Increased risk with co-infection of COVID-19 and flu

People who are hospitalised with COVID-19 and the flu at the same time have a higher risk of severe disease and dying compared to those who have COVID-19 alone, according to a new analysis.

Research, delivered as part of the International Severe Acute Respiratory and emerging Infection Consortium’s (ISARIC) Coronavirus Clinical Characterisation Consortium, has found patients with co-infection of SARS-CoV-2 and influenza were more than four times more likely to be ventilated and 2.4 times more likely to die than if they only had COVID-19.

This is the largest ever study of people with COVID-19 and other endemic respiratory viruses, with study of more than 305,000 hospitalised COVID-19 patients, and the findings are published in the latest edition of The Lancet.

The research team from the University of Edinburgh, University of Liverpool, and Imperial College London, UK, and Leiden University, the Netherlands, say their findings demonstrate the need for greater flu testing of COVID-19 patients in hospital and highlight the importance of full vaccination against both COVID-19 and the flu.

They analysed data of adults who had been treated in hospital with COVID-19 in the UK between 6 February 2020 and 8 December 2021.

Test results for respiratory viral co-infections were recorded for 6965 patients with COVID-19, of whom 227 also had the influenza virus. These patients experienced significantly more severe outcomes.

Professor Kenneth Baillie, professor of experimental medicine at the University of Edinburgh, said: “We found that the combination of COVID-19 and flu viruses is particularly dangerous. This will be important as many countries decrease the use of social distancing and containment measures.

“We expect that COVID-19 will circulate with flu, increasing the chance of co-infections. That is why we should change our testing strategy for COVID-19 patients in hospital and test for flu much more widely.”

Professor Calum Semple, professor of outbreak medicine and child health at the University of Liverpool, said: “We are seeing a rise in the usual seasonal respiratory viruses as people return to normal mixing.

“So, we can expect flu to be circulating alongside COVID-19 this winter. We were surprised that the risk of death more than doubled when people were infected by both flu and COVID-19 viruses.

“It is now very important that people get fully vaccinated and boosted against both viruses, and not leave it until it is too late.”

Professor Peter Openshaw, professor of experimental medicine at Imperial College London, said while being infected with more than one virus is not very common, it is important to be aware that co-infections do happen.

“The vaccines that protect against COVID-19 and flu are different, and people need both,” he said.

“The way that these two infections are treated is also different so it’s important to test for other viruses even when you have a diagnosis in someone who is hospitalised with a respiratory infection. This latest discovery by the ISARIC consortium again adds significantly to improving the way we manage patients.”

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