Still No ‘Twindemic,’ but Possibly Something Worse

This is the second flu season in a row that the healthcare community has held its breath waiting to see if the United States would be hit with dual widespread outbreaks of COVID-19 and influenza (aka, a twindemic). And so far, in spite of another COVID surge fueled by the Omicron variant, so good on that front. However, public health officials here and in other countries are reporting an increase in flurona—or, simultaneous diagnoses of flu and coronavirus in the same patient. While this likely doesn’t pose a threat to the public health system as a whole, it can be quite complicated for the affected individuals and the providers trying to help them. It’s actually not a new phenomenon, as cases have been identified retrospectively going back 2 years in the U.S. as well as in Israel, the United Kingdom, Brazil, and Hungary. Signs that a patient may have flurona are probably what you’d expect—fever, cough, fatigue, nasal congestion, sore throat, diarrhea, and body aches. According to the World Health Organization, transmission also takes place in a similar fashion (ie, droplets spread by coughing or sneezing, or breathing in close proximity). Risk for severe disease and poor outcomes hinges on vaccination status: patients who are vaccinated against both influenza and SARS-CoV-2 are most likely to experience mild cases; those who are vaccinated against one but not the other are at greater risk; and those who are not vaccinated against either virus are at greatest risk.