Ruminations: Double Virus Load : Flu and COVID-19 : "Flurona"

"Many regions are seeing higher flu activity and at the same time seeing high COVID activity. This leads to more co-infections with both pathogens."
"People working in the health-care system have always warned about the risk of having flu and COVID circulate at the same time."
"The flu is still at a very, very, very low activity at this point of time. Usually, we see a peak in January to February and currently we hardly see any flu."
"[If at risk of exposure, take precautions just as you would during any flu season or through the pandemic]; beyond that, I would say there's no need to be any more worried."
"The bottom line is simply get vaccinated against both. We have a flu vaccine and a COVID-19 vaccine that will protect from both."
Dominik Mertz, infectious disease specialist, professor, McMaster University

Health care workers take test samples in COVID-19 testing complex in Ma'ale Adumim, on December 30, 2021. (Yonatan Sindel/Flash90)

The term "flurona" originated from the Israeli Association of Public Health Physicians when in December 2020 an article on the vaccination rate for flu shots was published by the Association and the word "flurona" was used to describe "the potential for parallel outbreaks of influenza and COVID, and the resulting burden on the health system", according to Yitzah Cohen of the Corona Israel Information Headquarters.

At the end of 2021 there was a confirmed case of flurona in a 29-year-old pregnant woman who tested positive for both COVID-19 and flu. Israel's confirmed case was by no means the first such case. In June 2020 a study focused on doctors from Medilife Health Group in Istanbul, Turkey who reported six cases of co-infection in patients between March and May. Another study by doctors from Hospital Clinic Barcelona in Spain had four cases of "flurona" found in May 2020.

Flu cases are starting to rise across parts of the U.S. And that's concerning because fewer people are vaccinated for flu, compared to last year, according to the Centers for Disease Control and Prevention (CDC).

Co-infection incidents because they are still so rare, are needful of further study to more fully grasp such co-infections and determine what the best possible treatment might be comprised of, particularly for the elderly and the immunocompromised. The issue of flurona is now coming top of mind to medical experts in view of the highly contagious nature of the Omicron variant, along with the new loosening of pandemic restrictions.

There were only 69 confirmed cases of flu in Canada during the 2020-2021 flu season. And while influenza activity remains low, a total of 158 detected cases of influenza were identified between December 12, 2021 and January 1, 2022.

Social distancing, masking, handwashing restrictions have been successful in helping to curb the spread of COVID-19, and they have been useful as well in helping to limit the transmission of the flu virus. Cases of the flu have risen, at the same time that these restrictions have been loosened. The concern is that people working in the overworked health-care system will be faced with growing numbers of patients to care for while they are stretched to the limits with COVID cases.

To the present, flurona has been documented in many countries, among them the United States, Israel, Turkey, Spain, Iran, Brazil, the Philippines and Hungary. Those most at risk of co-infection have been exposed to respiratory viruses frequently, as historically these viruses are active in daycare and school settings. Those who should be practising the greatest care in infection avoidance however, remain the elderly and immunocompromised, at high risk for both COVID and flu.

Both the flu and COVID-19 have similar symptoms. Those who are co-infected may not be able to distinguish which virus is causing which symptoms, as a result. Public Health advises that the most common flu symptoms are fever, cough and muscle aches and pains. Additional symptoms are those of headache, chills, fatigue, loss of appetite, sore threat and runny nose.

COVID symptoms on the other hand, are most frequently that of coughing, difficulty in breathing, fever, chills, fatigue, muscle aches and headaches. "I think the only exception is those who have a loss of taste and smell. That's very, very likely COVID-19", added Professor Mertz. On the other hand, the most ubiquitous coronavirus now in circulation worldwide is the Omicron variant, and loss of taste and smell appears not to be symptomatic for that mutated strain.

Given the current state of knowledge about co-infection it is not yet understood whether someone with a co-infection will experience more severe symptoms; sufficient information on the combination of the two viruses to support a clear understanding is as yet absent. Both flu and COVID own different treatments but with both, treatment will have to be coordinated with the prescription drugs used to treat each, particularly high-risk patients.

Both viruses are known to spread in similar ways facilitated by coughing, sneezing and talking in close quarters. Best avoidance practise with COVID is remaining isolated when ill, improving ventilation, wearing a mask, practising social distancing, washing hands, and disinfecting surfaces. Flu-specific preventive measures are similar, including hand washing, avoiding touching nose and mouth, coughing into bend of arm, disinfecting surfaces and remaining sheltered at home when ill.