Before the COVID-19 pandemic, Katie Jordan suspects she never once wore a mask.
But when another respiratory sickness — not COVID, per her test results — knocked her down this fall semester, she didn't hesitate. When she had to venture out to the grocery store, she masked up.
"I knew (other shoppers) didn't want the cold that I had, even if what I had wasn't COVID," said Ms. Jordan, a doctoral candidate in engineering and public policy at Carnegie Mellon University. She thinks the pandemic has normalized masking for people with a range of respiratory symptoms, no matter what's ailing them.
Administrators at Pittsburgh-area universities think so, too. After influenza season's worst start in years socked local campuses, they hope habits embraced during the pandemic will help contain the virus when students return in January for the spring semester.
Students aren't just masking voluntarily but sidelining themselves from group activities when they feel unwell — both holdover practices from the pandemic that they said they hope will keep their peers unexposed and healthy.
"There's no longer any stigma to masking," said Dr. Elizabeth Wettick, interim director in Student Health Services at the University of Pittsburgh.
Where once students with upper-respiratory infections would rally and party, she said, now their peers would want to know: "What are you doing here?"
"People are cognizant that they don't want to sicken others," Dr. Wettick said. "That messaging has permeated, which is a real bonus."
Documented flu cases began climbing at Pitt's Oakland campus in mid-October and outpaced positive COVID tests by more than five to one soon after Halloween, Dr. Wettick said, citing university-collected health data. She estimated Pitt students haven't faced a flu season this oppressive in more than a decade.
At Slippery Rock University in Butler County, flu cases in the fall semester numbered more than double those of the last two fall semesters, spokesman Justin Zackal said. But he cautioned apples-to-apples comparisons with 2020 and 2021 are a challenge.
Pandemic masking standards and related precautions over the past couple years limited not only the coronavirus but also flu transmission, setting up an eventual flu resurgence, according to epidemiologists. Mr. Zackal said Slippery Rock lifted its masking policy March 1, 2022.
Even without a mask mandate, covering up has become a norm at Indiana University of Pennsylvania, said Melissa Dick, nurse director at IUP Health Service.
"I think it's accepted that if you don't feel well, put the mask on," Ms. Dick said.
She believes the mindset has made a difference: While IUP is seeing flu, it's not overrun with the virus, she said. Ms. Dick estimated case numbers there were about typical for flu season.
For this point in the season, statewide health data show by far the highest volume of confirmed flu cases in at least eight years. People in the commonwealth had more than 124,000 confirmed cases between early October and mid-December, according to the Pennsylvania Department of Health.
Overall new-case reports appeared to be easing slightly around mid-December. The state was counting 27 flu-rated deaths at that point.
Flu season generally follows an autumn-into-winter pattern, with a peak in cases often between December and February, according to the Centers for Disease Control and Prevention. But when flu strikes — and how long it lasts — are less predictable since the start of the pandemic, the CDC warned.
At Duquesne University, which recorded 149 flu cases by mid-December, students are keeping themselves out of class when they're sick and pledging to make up the class work, said Provost David Dausey. The university has an eye on the holiday break, too.
"We always ask people, if they're experiencing [illness] signs and symptoms before they come back, to wait" and delay their return to campus, said Mr. Dausey, a professor of medicine and health sciences.
He and other campus officials emphasized it's not too late for an annual flu shot, which they pitched as a primary safeguard against the virus. Data suggest early flu outbreaks in a campus environment could contribute to the virus' spread in the broader community, said Dr. Linda Nabha, an infectious-diseases specialist with UPMC.
In addition to providing the flu shot, a clean environment and health supplies, colleges and universities can emphasize flu prevention through direct communications including text messages and emails, the CDC said via email. Among its suggested messages: Sick students should stay out of class, and everyone should clean frequently touched objects and surfaces, cover coughs with a tissue and wash hands often with soap and water.
The CDC said people can consider masking, too, to protect against respiratory viruses.
Adjusting the culture
Back at Carnegie Mellon, flu volumes by mid-December were higher than expected but not overwhelming, according to Christine Andrews, the executive director of University Health Services. Indicators suggest an increase in January and February, she said. Having gone through the pandemic, the university "developed the capacity to assist students when it comes to notifying faculty and working with them to support flexible deadlines."
The university's culture has adjusted to better support staying home during illness, said Ms. Jordan, who is a vice president at the CMU Graduate Student Assembly. Still, she cautioned that day-to-day habits seemed to shift again later in the fall semester — back toward pre-pandemic norms. Precautions had appeared to lessen.
"It's one thing to miss a class. But you really can't miss a final" exam, Ms. Jordan said. "There's not much you can do in that situation."
She cited "a growing feeling that if you tested negative for COVID, even if you're symptomatic, it's fine for you to come to campus and continue as usual."
Her take: Everyone should apply COVID-style precautions to the flu. Dr. Wettick said students have gotten much sicker from the flu than historically many have been with COVID — tangling with high fevers, myalgias and nasty coughs.
"Just because it's not COVID doesn't mean it's not highly transmissible and dangerous," Ms. Jordan said.
