Be Cautious of Influenza during COVID-19 Pandemic

The current COVID-19 outbreak has sparked major concerns and significantly impacted the population worldwide, as the number of patients and fatalities continue to rise over the past few months. With the rainy season fast approaching, there is another infectious threat to consider with the emergence of influenza, a viral respiratory disease that can rapidly spread to the population of all genders and ages in the same manner as the COVID-19 virus. As of January 1 to April 28, 2020, Thailand recorded 33 times the number influenza patients when compared to the number of COVID-19 patients. Furthermore, Influenza has a 2 per cent global fatality rate and the chances of death can increase by up to 26 per cent in elderly patients. This year will also mark the first simultaneous spread of both viruses, which means that in addition to the threat of getting infected with one virus, the public are also at risk of co-infection from both influenza and COVID-19, which can intensify symptoms as well as cause more complexities during the course of the treatment.

Dr. Weerawat Manosuthi Deputy Director, Department of Medicine, Bamrasnaradura Infectious Diseases Institute stated “Influenza outbreaks usually occur during rainy season, which is a major source of concern especially during the COVID-19 outbreak because both influenza and COVID-19 have very similar symptoms and can be transmitted in the same way through droplets from coughing and sneezing. Although there are prevention vaccinations available, people who have received vaccines can still be infected with influenza because vaccines are only 40-60 per cent effective based on the strain of influenza causing the outbreak each year. Most recently, there have also been cases that indicate the possibility of co-infection from both viruses. In this case where the COVID-19 outbreak is already putting a heavy strain on the healthcare system, it is imperative that we source a more effective solution to tackle the flu during this time to avoid running into further issues in the long run”. 

The incident of being simultaneously infected by both viruses at the same or co-infection can exponentially increase the severity of the illness, especially in high risk groups such as the elderly population, people with existing medical conditions and compromised immune system, and pregnant women. Based on a study conducted in the United States and China, results indicated that COVID-19 infections can increase chances of co-infection by 20 and 80 per cent respectively. Additionally 60 per cent of co-infection that occurs in conjunction with COVID-19 is type A Influenza. Most alarming of all is that co-infection can lead to a fatality rate of 29-55 per cent.   

“Symptoms that are synonymous with influenza include high fever from 38-40 degrees Celsius, headache, nasal congestion and runny nose, sore throat, coughs, muscle aches and fatigue. Should patients discover any of those symptoms; they should immediately seek medical attention, especially in the case where symptoms continue to persist for over 48 hours to receive professional advice and prescription medication for antivirals accordingly. Antivirals can relieve influenza symptoms in 2.3-4 days, reduce risk of co-infection and contain the spread of the virus to other people which is crucial especially during the current quarantine. In addition, antivirals are the most effective when taken within the first 24 hours after showing symptoms. There are many options available for antiviral medications in the market today both in the forms of pills through consumption and powder through inhalation and it is important to consider the effectiveness as well as safety accordingly.” Dr. Weerawat added.

The current efforts to contain the spread of COVID-19 has caused major limitations in medical resources, especially in the scarcity of medical supplies such as the rapidly decreasing number of hospital beds, and most importantly exhausting the human resource of healthcare professionals (HCPs) who are constantly called to the frontline of the pandemic. These issues are likely to intensify should the second wave of the COVID-19 outbreak emerges during the flu season. Current advancements in technology has been utilized to develop treatments for influenza such as antivirals that are highly effective and can significantly reduce treatment time at the hospital, which will subsequently reduce the strain on HCPs as well as contain the spread of influenza and protect against the potential danger of co-infection.  

NPM-TH-0562-05-2020

Referance

1. Thai DDC. สถานการณ์โรคไข้หวัดใหญ่. Available from https://ddc.moph.go.th/uploads/files/1280920200508032433.pdf. Accessed 8th May 2020

2. Thai DDC. Covid-19 Infected Situation Reports. Available from

3. Paget, J.Et al., Global Seasonal Influenza-associated Mortality Collaborator Network and GLaMOR Collaborating Teams*. (2019, December). Global mortality associated with seasonal influenza epidemics: New burden estimates and predictors from the GLaMOR Project. Retrieved from(2020). Coronavirus disease 2019 (Covid-19) Situation Report – 46. Retrieved from

4. WHO (2020). Coronavirus disease 2019 (Covid-19) Situation Report – 46. Retrieved from

5. Key Facts About Seasonal Flu Vaccine. (2020, April 28). Retrieved May 6, 2020, from

6. Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens. JAMA. Published online April 15, 2020. doi:10.1001/jama.2020.6266

7. Xing. Et al., Precautions Are Needed for COVID-19 Patients with Coinfection of Common Respiratory Pathogens (3/2/2020). Available at SSRN:or

8. Kwon, J. (2020, April 28). Superinfections and Coinfections in COVID-19. Retrieved from

9. Hayden FG, et al. Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. N Engl J Med 2018;379:913-23.

10. Hayden FG, et al. Efficacy and safety of the neuraminidase inhibitor zanamivir in the treatment of influenza virus infections. GG167 Influenza Study Group. N Engl J Med 1997; Sep 25;337(13):874-80.

11. Hien H. When should antiviral drugs be administered in the treatment of influenza?. Medscape. Available from