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Jan 10, 2022
7 min read

Flurona: when COVID-19 meets the flu

If being in the middle of a pandemic wasn’t enough, there’s a new infection in town—meet what some are calling “flurona.” Flurona is a co-infection of two viruses: coronavirus and the flu at the same time. Cases were first reported in early 2022 in Israel. Since both viruses cause similar symptoms, the conditions are close to indistinguishable and include fever and a stuffy nose. Prevention is the key when it comes to these infections and that includes getting vaccinated against both, practicing good hand hygiene, and wearing a mask.

Even medical professionals are finding it difficult to keep track of what’s happening when it comes to COVID-19, and the latest revelation—flurona—is no exception. We turned to our very own Dr. Gina Allegretti, Health Guide’s resident infectious disease expert, to explain what flurona is, how it happens, and how to steer clear. 

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What is flurona?

“Flurona is what’s called a co-infection,” says Dr. Allegretti. “Basically, you get two infections for the price of one. In this case, a person can have COVID-19 and the flu simultaneously. It’s a new diagnosis, but it was likely only a matter of time until we found a case.”

Since the first case was reported in Israel in January of 2022, there have been reports of flurona in Los Angeles, and a few others have tested positive for both infections since (Times of Israel-a, 2022; LA Times, 2022). It has likely been around for a while, according to Dr. Allegretti. “But when you have symptoms of COVID and a positive COVID test, you’re probably just going to accept that you have coronavirus and wouldn’t bother getting tested for the flu as well (unless you’re hospitalized).”  Is it really possible to be infected with two things at once?

“It’s definitely possible to be infected with two things at the same time,” explains Allegretti. “For instance, a person infected with the flu is at risk for getting a bacterial lung infection called Staph aureus pneumonia at the same time. When you have a skin infection called an abscess, it’s usually filled with several different infecting bacteria. There are even situations where specific infections always happen together, like the Hepatitis D virus, which can only happen in a person who already has a Hepatitis B viral infection. And co-infections are even more common in people with weaker immune systems.”

So why was flu so uncommon early in the pandemic? Allegretti explains, “When we were all staying home during the winter of 2020, flu cases dropped significantly. But this year, as vaccination against COVID became more widespread and people started to feel some semblance of normalcy returning, the masks came off, the gatherings started back up, and we saw a greater spread of both the coronavirus and the flu.” 

Cases of the flu are still low compared to the pre-COVID years, but they are steadily increasing in the U.S. (CDC-d, 2021).

What are the symptoms of flurona? 

One of the reasons that people might not know they have both is that the symptoms are so similar. “A lot of the symptoms of COVID and the flu overlap, and knowing which one you have isn’t necessarily of consequence as long as you don’t need medical attention,” says Dr. Allegretti. 

Both viruses can cause fever, body aches, and congestion. Some symptoms are unique to COVID, like losing your sense of smell. But since there haven’t been many documented cases of flurona up until this point, it’s hard to tell what the predominant symptoms will be. 

Symptoms of both flu and COVID are: 

  • Fever
  • Headache
  • Sore throat
  • Runny nose and cough
  • Muscle aches and pains
  • Tiredness and fatigue
  • Vomiting and diarrhea 

Symptoms more common in COVID but not common with the flu are: 

  • Loss of smell and taste

Why is flurona suddenly a threat? 

‘Tis the season—for flu, that is. 

“COVID precautions like mask-wearing, social distancing, and increased handwashing and sanitizing may have helped limit the spread of influenza (the flu) in recent years, but with the rise of the omicron variant, we’re seeing more and more cases of each virus,” says Dr. Allegretti. Some experts worry that we’ll be susceptible to a “twindemic”—outbreaks of flu and COVID at the same time (NYTimes, 2021). 

Another issue, explains Allegretti, is that this year’s flu vaccine may have missed the mark. “Each year, researchers develop a new flu vaccine before the flu season even starts. It’s designed in advance to prevent the flu variants they predict will be dominant in a given year. This year, the dominant variant of the influenza virus is called H3N2. But one study suggests that the H3N2 virus developed new mutations that may make it evade the immunity provided by the vaccine.” This type of mismatch may make the vaccine less protective (Bolton, 2021). 

Is it more dangerous to have two viruses at once? 

