‘Twindemic’: COVID and flu
Dr. Jetelina noted Australia and New Zealand just wrapped up a flu season that saw flu numbers returning to normal after a sharp drop in the last 2 years, and North America typically follows suit.
“We do expect flu will be here in the United States and probably at levels that we saw prepandemic. We’re all holding our breath to see how our health systems hold up with COVID-19 and flu. We haven’t really experienced that yet,” she said.
There is some disagreement, however, about the possibility of a so-called “twindemic” of influenza and COVID.
Richard Webby, PhD, an infectious disease specialist at St. Jude Children’s Research Hospital in Memphis, said in an interview he thinks the possibility of both viruses spiking at the same time is unlikely.
“That’s not to say we won’t get flu and COVID activity in the same winter,” he explained, “but I think both roaring at the same time is unlikely.”
As an indicator, he said, at the beginning of the flu season last year in the Northern Hemisphere, flu activity started to pick up, but when the Omicron variant came along, “flu just wasn’t able to compete in that same environment and flu numbers dropped right off.” Previous literature suggests that when one virus is spiking it’s hard for another respiratory virus to take hold.
Vaccine, treatment underuse
Another threat is vaccines, boosters, and treatments sitting on shelves.
Dr. Sweat referred to frustration with vaccine uptake that seems to be “frozen in amber.”
As of Oct. 4, only 5.3% of people in the United States who were eligible had received the updated booster launched in early September.
Dr. Nuzzo said boosters for people at least 65 years old will be key to severity of COVID this season.
“I think that’s probably the biggest factor going into the fall and winter,” she said.
Only 38% of people at least 50 years old and 45% of those at least 65 years old had gotten a second booster as of early October.
“If we do nothing else, we have to increase booster uptake in that group,” Dr. Nuzzo said.
She said the treatment nirmatrelvir/ritonavir (Paxlovid, Pfizer) for treating mild to moderate COVID-19 in patients at high risk for severe disease is greatly underused, often because providers aren’t prescribing it because they don’t think it helps, are worried about drug interactions, or are worried about its “rebound” effect.
Dr. Nuzzo urged greater use of the drug and education on how to manage drug interactions.
“We have very strong data that it does help keep people out of hospital. Sure, there may be a rebound, but that pales in comparison to the risk of being hospitalized,” she said.
Calm COVID season?
Not all predictions are dire. There is another little-talked-about scenario, Dr. Sweat said – that we could be in for a calm COVID season, and those who seem to be only mildly concerned about COVID may find those thoughts justified in the numbers.
Omicron blew through with such strength, he noted, that it may have left wide immunity in its wake. Because variants seem to be staying in the Omicron family, that may signal optimism.
“If the next variant is a descendant of the Omicron lineage, I would suspect that all these people who just got infected will have some protection, not perfect, but quite a bit of protection,” Dr. Sweat said.
Dr. Topol, Dr. Nuzzo, Dr. Sweat, Dr. Webby, Dr. Mokdad, and Dr. Jetelina reported no relevant financial relationships.
A version of this article first appeared on Medscape.com.