Recently, headlines have been dominated by reports about dual flu-virus and coronavirus infections. Last week Israel confirmed its first case of “flurona,” in an unvaccinated woman, followed by a growing number of cases in children in the United States. None were seriously ill, but the name “flurona” stuck.
“It sounds like ‘sharknado,’” Dr. Saad B. Omer, the director of the Yale Institute for Global Health, said. “But it’s not a known medical term.”
How concerned should we be as flu season approaches and Omicron variants continue to rise? To better understand what it means to test positive for both Omicron and flu viruses, we spoke to experts. Here’s what we learned.
Why am I only hearing about this now?
Since the pandemic, people have been testing positive for both Covid-19 as well as influenza or flu.
Researchers in China discovered almost 100 cases in Wuhan of patients who tested positive for both diseases between late January and late March 2020. The Atlantic reported that a Queens family tested positive for both diseases in February. Researchers in Barcelona also published a May 2020 paper that described four people who had both diseases in the early months after the pandemic.
These co-infections were not common in the past, when vaccines were not available. For example, a spring 2020 study in New York City found that only 36 people, or less than 3%, had simultaneous respiratory infections after more than 1,200 Covid-19 patients were tested. Last winter’s flu and cold season was also subdued. Many people wore masks and socialized less.
“The reason we haven’t talked about it much is that it’s not been clinically a challenge yet,” said Dr. Jonathan D. Grein, an infectious disease physician and the director of hospital epidemiology at Cedars Sinai Medical Center. “We anticipate that as flu becomes more prevalent, we will see more co-infections.” If it becomes a serious problem, experts expect to know a lot more about it in the coming months.
Is co-infection a way to make me twice as sick?
A co-infection doesn’t immediately mean that a patient will be doubly sick. A strong immune system may help the body fight all kinds of pathogens. One infection could trigger additional protection.
“An infection to one might help to aid your immune response to another,” Dr. Grein said, “because it’s activating that same immune response that’s going to be effective in fighting both.”
Still, scientists don’t know for sure yet, because so few people have tested positive for both Covid-19 and influenza. However, doctors don’t seem to be too concerned based on past trends.
“The majority of people who have influenza do just fine. The majority of people who have Covid do just fine, especially if they’re vaccinated,” said Dr. Andrew D. Badley, A specialist in infectious diseases The Mayo Clinic chair of the SARS-CoV-2 Covid-19 task force. “It is hard to predict,” he continued, “but we expect that the majority of people who are co-infected with the two viruses will also do just fine.”
But as Dr. Badley and other experts pointed out, it’s generally better to have one infection rather than two. There’s more chance for complications with two infections, and it’s a bigger strain on the body.
“The human immune system can create antibodies for multiple pathogens simultaneously,” said Dr. Andrew Noymer, an epidemiologist and associate professor of population health and disease prevention at the University of California, Irvine, who studies influenza.
“But given the choice between being infected with one or two, I would always choose one,” he continued, adding, “I can’t tell you that two is so much worse than one, but the less viral threats, the better.”
Who is the most vulnerable?
Dr. Omer, who is also a Yale professor of epidemiology and infectious disease, identified two groups he believed might be most at risk for co-infection.
First: unvaccinated adults. “Based on previous work on vaccinations, people who refuse one vaccine might refuse others as well,” he said. He said he expected there to be a “significant overlap between people who refuse both vaccines.”
Second: children under 5 who are too young for Covid-19 vaccination. Children are also petri dishes. They have been through fewer flu cycles than their parents. So even if a child got a flu shot, Dr. Omer said, “their library of protection is narrow” against the many viral flu strains that can emerge each year.
What are the potential risks for the elderly or frail?
Experts agreed that a patient already susceptible to severe disease from one illness could be even more at risk if they are infected twice.
“It is probable that those people who would have had a bad outcome from flu will have a very bad outcome from the combination of flu and Covid,” Dr. Badley said.
What are the potential risks for children?
Pediatricians were optimistic that “flurona” would not overwhelm most children. That’s because kids may be more likely than adults to get multiple infections at the same time.
“It’s not that surprising to most of the people who work in pediatrics,” said Dr. Frank Esper, a pediatric infectious disease physician at Cleveland Clinic Children’s Hospital. “We see co-infections all the time.”
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“Co-infections with coronavirus are expected,” Dr. Esper continued. “I do not find it to be alarming.” His research team has found that co-infections with a variety of respiratory viruses are more common in children than adults. He said that previous studies also showed that co-infections with two different viruses don’t make a child more sick.
Aaron M. Milstone is a professor of pediatric infectious diseases at Johns Hopkins University School of Medicine. He also expressed cautious optimism. Just because a child has two viruses, he said, “doesn’t mean that the immune response will be twice as aggressive or generate twice as many symptoms.”
“Because the viruses have been co-circulating, it is very reassuring — especially for parents — that we have not seen a lot of children coming into the hospital with severe co-infections,” Dr. Milstone said. He added, “We’re not all of a sudden seeing more kids in the intensive care unit.”
What happens if I get positive for both viruses?
First and foremost: Don’t panic. It may be extra stressful, but that doesn’t mean you’re about to get extra sick. Also, it’s possible that you may have already had one virus and recovered from it, but that it’s still showing up in your test results.
Call your doctor if you are experiencing severe symptoms or trouble breathing. Doctors indicated that they would treat patients with multiple infections in the same manner as they would treat someone with only one. Experts do not believe the treatments would work against each other or cause problems in the patient’s body.
“The decision to treat for Covid has to do with how sick you are,” Dr. Badley said. “That would not change if you had flu at the same time. What might change is that you might also get therapies that are directed toward influenza.”
How can I prevent coinfection?
The medical advice is the same: Get vaccinated for both Covid as well as flu. Get vaccinated now.
Both children and adults can receive both vaccines simultaneously. Children between the ages of 5 and 6 years old are eligible to receive the Covid-19 vaccine.
“We have given multiple vaccines at the same time for decades,” Dr. Badley said, with no ill effects. “The side effects are the same” when administered together, “and the side effects for both vaccines are very, very low.”
Experts also recommend wearing masks and taking social distancing steps when necessary. The coronavirus and flu are both airborne viruses. Limiting your exposure will reduce your chances of contracting them.
“If you don’t want to get the coronavirus, and you don’t want to get flu,” Dr. Esper said, “the best thing you could do is: Do basically everything you did last year.”
Source: NY Times