Why this winter’s flu feels worse and what’s fuelling it

South Africans are right to feel like this winter’s flu is hitting harder, according to The Citizen. Health data and clinicians say influenza arrived earlier than in most past seasons and is circulating alongside respiratory syncytial virus (RSV), increasing pressure on clinics and hospitals.

Early start, clear numbers

The National Institute for Communicable Diseases (NICD) reports the influenza season began in week 11 of 2026 the week of 9 March which is earlier than most previous seasons but consistent with 2025. Over the NICD reporting period from 29 December 2025 to 24 May 2026, 489 influenza cases were detected from 3 031 samples, a detection rate of 16.1%. In the week of 18 to 24 May, 71 influenza cases were found from 226 samples, a detection rate of 31.4%.

Two viruses at once

The NICD recorded 398 RSV cases from the same 3 031 samples over the reporting period. The RSV season also began in week 11, and the report says activity is currently moderate.

“We also have a lot of RSV, which is similar to the flu. So it’s a double whammy in that we’re having two viral infections that are very contagious that are going around at more or less the same time,” GP Dr Marlin McKay told The Citizen. “It’s literally doubling the volume of cases that we are seeing because not just influenza, it’s RSV as well.”

Not a deadlier strain behaviour is a factor

The circulating influenza subtypes reported by the NICD are A(H3N2), A(H1N1)pdm09 (across two subclades), and B/Victoria, with A(H3N2) the most prevalent among confirmed subtyped cases. The Citizen quotes McKay saying the strains are not clearly more severe than in recent years, but other factors are worsening outcomes.

“I don’t think it’s any more severe than what we’ve seen in the last few years. But because of various things, like I said, chronic conditions, obesity, our lifestyle, our stress, people tend to be more ill.”

McKay told The Citizen that declining basic hygiene habits and more indoor congregation in cold weather are accelerating transmission. “We’re forgetting basics like masks and hand hygiene. So we are transmitting the flu more commonly or much faster than before. So we’re not able to contain it,” he said.

Where cases are appearing

NICD surveillance across public clinics, private GP practices and inpatient hospitals shows uneven distribution. In public primary health care clinics, Edendale Gateway in KwaZulu-Natal recorded the highest influenza total at 79 cases from 320 samples, followed by Eastridge in the Western Cape with 63 from 277, and Jouberton in the North West with 39 from 144. In private GP practices, the Western Cape recorded 72 cases from 151 samples, and Gauteng 39 from 326. Public hospitals with high inpatient influenza totals include Klerksdorp-Tshepong in the North West with 52 cases from 333 samples.

RSV cases are concentrated in public hospitals: Red Cross War Memorial Children’s Hospital recorded 105 cases, Harry Gwala Hospital 78, and Helen Joseph‑Rahima Moosa Hospital 79.

Delayed care and self-medication are making things worse

The Citizen reports that many patients are delaying medical care and self-medicating, which clinicians say prolongs illness and extends the period patients remain contagious. Dr McKay described a common pattern of late presentations after several days of home treatment.

“What I’m seeing, at least, is that patients are first self-medicating. Most of them. So they come in and say, doctor, you know, I’ve had this thing for the last five days… because it wasn’t managed as flu from day one and they’ve been self-medicating, the flu symptoms are persisting longer, which means that they are contagious for longer.”

McKay warned there is a narrow window for effective antiviral treatment.

“Within 24 hours of the symptoms start, so that’s our first problem. And so by the time they do come, they’re not better. And in fact, they are getting worse. That’s what brings them in.”

What doctors recommend

The Citizen reports treatment advice from clinicians includes using antivirals when given early, bed rest, fluids, and symptomatic management. Doctors also advised that those diagnosed with flu should stay off work or school for at least seven days to recover and avoid infecting others.

Vaccination remains the primary prevention measure, McKay told The Citizen: “It’s the flu vaccine that will make the difference in terms of protecting people against these severe flu illnesses, because we can’t take flu lightly. Flu is deadly, especially in the young, in the old, and those with chronic conditions.”