Though COVID infections are at present low or in decline in most western nations except for the UK, there’s nonetheless an extended technique to go earlier than the specter of the pandemic is over. An enormous concern this winter is that if there’s a resurgence of COVID with different respiratory sicknesses coming again strongly alongside it – significantly influenza.
In each the southern and northern hemispheres, influenza infections quickly declined and largely disappeared quickly into pandemic. Social distancing measures used to comprise COVID had been much more efficient in lowering the unfold of influenza. However sadly, this implies we now must be braced for flu to be particularly dangerous this 12 months.
In some methods, immune responses to COVID and influenza are the identical. A comparatively current an infection or vaccination gives good safety in opposition to a subsequent an infection, however quickly that safety begins to wane. Early reinfections, nevertheless, are typically asymptomatic or comparatively gentle. However the longer the hole between producing immunity and being reinfected, the extra extreme the following an infection is prone to be.
That is significantly apparent when taking a look at how influenza impacts individuals who stay on distant islands. As a result of they’ll go for lengthy intervals with out being uncovered to the flu, once they do finally encounter it, their mortality charges are larger. One research that checked out individuals residing in Tristan da Cunha, a bunch of remoted south Atlantic islands, discovered that having just some years between flu exposures appeared to extend the chance of the illness.
So the priority is that, with COVID management measures having nearly utterly restricted individuals’s publicity to flu over the past 18 months, pure immunity can have fallen throughout the inhabitants. We’ve basically all been residing on distant islands for the reason that starting of 2020 due to the lockdowns, journey restrictions and working-from-home measures which have been deployed.
When flu does return, it subsequently could have an effect on extra individuals and trigger extra extreme illness then we’d usually see in a typical flu season. The identical will in all probability additionally apply to different respiratory viruses. Actually, this may already be occurring – not too long ago there have been many anecdotal experiences of individuals getting significantly extreme colds within the UK.
Nonetheless, it’s not simple to foretell when precisely flu will return, nor how a lot worse or extra frequent it is going to be. At current, influenza charges are nonetheless fairly low within the UK, however this might change fairly quickly if the virus begins to unfold.
Happily, we have now protected and efficient flu vaccines that cut back each the chance of an infection and extreme illness. However they aren’t as efficient as a lot of the present COVID vaccines. Plus, how properly they work varies 12 months on 12 months. Flu viruses mutate extra shortly, which means a number of strains find yourself circulating, altering annually. If what seems to be the dominant viral pressure every winter isn’t included within the vaccine, then its effectiveness will likely be decrease.
Suggestions for which viruses to incorporate within the annual flu vaccines – created individually for the northern and southern hemisphere winters – are made by the World Well being Group, which assesses the strains which have been circulating beforehand. However with flu circumstances having been so low this previous 18 months, predicting which viruses will likely be dominant this winter is harder than ordinary. So on high of probably being extra prone to flu, there’s additionally a larger than regular threat this 12 months of getting a vaccine that isn’t as efficient as ordinary.
How this combines with COVID
Even earlier than the pandemic, winter flu added important stress on each GP companies and hospitals annually. Dealing with it now, at a time when the well being service has many COVID sufferers occupying hospital beds, could be particularly tough and would intensify stress on the well being service additional nonetheless. In the end, extra pressure on the NHS places individuals’s well being in danger.
However there’s additionally an extra threat: co-infection. It’s potential to have COVID similtaneously one other bacterial, fungal or viral an infection. Actually, one research that checked out hospitalised COVID sufferers estimated that 19% had been additionally carrying one other an infection. It discovered that sufferers with co-infections had been extra prone to die.
Early within the pandemic, when influenza was nonetheless circulating, UK-based researchers had been in a position to evaluate the outcomes of individuals with COVID alone vs a COVID-influenza co-infection. Individuals with a co-infection had been about twice as prone to be admitted to intensive care, twice as prone to require air flow and about twice as prone to die than those that simply had COVID.
It’s not potential to say if we’ll see a serious influenza epidemic within the UK this 12 months, but when not, there’ll nearly definitely be one quickly. And when influenza does return, it’s prone to have an effect on extra individuals than in most pre-COVID years and trigger extra deaths than is typical. The quantity might be sizeable. In a nasty winter, flu kills over 20,000 individuals in England.
Due to the direct menace posed – and the elevated stress flu will placed on well being companies that may in all probability nonetheless be struggling to deal with COVID – it’s doubly essential that folks take up the provide of influenza and booster COVID vaccines if and when supplied this autumn.
Paul Hunter consults for the World Well being Group (WHO). He receives funding from the UK Nationwide Institute for Well being Analysis, the WHO and the European Regional Improvement Fund.