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17/09/2020

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Every year around this time, public health officials start warning about the approach of flu season. But this year is a little bit different thanks to the COVID-19 pandemic.

Now, experts are warning about the possibility of a “twindemic,” or the overlap of flu season and an expected surge in COVID-19 cases this fall and winter. Here’s what you need to know about the possibility of an upcoming twindemic, what it might look like, and what it can mean for public health.

What is a ‘twindemic,’ exactly?

The term “twindemic” was first introduced—to the general public, at least—by The New York Times in an article published on August 16. The Times credits L.J. Tan, PhD, as an "early promoter of the term." Tan is the chief strategy officer for the Immunization Action Coalition, a nonprofit group that works to increase vaccination rates.

A twindemic, per the Times, is the possibility of a severe flu season coinciding with a surge in COVID-19 cases. Even a mild flu season is concerning, given that the inevitable serious cases of the flu tax the medical system each year, Amesh A. Adalja, MD, senior scholar at the Johns Hopkins Center for Health Security, tells Health.

As of right now, experts aren’t totally sure if we’ll have a severe flu season and subsequent twindemic. The only predictor, Dr. Adalja says, is from looking at countries in the southern hemisphere like Australia, which are currently going through their winter flu season. Flu cases there have plummeted during the season, even seeing as much as a 98% drop in cases in April, according to the Australian Government’s Department of Health. A recent report from the country’s FluTracking surveillance system found that flu cases are “historically low,” with just 0.43% of people reporting influenza-like illness.

But, while that sounds like great news, Dr. Adalja doesn’t expect that we’ll see the same results. “We probably won’t get the same level of control of influenza as countries like Australia,” he says, noting that in the US, we don't currently have same social distancing regulations in place. “We have to prepare for a challenging flu season.”

What can happen if a twindemic occurs?

A lot. “We are anticipating a very vigorous winter respiratory virus season, with COVID-19 out there, perhaps increasing even more, and with influenza coming on the scene,” William Schaffner, MD, an infectious disease specialist and professor at the Vanderbilt University School of Medicine, tells Health. “There are other respiratory viruses, too.”

Even when you just look at the flu and COVID-19, “it will be challenging for doctors to distinguish one from the other,” Dr. Schaffner says.

A huge concern of doctors is the risk that the medical system will be overloaded trying to care for both COVID-19 and flu patients at once. “This is a real risk,” Richard Watkins, MD, an infectious disease physician in Akron, Ohio, and a professor of internal medicine at Northeast Ohio Medical University, tells Health.

“Even if we have to deal with a moderate-sized flu epidemic—which all by itself can stress hospital facilities—at the same time as the pandemic, we may be in for a quite rough winter,” Dr. Schaffner says.

What can you do now to prepare for a potential twindemic?

Experts stress the importance of getting your flu shot. “People should definitely get the flu vaccine, because the last thing they need is to get COVID-19 and the flu,” Dr. Watkins says.

“I implore people: Get vaccinated against influenza,” Dr. Schaffner says. “It’s one of the viruses we can do something about.” Dr. Schaffner admits that the flu vaccine “isn’t perfect” but points out that it can prevent infections completely. In cases where it doesn’t, “you’re less likely to be admitted to the ICU and less likely to die if you get vaccinated. And we can use all the help we can get,” Dr. Schaffner says.

As for when to get the vaccine, Dr. Adalja recommends aiming for some time in October to make sure it protects you throughout the season. However, if you need to get it earlier (or later, if you miss the October deadline), he says that’s OK, too.

Finally, experts stress the importance of keeping up known methods of preventing the spread of COVID-19, like social distancing, wearing masks, and washing your hands regularly. “They help protect against COVID-19 and the flu,” Dr. Schaffner says.

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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