A feared “twindemic” of influenza and COVID never came to pass last year, but the outlook for such a confluence this winter is resurfacing similar concerns among epidemiologists and other infectious disease experts. Flu cases started to tick up in October and November, and those months saw an outbreak at the University of Michigan at Ann Arbor.
Like COVID, flu can have serious long-term effects, says Melissa Andrew, an associate professor of medicine at Dalhousie University in Nova Scotia. “Influenza is an important trigger for heart attacks and strokes. And in older people, it can cause delirium,” she says. Delirium, also a risk factor for dementia, can lead to cognitive decline and can increase the risk of falls and hip fracture.
Even a mild flu season, Belongia says, could take a “health care system that is already at the tipping point and tip it over even further,” with severely ill flu patients competing for resources with very sick COVID patients. There is another early signal of possibly milder outcomes: Current flu infections are hovering a little above those seen in the 2015–2016 season, which had one of the lowest death counts from influenza in the past nine years. Flu seasons vary greatly in how they play out, Belongia says.
The slight mismatch is unsurprising because the committees that selected the vaccine’s flu strains had limited data on the latest strains—a result of minimal influenza circulation for almost two years—says Kawsar Talaat, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health.
“We have a population of people who are more susceptible and whose immune systems haven’t really seen a flu virus for a couple of years or more,” Belongia says. “In that setting, you want all the protection you can get and to give your immune system a head start with the vaccine.”
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