Getting ready to ditch your mask as the percentage of the U.S. population vaccinated against COVID-19 steadily rises? Not so fast, warns Dr. Donald Milton, professor of applied environmental health and a leading expert on how viruses spread through air.

The problem? We still don’t know what’s happening with seasonal flu. (Remember that threat?)

A new $2,539,000 gift from Flu Lab will support Milton’s study on the potential for a resurgence later this year of influenza—which practically disappeared in many parts of the world during the pandemic—and on how flu could interact with the virus that causes COVID-19.

Although that relationship is still in question, Milton’s previous research has clearly shown that masks are an effective way to limit the spread of various viruses, including flu, which could return with a vengeance.

“From an immunological perspective, people are going to be more susceptible to flu next season because we haven’t been exposed for some time and we also don’t know how the virus is evolving,” said Milton. “Now that we have all been scarred by COVID-19, there will be a lot of people who want to wear masks during flu season, and I think that will make a difference. On the other hand, if people are like ‘it’s over, let’s party,’ it may be different.”

Milton, who has been studying how respiratory viruses pass between people for over 25 years, has led the Stop COVID study since last May to zero in on the specifics of novel coronavirus infections. With Flu Lab funding, his Public Health Aerobiology, Virology, and Exhaled Biomarker Laboratory (aka “PHAB Lab”) will expand its capacity to identify, recruit and test people infected with COVID-19 early in the course of infection, before the onset of symptoms.

This will enable the lab team to understand how the virus travels in the tiny particles exhaled in people’s breath, as well as capture potential interactions between SARS-CoV-2 and the influenza virus if any participants are infected with both. And by enrolling enough study participants and tracing their contacts, he hopes to pinpoint potential hot spots of influenza transmission on campus.

Milton is partnering with Stephen Thomas, professor of health policy and management and director of the Maryland Center for Health Equity (M-CHE) in the university’s School of Public Health, to recruit participation from three local barbershops that are part of Thomas’ Health Advocates In-Reach and Research Campaign (HAIR), a network of Black barbers and stylists trained to be community health advocates. These shops and salons have played a role in educating patrons about the importance of vaccinations and preventive health screenings in partnership with M-CHE, which aims to increase flu vaccine acceptance in Black, Latino and other communities of color.

The PHAB Lab will install an upper-room germicidal UV-C fixture in one of the shops, a system that effectively kills viruses in the air with UV light, which will allow the research team to study its effectiveness by comparing COVID-19 and influenza transmission at the three shops. All will be provided with better masks and assistance in helping them comply with new standards for infection control set by the Occupational Safety and Health Administration (OSHA).

Milton anticipates that continued mask wearing will be needed to minimize the spread of flu and prevent a resurgence of COVID-19 and its variants. His hope, though, is to find effective and reliable ways to eliminate viruses and prevent their spread that don’t depend on personal behavior.

He is also exploring potential partnerships with local restaurants that might participate in the study. Support from Flu Lab “gives us some creativity,” he said, in finding new ways to possibly prevent the next pandemic and its associated impacts, including economic woes from business closures. 

“We learned from COVID that restaurants are important places where people spread respiratory infections,” said Milton. “Through this study, we could make restaurants safe places and learn more about the flu in the process.”