Coinfection With COVID-19 and Influenza


George Loukatos, MD, defines the term “flurona” and provides insight on common symptoms and targeting treatment from a respiratory standpoint for coinfection with SARS-CoV-2 and influenza.

George Loukatos, MD: “Flurona” is a term that has been floated out there by the media, and it basically refers to having coinfection of COVID-19 and the flu at the same time. Here on the Gulf Coast as well as nationally, it’s a rare phenomenon. We’ve had a handful of patients over the course of the last year who we've seen that in. Thankfully, their patient outcomes have not been severe. We worry about flurona in people who we would worry about who have the flu or who have COVID-19, people who have comorbidities or significant underlying conditions that would put them at risk for a poor outcome with either one. In general, the fear of flurona seems to be overstated. Nationally, they’re thinking about 1% of the people who are infected with COVID-19 may also have infection with the flu, and I don’t believe the outcomes are any worse in those patients than they are in people who just have infection with one or the other. The bigger issue in dealing with 2 potentially serious viruses is distinguishing which one the patient has because the symptoms are so similar. We need a diagnostic tool to figure out, OK, how are we going to treat this person? Are we treating COVID-19 or are we treating the flu, because the treatments are different.

The main risk that we worry about with anyone who catches COVID-19 or the flu, we’ve known for years, is that people who have significant comorbidities or preexisting conditions are at risk for poor outcomes. Either way, whether they have COVID-19, flu or both, we need to base our risk stratification on their preexisting conditions. However, the treatment for COVID-19 and flu are very different. Besides supportive care, which we provide for both, there are medications for flu that we can give if we diagnose it early enough. There are treatments for COVID-19 that we can give, whether it’s immunoglobulin infusions or oral medications. As clinicians, we’re worried about making the correct diagnosis, does this patient have flu or do they have COVID-19, so that we can tailor their treatment in the appropriate manner.

With both COVID-19 and flu, our primary concern when you talk about globally, the patient’s body and how they’re dealing with it, is that they both primarily affect the patient’s lungs and suppress their immune system. Our treatment is tailored toward supporting them from a respiratory standpoint. With COVID-19, we are still, as clinicians here on the Gulf Coast, focusing on prophylactic treatment for coinfection with bacteria. Meaning besides immunoglobulin infusions and things to support the immune system, various vitamin cocktails that we’ve been using, our focus is to try to prevent bacterial superinfection on top of the COVID-19 pneumonitis. We have been prophylactically giving antibiotics to people who are higher on the risk stratification, so that they don’t develop bacterial pneumonia because we’re finding those are the people who are not doing well when they’re hospitalized.

That is not something we typically do with the flu, unless the patient is exceptionally high risk and would be elderly and has a bunch of other comorbidities. Some clinicians might err on the side of caution and start antibiotics, but we know that the flu traditionally is a virus and we treat it with antivirals rather than antibiotics. Again, it’s important to know which virus we’re dealing with so we can tailor the treatment plan toward that. That’s why these tests that allow us to diagnose which virus we’re dealing with are important right now because the symptoms of COVID-19 and the flu are still extremely similar. Typically, the patient’s going to have fever, body aches, myalgias, headaches, sore throat, cough, runny nose, fatigue, which all are termed flu-like-symptoms, but those are the symptoms of COVID-19 as well.

Interviewing the patient, it’s impossible to tell whether they have COVID-19 or the flu, that’s why we’ve been using these tests. In my practice, once historic flu season started, we’ve been using those exclusively for symptomatic patients. If someone’s got a fever and cough, we need to know, do they have COVID-19 or flu, and we’re going straight to our combo test that tests for both.

Transcript Edited for Clarity

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