“It’s different with every virus, and with only a few cases to base it on, it’s impossible to know for sure,” says Dr. Allegretti. During an interview on CNN, Dr. Nadav Davidovich of the School of Public Health at Ben-Gurion University in Israel said that, although increased flu cases make co-infections more likely, people who have no underlying conditions and are vaccinated will probably not have severe effects (CNN, 2022).

The first two individuals diagnosed with flurona—an unvaccinated pregnant woman in her 30s and a healthy teenage boy who had just returned from a trip to Cabo San Lucas—are currently home and reportedly in good condition (Times of Israel-a, 2022; LA Times, 2022). Healthy adults who get the flu typically have mild symptoms and don’t develop severe illness. But people who are at high risk for severe COVID or flu complications may also be at risk for severe flurona. This includes (CDC-a, 2022): 

  • People over age 65 
  • People with underlying medical conditions like diabetes, lung disease, obesity, kidney disease, liver disease, heart disease, and cancer
  • People who have weakened immune systems, like individuals with HIV or people who have had organ transplants
  • People taking medications that affect the immune system
  • People who are pregnant
  • People who smoke 

What can I do to prevent flurona?

The good news is that the things you’re already doing to prevent COVID are the same things that will help you prevent influenza or the combo, flurona. These include:

  • Vaccines: Getting vaccinated is still an important way to protect yourself and others. It’s a good idea to get both the full COVID-19 vaccine series and a flu vaccine. 
  • Hand hygiene: Washing your hands with soap and water for 20 seconds or with alcohol-based hand sanitizers can keep some of the germs at bay. Don’t forget to keep your hands away from your face. 
  • Masks: Masks can protect you from both viruses, so it’s a good idea to wear one when you’re indoors in a public place. The most effective masks against COVID are N95 and KN95 respirators, which form a close seal to your face and have tiny pores to prevent infectious respiratory droplets from filtering in and out. If you only have cloth masks or surgical masks, choose multi-layered versions, knot the straps for a tighter fit, and double mask.
  • Staying home: Stay at home when you feel sick, and stay away from others who are sick. Follow guidelines in your area regarding social distancing.
  • Knowing your area: Some regions have higher amounts of flu or COVID circulating than others. You can keep track of flu activity in your state using the CDC’s interactive FluView tool. 

What should I do if I think I have flurona?  

If you have symptoms of COVID or flu, it’s a good idea to contact your healthcare provider. Your provider can help you figure out if your symptoms are mild or if they need further evaluation and treatment. 

You may also need flu and COVID-19 testing. The good news is, rapid COVID tests can be performed even from the comfort of your own home. Flu tests usually have to be done outside the home, but they’re available in many places, including large chain pharmacies like CVS and Walgreens. 

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If you have mild symptoms, the best thing for you may be to recuperate at home. Try to stay away from others in your household as much as possible, and wear a mask to keep from spreading the viruses to them as well. While you’re at home recovering, things you can do to manage your symptoms include:

  • Get plenty of rest.
  • Drink lots of fluids to stay hydrated.
  • Control your fever (use cool/lukewarm cloth, lukewarm baths, or fever-reducing medication).

If your symptoms are getting worse—for example, if you’re having trouble breathing—talk to your healthcare provider or seek emergency care (CDC-c, 2021). 

Flurona may be a new entity, but luckily we’ve learned information about COVID and influenza that may help us tackle it. It’s a good idea to protect yourself and others through practices like getting vaccinated, wearing a mask, following social distance guidelines, and having good hand hygiene. 

