South Africans are right to feel like this winter’s flu is hitting harder.
Influenza and RSV are circulating simultaneously this winter, with data confirming what many people are already feeling.
A GP warns that delayed treatment and poor hygiene habits are making things worse.
Flu season arrived earlier than expected
The National Institute for Communicable Diseases’ latest Respiratory Pathogens Report confirms the influenza season began in week 11 of 2026, week of 9 March, earlier than most previous seasons, though consistent with 2025.
The report covers 29 December 2025 to 24 May 2026 and recorded 489 influenza cases from 3 031 samples tested, a detection rate of 16.1%.
General practitioner Dr Marlin McKay said while seasonal complaints are common, this year’s concern is legitimate.
“Every year, you will have this sort of anecdotal, people will say, I’ve never been so sick. But the science shows that our flu season actually started early, around about February already, which is a little different, and it’s going to last longer,” he said.
The NICD reports that influenza transmission is at a moderate level in public clinic outpatient surveillance and inpatient hospital surveillance, and lower in private GP practices.
In the week from 18 to 24 May 2026 alone, 71 influenza cases were detected from 226 samples, a detection rate of 31.4%.
McKay was direct about what a longer season means in practice. “Because we’re having a longer winter season, it means that we’re going to have more people sick and, yes, potentially even more serious illnesses,” he said.
Where influenza cases are being recorded
The NICD’s surveillance across three systems. These are public primary health care clinics, private GP practices, and inpatient public hospital pneumonia surveillance, and they show the flu burden is not evenly distributed.
Among public primary health care clinics, Edendale Gateway in KwaZulu-Natal recorded the highest number of influenza cases at 79 from 320 samples, followed by Eastridge in the Western Cape with 63 from 277, and Jouberton in the North West with 39 from 144.
Agincourt in Mpumalanga recorded 37 from 145 samples.
In private GP practices, the Western Cape recorded the highest provincial total at 72 cases from 151 samples, followed by Gauteng with 39 from 326.
The Eastern Cape and KwaZulu-Natal each recorded five, while several provinces recorded none.
In public hospitals, Klerksdorp-Tshepong in the North West recorded the highest inpatient influenza total at 52 cases from 333 samples, notable given that the North West recorded no influenza cases through private practices at all, meaning those patients are accessing care almost entirely through the public system.
Red Cross War Memorial Children’s Hospital and Harry Gwala Hospital each recorded 29 cases, while Helen Joseph-Rahima Moosa Hospital in Gauteng recorded six.
It is not a deadlier strain, but behaviour is making it spread faster
The flu strains circulating this year are not significantly more severe than in recent seasons.
The reason people are getting sicker and staying sick longer has more to do with behaviour than biology.
“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 said.
According to the NICD, three subtypes are currently circulating – A(H1N1)pdm09, A(H3N2), and B/Victoria – with A(H3N2) the most prevalent among confirmed subtyped cases at 61, followed by A(H1N1)pdm09 at 65 across two subclades, and B/Victoria at 18.
Transmission is being accelerated by the decline of basic hygiene habits.
“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,” the doctor said.
“And then with the cold weather, what are we doing? We’re staying indoors. The windows are closed. And when we’re coughing, we don’t do it into our sleeve. So we’re spreading the germs, the flu virus is just spreading much faster.”
RSV adding to the pressure
Influenza is not the only virus driving the surge.
Respiratory Syncytial Virus (RSV) is circulating simultaneously, with 398 cases recorded from 3 031 samples over the reporting period.
NICD reported that in week 21, 57 RSV cases were detected.
The RSV season also began in week 11, and activity is currently moderate.
McKay described the two viruses circulating together as a compounded burden.
“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,” he said. “It’s literally doubling the volume of cases that we are seeing because not just influenza, it’s RSV as well.”
RSV cases are particularly concentrated in public hospitals. Red Cross War Memorial Children’s Hospital recorded 105 cases, followed by Harry Gwala Hospital with 78 and Helen Joseph-Rahima Moosa Hospital with 79.
Self-medication is prolonging illness and spreading infection
Many patients are not seeking help early enough.
McKay said the pattern he is seeing is one of delayed care, with patients arriving after days of self-treatment. This worsens outcomes and keeps people contagious for longer.
“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. And they’re describing the typical flu symptoms, but 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,” he said.
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,” McKay said.
Those diagnosed with flu should stay off work or school for at least seven days, both to recover and to avoid infecting others.
When to stop self-treating and see a doctor
McKay explained that a common cold, which is usually marked by cough, sore throat and runny nose while still feeling functional, can be managed at home.
However, he noted that influenza is an entirely different matter.
“Influenza hits you hard and hits you fast. So the patient will say, ‘At two o’clock, at five past three, I felt like a bus hit me.’ So you literally feel like you’re gonna die,” the doctor said.
The symptoms that require immediate medical attention are severe headache, severe body aches and pains, a dry cough, and a high temperature.
Treatment principles remain consistent across strains. McKay suggested an antiviral to shorten the illness, bed rest, fluids, and symptomatic management.
He, however, emphasised that the most effective intervention remains prevention.
“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,” he said.
