With delta followed by omicron dominating 2021, some may wonder if “flurona” — which refers to a co-infection of the flu and the novel coronavirus, which causes COVID-19 — is worthy of major cause of concern in 2022. But as fear mounts and the word takes over headlines, many families with older loved ones are growing concerned over flurona’s potential impact on seniors.
The flu season hits every winter, and this year is no exception with healthcare providers using vaccines to prevent illness, hospitalization and deaths, explains Dr. David Cutler, a family medicine physician at Providence Saint John’s Health Center. But, “the past two winters have seen relatively few influenza cases because people have been masking, distancing and taking other measures to prevent COVID.”
So how does flurona play into this, what impact will it have on case surges and how much of a threat is it for the senior population? We consulted experts to break down what flurona actually is as well as what older adults and their families need to know.
What is flurona?
“Flurona” refers to influenza and coronavirus infections that occur at the same time, and it’s not a new concept. In the winter of 2020, when the pandemic was limited to China, many cases of simultaneous COVID and flu were detected, says Cutler. “And when the pandemic spread to New York City in the spring of 2020, there were hundreds of patients there testing positive for flu and COVID simultaneously,” he says. “But overall, it was a very tiny percentage of the thousands of COVID cases.”
However, the term “flurona” itself isn’t an actual medical or scientific term. Instead, the experts we spoke with note that it’s a “made up” word that combines “flu” and “rona” from coronavirus.
“The term ‘flurona’ is misleading since it suggests that the two viruses have merged into one, which is not accurate.”
— DR. THOMAS GILL, PROFESSOR OF GERIATRIC MEDICINE, EPIDEMIOLOGY AND INVESTIGATIVE MEDICINE AT YALE SCHOOL OF MEDICINE
“The term is misleading since it suggests that the two viruses have merged into one, which is not accurate,” says Dr. Thomas Gill, professor of geriatric medicine, epidemiology and investigative medicine at Yale School of Medicine. “Persons can become infected at the same time with the flu and COVID, just like they can become co-infected with the flu and any other virus, including the common cold, RSV, etc.”
Cutler adds, “For example, we sometimes see strep throat and mononucleosis infections at the same time. And women will sometimes get vaginal and urinary infections together.”
Why is there so much hype around flurona?
Although flurona isn’t some new hyper-contagious infection ready to teach the omicron variant a thing or two, that doesn’t mean that the concept isn’t still dangerous — especially for seniors.
“Since both influenza and COVID can cause respiratory infections, the thought is that if you got both together, you might be much, more worse off than if you got one infection alone,” explains Andrew Pekosz, who holds his doctorate in molecular and cell biology and is a virologist and professor of microbiology and immunology at the Johns Hopkins Bloomberg School of Public Health.
However, despite this initial fear, there is no need for sweeping alarms across the country, notes Pekosz. “It turns out that this doesn’t happen very frequently, and when it does, it doesn’t seem to be any more severe than either infection alone for most people,” he says.
So why has flurona become a trending term that currently invokes the same level of concern as the word omicron? To Cutler, the answer is simple: “It makes for a sensational story, a catchy name, the risk of co-infection does exist, but that’s about it,” he says. “Flurona is not a disease, it is an idea. And while it does exist, it is uncommon, preventable and unlikely to change the course of the pandemic.”
“Influenza rates are higher this year than last year. So more people may be co-infected with the flu and COVID this year than last year.”
— DR. THOMAS GILL
Do seniors need to worry about coming down with a co-infection of the flu and COVID?
Although there is no need for the general public to fear flurona, it does pose a more serious risk to those who are elderly and considered most at risk of dying from COVID complications, according to the Centers for Disease Control and Prevention (CDC).
Dr. Shravani Durbhakula, an assistant professor of anesthesiology, critical care medicine and pain medicine at Johns Hopkins School of Medicine points out that there’s also a current combination of two unfortunate factors that could make flurona a legitimate concern for seniors: The predominant flu strain this year (H2N3, and influenza A subtype) is known to cause more severe disease, and vaccination rates for influenza are low this year.
“We know that influenza results in deaths every year, with the elderly being most susceptible, and this strain is particularly concerning,” says Durbhakula. “As a population, Americans are experiencing vaccine fatigue,” and although the current flu shot isn’t specifically targeting H2N2 this year, “it is still effective against severe disease and hospitalizations.”
Flurona is also a valid, real-time concern for the elderly because of the season we’re in. “Influenza typically occurs in the winter months, and rates are higher this year than last year,” adds Gill. “So more people may be co-infected with the flu and COVID this year than last year.”
Are co-infections, in general, more serious or common for seniors?
The simple answer is yes and no. Since co-infection refers to having two or more infectious agents at the same time, it’s more common than some realize — just not in terms of COVID and the flu. “There are a lot of co-infections documented each year, the numbers vary but it can be as much as 10% of respiratory infections have two or more viruses/bacteria detected at the same time,” says Pekosz. However, he also notes that “co-infection rates can vary from year to year and across age groups.”
So although co-infections may not be more common, especially a combo of COVID and the flu, in the senior population, it is more dangerous for an older adult to have to fight off double infections.
“Since the immune response of older adults to infections is not as strong as that in young adults, older adults can have worsened outcomes to both COVID and influenza individually,” explains Shaw. “It is possible that having both at the same time can be worse than having one or the other, but we actually don’t have a lot of information on whether this is the case.”
Gill also notes that although potentially more dangerous, COVID and influenza co-infections may actually be less common in seniors because this age group actually has higher vaccination rates for both COVID and the flu than any other age group. Of those 65 and older, 95% are now fully vaccinated against COVID, according to the CDC and by December 2021, an estimated 75% of adults aged 65 and older had gotten their flu shot.
But in general: A senior may not mount as effective an immune response as a younger person, notes Durbhakula, and this makes the elderly more susceptible to severe disease.
“Both influenza and COVID can be effectively prevented with vaccines.”
— DR. DAVID CUTLER, A FAMILY MEDICINE PHYSICIAN AT PROVIDENCE SAINT JOHN’S HEALTH CENTER
How does a senior’s vaccine status affect potential co-infections?
Simply put, the risks are significant for those who are not vaccinated against COVID and/or the flu, explains Durbhakula. “This is especially true for the immunocompromised, elderly and immunosuppressed,” she says.
People who are fully vaccinated against COVID are well protected from serious illness, hospitalization or death but according to Cutler, it’s unvaccinated people who are causing the major concern right now, especially those who are high-risk. “Both influenza and COVID can be effectively prevented with vaccines,” he says. “However, since no one is completely protected from these infections, it is important to take a ‘layered’ approach to prevention.”
The bottom line on flurona and seniors
Vaccines are the most important layer of protection — from COVID, the flu or a co-infection of the two. All eligible Americans should be taking advantage of this to help protect themselves as well as those most at risk like the elderly. ”There is safe, effective protection against illness, hospitalization and death, and it is not being used adequately,” says Culter. And that deserves our focus more than flurona.