References

  1. Bolton, M. J., Ort, J. T., McBride, R., Swanson, N. J., Wilson, J., Awofolaju, M., et al. (2021). Antigenic and virological properties of an H3N2 variant that will likely dominate the 2021-2022 Northern Hemisphere influenza season. medRxiv. Pre-print. doi: 10.1101/2021.12.15.21267857. Retrieved from https://www.medrxiv.org/content/10.1101/2021.12.15.21267857v1
  2. Centers for Disease Control and Prevention (CDC-a). (2021). People with Certain Medical Conditions. Retrieved on Jan. 5, 2022 from https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html
  3. Centers for Disease Control and Prevention (CDC-b). (2022). Weekly U.S. Influenza Surveillance Report: Flu View. Retrieved on Jan. 5, 2022 from https://gis.cdc.gov/grasp/fluview/fluportaldashboard.html
  4. Centers for Disease Control and Prevention (CDC-c). (2021). What to Do if You are Sick. Retrieved on Jan. 5, 2022 from https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sick.html
  5. Centers for Disease Control and Prevention (CDC-d). (2022). Flu Season. Retrieved on Jan. 6, 2022 from https://www.cdc.gov/flu/season/index.html
  6. CNN. (2022). What is ‘flurona’ and how serious is it? Retrieved on Jan. 5, 2022 from https://www.cnn.com/2022/01/04/health/flurona-flu-covid-explainer-scli-intl/index.html
  7. Columbus Dispatch. (2022). ‘Flurona’: When you’re hit with double whammy infections of flu, COVID-19. Retrieved on Jan. 5, 2022 from https://www.dispatch.com/story/news/2022/01/04/flurona-flu-covid-combination-symptoms-fever-sore-throat-cough-pneumonia/9087925002
  8. The Cut. (2022). What Fresh Hell Is ‘Flurona’? Retrieved on Jan. 5, 2022 from https://www.thecut.com/2022/01/first-verified-flurona-infection-confirmed-in-israel.html
  9. The Daily Beast. (2022). 2022’s Hottest New Illness: Flurona. Retrieved on Jan. 5, 2022 from https://www.thedailybeast.com/2022s-hottest-new-illness-is-flurona
  10. Forbes. (2022). ‘Flurona’ Cases Raise Concerns Of Severe Double-Infections. Retrieved on Jan. 5, 2022 from https://www.forbes.com/sites/zacharysmith/2022/01/04/flurona-cases-raise-concerns-of-severe-double-infections/?sh=f5f87144c89b
  11. Los Angeles Times (LA Times). (2022). L.A. County testing site detects first ‘flurona’ case, a co-infection of flu and COVID. Retrieved on Jan. 5, 2022 from https://www.latimes.com/california/story/2022-01-05/l-a-county-detects-first-flurona-case-combination-of-flu-covid
  12. Newsweek. (2022). What We Know About Flurona and Symptoms of COVID Vs Flu. Retrieved on Jan. 5, 2022 from https://www.newsweek.com/what-flurona-symptoms-covid-israel-twindemic-flu-1665269
  13. New York Daily News (NY Daily News). (2022). Israel detects its first ‘flurona’ case – and it’s exactly what it sounds like. Retrieved on Jan. 5, 2022 from https://www.nydailynews.com/news/national/ny-israel-first-flurona-flu-corona-covid-twindemic-20220104-2yqz7foayzhg3hgtzaaxxnxwci-story.html
  14. New York Times (NY Times). (2021). Fearing a ‘Twindemic,’ Health Experts Push Urgently for Flu Shots. Retrieved on Jan. 6, 2022 from https://www.nytimes.com/2020/08/16/health/coronavirus-flu-vaccine-twindemic.html
  15. Penn Live. (2022). ‘Flurona’: First verified case of a rare double infection of COVID-19 and influenza reported in Israel. Retrieved on Jan. 5, 2022 from https://www.pennlive.com/nation-world/2022/01/flurona-first-verified-case-of-a-rare-double-infection-of-covid-19-and-influenza-reported-in-israel.html
  16. The Times of Israel-a. (2022). ‘Flurona’: Israel records its first case of patient with COVID and flu at same time. Retrieved on Jan. 5, 2022 from https://www.timesofisrael.com/flurona-israel-records-its-first-case-of-patient-with-covid-and-flu-at-same-time/
  17. The Times of Israel-b. (2022). Nearly 3,000 hospitalized with flu since September, amid ‘twindemic’ fears. Retrieved on Jan. 6, 2022 from https://www.timesofisrael.com/nearly-3000-hospitalized-with-flu-since-september-says-health-ministry/
  18. World Health Organization (WHO). (2021). Coronavirus disease (COVID-19): Similarities and differences between COVID-19 and Influenza. Retrieved on Jan. 6, 2022 from https://www.who.int/emergencies/diseases/novel-coronavirus-2019/question-and-answers-hub/coronavirus-disease-covid-19-similarities-and-differences-with-influenza