Flu season is fast approaching as the COVID-19 pandemic continues, leaving employers and health care providers alike worrying how they will differentiate between the two and protect their workforce.

With no coronavirus vaccine available yet, health safety experts hope employers encourage flu vaccines to mitigate the risk of co-infections and to reduce symptoms screening confusion between influenza and coronavirus.

“We know what the challenge is this year and every year for patients, families and health care facilities dealing with influenza and a variety of other respiratory illnesses … on top of the COVID-19 situation,” said Dr. Lisa Maragakis, associate professor of medicine and infectious disease at Johns Hopkins University School of Medicine. “It’s a concern, both from the burden on the health care facilities as well as the potential consequences to patients themselves if they’re at risk for influenza.

Reports of flu and COVID-19 co-infection have been reported in the Southern Hemisphere, and the similar symptoms of the two viruses can make it difficult for health care workers to diagnose and treat, according to Dr. David Zieg, a Denver-based partner and clinical services leader at Mercer LLC, who blogged about the issue Tuesday.

Only 62% of employers are planning to issue special communications to workers about the importance of getting a flu vaccine, which Mercer called “shockingly low considering it’s unclear what co-infections of COVID-19 and influenza might look like” in a statement announcing the results of its latest survey on Tuesday.

Attorney Kevin Troutman, partner in the Houston office of Fisher Phillips LLP and co-chair of the firm’s national health care practice group, said many of his clients have inquired about encouraging or mandating flu shots, as well as the COVID-19 vaccine, when it becomes available.

While the U.S. Equal Employment Opportunity Commission has stated in the past that employers can require flu shots, the need for vaccines should be job-related, such as those working in health care, Mr. Troutman said.

Other industries, however, need to take an assessment of what the risks are of employees contracting the flu, what the workers’ duties are, and whether employees are working in close contact with each other, he said.

“If you require it and you can’t link it to the employee’s job, it’s going to be a harder requirement to enforce,” Mr. Troutman said.

But the flu vaccine is even more important than ever given the challenges of trying to determine whether a worker has flu or coronavirus, said Deborah Roy, Falmouth, Maine-based president of SafeTech Consultants Inc. and president-elect of the American Society of Safety Professionals.

“Although the symptoms are somewhat different, they’re enough alike to be difficult to assess, and right now, since we’re not at a point where COVID testing is quick, easy and accurate, that’s going to be more of a challenge,” she said. “Interestingly enough, we have pretty good experience … in terms of getting out a flu vaccine in a pandemic situation.”

In 2009, as the head of health, safety and wellness at Freeport, Maine-based L.L. Bean Inc., Ms. Roy was tasked with running the retailer’s pandemic response to the H1N1 pandemic. She decided to provide that vaccine free on site to both employees and their adult dependents —a children’s vaccine had not yet become available. The company did not mandate the vaccine, but provided a significant amount of education and created easy, free access to the vaccine, which had a significant impact on vaccination participation, she said.

While people don’t often think about 2009 as a pandemic year, 60 million people in the U.S. developed the H1N1 flu according to the U.S. Centers for Disease Control and Prevention. While it wasn’t as deadly as coronavirus, many employers created strategies to administer the flu vaccine when it became available later that year, Ms. Roy said.

She set up a flu clinic at the corporate office, creating a system where employees could leave their stations, walk in one door, receive the vaccine and walk out the other and back to their stations in about 10 minutes. The company handled the vaccines on their own, cleaning out commercial refrigerators and installing specialized thermometers to monitor the temperature of the vaccines when they arrived. For other, more remote offices, the company tested out its own stock of camping coolers to see which ones could maintain the most consistent temperature to preserve the vaccines on the trip out to those offices and to hold them while the flu clinic operated.

“A lot of employers, such as those with big distribution facilities and manufacturers — they can all pretty much (vaccinate) in the workplace,” Ms. Roy said. “If you have large numbers of employees, it’s usually more efficient. It’s also much less costly to do the vaccination on site then to send someone to the physician’s office.”

While some employers may consider making flu vaccines mandatory, Mr. Troutman recommends that employers instead strongly encourage the vaccine — an approach preferred by the EEOC. If mandatory, employers need to consider accommodations for workers who decline the shot because of medical reasons or sincerely held religious beliefs or be in danger of violating Title VII of the Civil Rights Act or the Americans with Disabilities Act, he noted.

“In general, even though it is legal for private employers to mandate vaccines as a condition of employment … I generally don’t recommend a mandate with some exceptions,” said Lindsay Ryan, shareholder in the Los Angeles office of Polsinelli PC.

Employers that mandate vaccines also need to be prepared to face resistance from employees, because “even those who wouldn’t consider themselves anti-vaxxers may be reluctant or feel like the employer was invading their privacy,” she said. “If employers are mandating vaccination and they find out that employees are suffering any negative health effects, they may see a rise in workers comp claims.”

However, Ms. Roy said that during her 12 years of vaccinating thousands of L.L. Bean workers for the flu, she’s only seen two minor reactions. Those cases were reported to the federal Vaccine Adverse Event Reporting System, where “money is available … to actually protect individuals who have been harmed (by a vaccine),” Ms. Roy said.

For employers that do strongly encourage vaccination, they may need to consider that reactions to the vaccine may mimic some coronavirus symptoms, such as a low-grade fever or body aches, Dr. Maragakis. To combat this, Johns Hopkins — which requires flu vaccines for its employees — is considering adding a question to its COVID-19 screening inquiring about a flu vaccine in the prior 48 hours to “help tease apart reactions to the vaccine from symptoms of COVID-19.”

More insurance and workers compensation news on the coronavirus crisis here.