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Flu levels may be lower this year - but with Covid-19 around winter could be more dangerous than ever

A “twin attack” of Covid-19 and flu could be devastating for vulnerable groups.

Image: Shutterstock/Andrii Vodolazhskyi

HEALTH EXPERTS ARE looking to the Southern Hemisphere for an insight into how the season flu and Covid-19 interact and are warning that compliance with public health measures will be more important than ever this winter. 

Any significant level of flu in the community could lead to the test and trace system in particular being overwhelmed as people present with similar symptoms, they say. There is a fear that this would lead to Covid-19 cases falling through the cracks, resulting in a rise in cases in the community and in hospitals.

Speaking to TheJournal.ie following the launch of the HSE’s Winter Plan this week, Chief Clinical Officer Dr Colm Henry said even before the Covid-19 pandemic, health officials carefully watched the experience with flu in the Southern Hemisphere each year. 

“We learn from that in advance of the flu season hitting Ireland. So we know it certainly appears to be a more benign form this year, but it will come – it always does every year,” he said.

In the Southern Hemisphere countries, very low levels of flu were reported in winter. Among more than 60,000 specimens tested in Australia, only 33 influenza positive test results were detected. There were just 12 detected among more than 21,000 specimens tested in China and six among 2,098 specimens tested in South Africa.

Professor Ian Barr, deputy director of the World Health Organization’s collaborating centre for reference and research on influenza in Melbourne recently told The Guardian that flu cases “have fallen off a cliff since March”.

Fewer than 40 Australians have died from influenza this year, compared to more than 950 last year and Barr said there have been no deaths from flu in the past three to four months. While flu levels remained low, Covid-19 numbers have still increased in many areas. Experts say the flu season highlighted how much more virulent and deadly Covid-19 is compared to flu. 

Dr Henry said because flu and Covid-19 both seriously impact on vulnerable and older groups, health officials want to “avoid a twin attack on the same populations” in Ireland. 

He said the focus will also be on keeping down the level of flu among those who will not be seriously ill with it, but who may pass it on to those vulnerable groups.

This is why the flu vaccine without charge has been extended to a number of other groups this year, including to children aged two to 12. Previously this applied only to those over the age of 70.

‘No reason you couldn’t get both’

A new study from Yale University earlier this month suggested the common cold may be able to prevent the flu virus from infecting airways. Researchers said the rhinovirus could jump-start the body’s antiviral defences, providing protection against the flu.

They said the findings help answer a mystery surrounding the 2009 H1N1 swine flu pandemic, when an expected surge in swine flu cases never materialised in Europe during that autumn.

Dr Ellen Foxman, lead researcher, said however it is not known whether the annual seasonal spread of the common cold virus will have a similar impact on infection rates of those exposed to the coronavirus that causes Covid-19.

“It is impossible to predict how two viruses will interact without doing the research,” she said.

When asked if there was any evidence that other viruses this winter might prevent people from catching Covid-19, Dr Henry said:

“I’d love to say there was, it’s been six months of magical thinking and sometimes the magical thinking finds its way into the medical scientific world. We all want to hear stories and latch onto stories that give us some relief from what’s happening.

“There is no crossover immunity between the flu and Covid-19, they’re two separate illnesses.”

He said there is “no reason why you couldn’t get both and having one doesn’t confer immunity to the other”. The first recorded fatal Covid-19 case outside China was in a 44-year-old man in the Philippines who also had flu.

One thing healthcare workers and officials do believe could help keep the situation under control is continued compliance with the public health measures.

Dr Henry said public health experts have long been calling for people to follow the types of basic measures with which we’re all now familiar, like hand hygiene and proper cough and sneeze etiquette.

“They will tell you these are the very practices that would have kept us safe before in flu or cold season,” he said.

Test and trace

Dr Eoghan de Barra, consultant in infectious diseases at Beaumont Hospital in Dublin, told TheJournal.ie that with rising Covid-19 case numbers in the capital as we move into autumn and winter, healthcare workers are “preparing for the worst while hoping for the best”.

“In a bad flu year we’d have maybe 4,000 extra hospitalisations and 160 or 170 extra in ICU over the winter. That’s the winter pressure we usually see that results in the trolley crisis,” he said.

“This could be that situation multiplied many times over if the spread of Covid goes in a certain direction this winter.

“There are a number of reasons that Covid-19 is a pandemic, much of it is that it spreads so easily and many people don’t have symptoms so people don’t suspect a friend they’re meeting for a coffee or in the park.”

He said the prospect of dealing with flu and Covid-19 is “daunting” and the implementation of the HSE’s €600 million Winter Plan will have to be “robust”.

“This means ideally taking flu out of the picture,” Dr de Barra said.

He said he wanted to encourage people to get the flu vaccine this year. 

“It’s not just about preventing numbers with flu in hospitals, if the vaccine stops you getting a febrile illness [displaying a fever] it will stop you getting a Covid-19 test, it’ll stop you missing work while you have to isolate and it’ll stop your household contacts having to isolate while you wait for a test result too.”

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He said it will help to ensure real Covid-19 cases are caught earlier by the testing system if it is not put under pressure by people displaying symptoms of flu, which can be similar.

Dr Paddy Mallon, consultant in infectious diseases at St Vincent’s Hospital also said he is concerned that the “front-end of the system which we rely on to protect us will be overwhelmed”.

“That’s when you start to see Covid cases slipping through the net,” he warned. “The testing system is now already under stress and anything additional makes matter worse.

“I would prefer to be in a position where there are much lower community transmission rates and the testing system can keep on top of things, and then if we had a low flu level that would be an ideal position.

“The key thinking about the health system is to be able to do the non-Covid work. Every Covid-case that comes into the hospital takes us one step away from getting back to the workload we need to do. 

“Obviously the Covid cases are very deserving cases, but the bottom line is those cases are preventable.”

- With reporting from Press Association.

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