings for its private winter flu jab service, although walk-in appointments or in-store bookings may still be available, and corporate flu jab service customers can apparently still book online. The UKHSA has also recommended that antiviral medicines can be prescribed in primary care settings for people with flu if they are in clinical at-risk groups or are at risk of severe illness and complications from the virus. Antivirals for Covid are already available for certain groups, although some have expressed confusion and frustration over timely access to such treatments. “If you are someone who would be offered antivirals, test yourself for Covid early,” said Hunter, adding that even if it is negative, it would suggest treatment for flu might be necessary. What about Christmas? With several Covid Christmases under Santa’s sizable belt, much of the advice this winter will be familiar: wash hands, maintain good ventilation, consider wearing a mask in crowded spaces, and if you are feeling rough it is best to stay tucked up and away from others, particularly those who are more vulnerable.