Twindemic is a term used during the COVID-19 pandemic, referring to the possibility of a severe flu season happening alongside an increase in cases of COVID-19 during the fall and winter of 2020 and 2021. A consequence of a twindemic may be a mixture of two different infections in the same person at the same time. The term twindemic is a portmanteau of “twin” and “pandemic“.
The term was used by an August 2020 article from The New York Times written by Jan Hoffman. In the article, Hoffman credited Dr. L.J. Tan of the Immunization Action Coalition as an “early promoter” of the possibility of a twindemic. After the publication of The Times‘ article, several media outlets began to report on the possibility of a twindemic. Health experts responded to the threat of a possible twindemic by encouraging more people to get the flu vaccine.
A twindemic did not occur during the flu season in late 2020 due to cases of the seasonal flu being at historic lows in the United States and globally. These low amount of flu cases were attributed to measures put in place to prevent COVID-19 from spreading, including face masks, social distancing, and hand washing.
Health experts renewed concerns of a possible twindemic happening during the fall and winter of 2021 due to loosening restrictions. In April 2022, Apoorva Mandavilli of The New York Times speculated that a twindemic has not occurred because “exposure to one respiratory virus may put the body’s immune defenses on high alert, barring other intruders from gaining entry into the airways. This biological phenomenon, called viral interference, may cap the amount of respiratory virus circulating in a region at any given time.” In the United States, flu cases, hospitalizations and deaths were up from the previous flu season, but were still lower than the pre-pandemic average.
In January 2022, Israel reported, for the first time, a mixture of COVID-19 and influenza infections, colloquially known as “flurona”. In Brazil, four cases of the double infection have been identified, including a 16-year-old male from Rio de Janeiro. In Fortaleza of Ceará state, two children, including a one-year-old child tested positive without complications, and also a 52-year-old man who did not need hospitalization. In São Paulo, the Secretariat of Health announced that its state had 110 cases in 2021.
Flurona infections have also been reported in the United States, the Philippines and Hungary.
‘Twindemic’ warning as people urged to take “vital” flu and COVID-19 vaccines
The UK’s Health Protection Agency (UKHSA) said that people should protect themselves from H3N2 – a subtype of influenza type A – and the coronavirus before there is an expected resurgence of both in the cold months.
H3N2 is currently the most common cause for the flu, and recently made waves in Australia, while it circulated in the UK last year, but was limited in effect due to COVID restrictions.
With the lifting of the ban in 2022, Old Britons are being warned that there is less protection. The UKHSA said last year was a record update for the free flu jab, with more than 82 per cent-65 per cent receiving it, but there was less uptake in groups that were still vulnerable, such as pregnant women.
It also said that there are signs that COVID rates are starting to rise again, while millions of people are losing their protection from jobs.
An earlier study into the pandemic suggests that catching both, known as co-infection, doubles someone’s chance of dying compared to someone with COVID alone.
“This winter may be the first time we see the effects of the so-called ‘twindemic'”, said Steve Russell, the NHS director for vaccination and screening.
“It is important that people most susceptible to serious illness from these viruses come forward for vaccines to protect themselves and those around them.”
“If you have been offered a flu vaccination or a COVID-19 booster, you should book as soon as possible and with more vaccination centers this year than ever, they are quick, convenient and will provide vital protection this winter. “
UKHSA Chief Medical Adviser Dr Susan Hopkins echoed the call, who said both viruses are “unexpected, but there are strong indications that we may be facing the threat of a widely-spreading flu, given the low risk of natural immunity.” May face low levels. The last three winters and the rise in COVID-19 is swirling with a lot of variants that can evade the immune response.”
“This combination poses a serious threat to our health, especially in high-risk groups.”
Noting that the flu strain “can cause particularly severe illness” she said “getting a flu jab is a sensible, potentially life-saving thing to do.”
People in the Southwest are being urged to get a free flu vaccine and a Covid-19 booster jab before expecting a tough winter. This comes as recent data shows that the rates of Covid-19 are starting to rise again.
The UK’s Health Protection Agency says H3N2 – a subtype of influenza type A – is currently the most commonly detected flu virus worldwide and has caused waves of infection in the Southern Hemisphere. Tensions flared in Britain last winter, but were kept in check by COVID-19 restrictions.
Since people shook very little and worked from home, they were protected from getting the flu. However, this reduced the level of natural immunity to H3N2 formation within the population.
this image is covid testing in hospital,‘Twindemic’ warning as people urged to take ‘vital’ flu and Covid-19 vaccines
Data shows there was a record uptake of the flu jab in 2021/22 among people aged 65 and over, with 82 percent receiving it. There was less uptake among people in clinical risk groups and pregnant women and these groups are being encouraged to come forward this year.
All elementary school children and some middle school children are eligible this year for the flu nasal spray, which is usually given at school. GP Surgery is also inviting children between the ages of two and three to their practice for this nasal spray vaccination.
The agency says that since most young children may not have contracted the flu yet, they may not have built up any natural immunity to the virus. That means it’s especially important for them to get the flu vaccine this year.
There are also early signs that the covid-19 infection rate is increasing again. Study results show that people who catch both the flu and COVID at the same time, known as co-infections, are more likely to die than people with only COVID-19. The probability is almost double.
People are being encouraged to practice good hand hygiene along with getting vaccines to protect against respiratory viruses this winter. The agency is also encouraging everyone to wear a mask in crowded or enclosed public places and to cover their nose and mouth when coughing and sneezing.
Dr Susan Hopkins, UKHSA’s Chief Medical Adviser, said: “Flu and COVID-19 are unpredictable, but there are strong indications that we may be facing the threat of a wide-spread flu, a low risk over the past three winters. Due to low levels of natural immunity and an increase in COVID-19, there are many types that can evade an immune response. This combination poses a serious threat to our health, especially in high-risk groups.
“The H3N2 flu strain can cause particularly severe illness. If you are elderly or vulnerable because of other conditions you are at greater risk, so getting the flu jab is a sensible, potentially life-saving thing to do.
“We are extremely fortunate to have vaccines against these two diseases. Most eligible groups have been selected because they are at higher risk of severe illness. Younger children are unlikely to have built up any natural immunity to flu and therefore it is particularly important they take the nasal spray vaccine this year. So, if you are offered a jab, please come forward to protect yourself and help reduce the burden on our health services.”
Professor Dominic Mellon, UKHSA South West Regional Deputy Director, added: “Both flu and COVID-19 can cause serious illness and hospitalisation and this winter they will be circulating together. This along with lower levels of natural immunity will mean that it’s particularly vital to get vaccinated, especially if you’re in a higher risk group.