It’s been branded ‘Florona’ and headlines have been screaming its detection in Israel. To be sure though, it is not a new variant of the novel coronavirus, or a health scare never encountered before. ‘Florona’ is rather a new coinage being used to describe a dual infection with, or coinfection of, the influenza virus and Sars-CoV-2. That has implications for how severe the symptoms can be and recovery. Here’s what you need to know.
What Is ‘Florona’?
Reports in Israel say one of the first cases of Covid-19 and influenza in the same person was that of a pregnant woman at a hospital. Amid the rise of the Omicron variant and the continuing spread of Delta cases, it is understandable that such coinfection has sparked fears. Reports say that Israeli doctors have observed a surge in influenza cases in the past few weeks.
It is viewed as a major breakdown of the immunity system for a person to simultaneously contract both influenza and Covid-19 but, in this specific case of the woman admitted to hospital for delivery, reports said that she was vaccinated for neither of the diseases.
The US Centres for Disease Control and Prevention (CDC) says that for both Covid-19 and influenza, “one or more days can pass between when a person becomes infected and when he or she starts to experience illness symptoms" although for a Covid-19 infection, “it could take them longer to experience symptoms than if they had flu". In flu, the CDC notes, a person experiences symptoms anywhere from 1 to 4 days after infection while with Covid-19 onset of symptoms happens about “5 days after being infected, but symptoms can appear 2 to 14 days after infection".
The CDC further says that both flu viruses and the novel coronavirus “can be spread to others by people before they begin showing symptoms; by people with very mild symptoms"m and by asymptomatic people. It spreads mainly between people who are in close contact with one another of under 6-ft distance and is borne by “by large and small particles containing virus that are expelled when people with the illness (Covid-19 or flu) cough, sneeze, or talk", which in turn can be inhaled. Infection is also possible by touching a surface contaminated with droplets from an infected person and then touching one’s eyes, nose or mouth.
Why Are Cases Arising Now?
While one may greet the ‘florona’ reports as an added concern in the times of Covid-19, experts say that “coinfection of viruses frequently occurs in nature". In fact, right from the beginning of the pandemic public health experts have been worried about a “twindemic" of Covid-19 and influenza cases, but social distancing and other precautionary measures against the novel coronavirus are seen as having considerably checked the spread of influenza cases. That is, until now, when relaxation in curbs has increased interactions among people, making it easier for all kinds of pathogens to circulate.
“Whatever the historic prevalence of coinfection, the twindemic never happened last winter. Perhaps due to mask wearing and social distancing, flu numbers in the US were much, much lower than normal during the 2020-21 season," said a report in The Atlantic magazine.
Further, a study published in the journal Nature noted that “unfortunately, during the last winter flu season… little epidemiological evidence was collected regarding the interaction between Covid-19 and flu, likely due to a low [influenza virus] infection rate resulting from social distancing". However, “with pandemic restrictions relaxing, and fewer people getting flu shots, the same warnings have returned".
What Are The Symptoms Upon Coinfection?
The World Health Organisation (WHO) says “it is possible to catch both diseases at the same time" and that both viruses “share similar symptoms, including cough, runny nose, sore throat, fever, headache and fatigue". However, the symptoms may vary among people and “some may have no symptoms, mild symptoms or severe disease". It points out though that “both influenza and Covid-19 can be fatal".
The Nature report says that Covid-19 and influenza are both “airborne transmitted pathogens that infect the same human tissues", that is, the respiratory tract and nasal, bronchial, and lung cells. Thus, the overlap of the Covid-19 pandemic and seasonal influenza “might place a large population under high risk for concurrent infection with these two viruses", it adds.
What Is The Worry?
The Nature report said experiments had shown that influenza “preinfection significantly promoted the infectivity of Sars-CoV-2" and that “increased Sars-CoV-2 viral load and more severe lung damage were observed in mice coinfected" with influenza.
The researchers said that their study shows how influenza “has a unique ability to aggravate Sars-CoV-2 infection, and thus, prevention of [influenza] infection is of great significance during the Covid-19 pandemic".
Guidelines issued by the Union Health Ministry for the “management of co-infection of Covid-19 with other seasonal epidemic prone diseases" say that “the seasonal pattern of epidemic prone diseases observed every year in our country" means that diseases like dengue, malaria, seasonal influenza, Chikungunya, etc. “can not only present as a
diagnostic dilemma but may co-exist in Covid cases", presenting challenges “in clinical and laboratory diagnosis of Covid" while having a bearing on clinical management and patient outcomes.
“If there is a co-infection, then apart from the febrile illness there may be constellation of signs and symptoms that may lead to difficulty in diagnosis," it says.
How To Detect A Dual Infection?
The health ministry said that both Covid-19 and seasonal influenza present as Influenza-Like Illness (ILI) or Severe Acute Respiratory Infection (SARI) and, hence, “all ILI/SARI cases in areas reporting Covid-19 cases must be evaluated and tested for both Covid-19 and seasonal influenza, if both viruses are circulating in population under consideration". It adds that, in the winter season, “seasonal influenza cases may show an upward trend, and there could be cases of coinfection with Covid-19".
However, given the similarity of symptoms, the ministry notes that “laboratory investigations are also not very helpful in differentiating between the two" but co-infection should be ruled out only “with proper diagnostic method at the early stage to initiate proper specific management to reduce morbidity and mortality".
A report in The Indian Express cited an expert as saying that different PCR tests are done to detect the influenza virus and the novel coronavirus and the infection can be confirmed only by lab tests. The CDC though points out that “there is a test that will check for seasonal flu type A and B viruses and Sars-CoV-2" and it is being used by US public health laboratories for surveillance purposes.
What About Treatment, Vaccination?
The WHO says that while all age groups can contract a coinfection of influenza and Covid-19, older adults, those with comorbidities and weakened immune systems and healthcare workers and pregnant women and those who have recently given birth are at high risk of getting infected by influenza and Covid-19.
The global health agency says that treatment for Covid-19 at medical facilities include oxygen, corticosteroids, and IL6 receptor blockers for severely ill patients along with advanced respiratory support, like ventilators, for people with severe respiratory illness. For influenza, antiviral drugs “can reduce severe complications and death, and they are especially important for high-risk groups". It adds that it is “important to remember that antibiotics are not effective against influenza or Covid-19 viruses" while noting that “People with mild symptoms of both diseases can usually be treated safely at home".
Stressing on the need for vaccination, WHO says that the “most effective way to protect yourself from both influenza and severe Covid is to get vaccinated with both influenza and Covid vaccines", pointing out that vaccines for Covid-19 do not protect against influenza and vice-versa. WHO says it recommends the influenza vaccine for “older individuals, young children, pregnant people, people with underlying health conditions, and health workers".