Both Covid and flu could surge this winter causing a dreaded ‘twindemic’, experts fear — with some southern states already feeling the early stages of an influenza resurgence.
The flu was largely wiped out over the past two years of the pandemic when lockdowns, working from home and the far more transmissible coronavirus limited its ability to spread.
But there are concerns the seasonal virus will make a deadly return this winter after it rampaged across the southern hemisphere in recent months.
A lack of exposure to the pathogen over the past two years has left the immune system of many Americans unprepared for the flu, increasing the risk of a more severe infection.
There are already early signs the flu is making a comeback with large rises across the US south in recent weeks, with Texas reporting a tripling in cases over the past three weeks.
Dr Luis Ostrosky, chief of infectious diseases with UTHealth Houston and Memorial Hermann, told DailyMail.com that current figures in Texas are usually not experienced until the peak of flu season in December.
The Centers for Disease Control and Prevention (CDC) is reporting moderate flu activity in Georgia and New Mexico as well. Florida also reported an unusual surge of the virus over summer that has since tapered off. Washington D.C. is also experiencing what the agency describes as the worst outbreak in the nation right now.
Only a few hundred flu cases have confirmed by health officials nationwide this month, though figures are significantly underreported. As colder weather pushes more Americans indoors, experts fear the virus will begin to rampantly spread among an under-prepared population.
If previous winters are anything to go by, Covid cases are also bound to erupt this winter as well — with the latter halves of 2020 and 2021 seeing spikes.
Officials say poor vaccine uptake — just one per cent of eligible Americans have had the new Omicron booster —means there is still scope for a deadly Covid outbreak, even with the milder BA.4 and BA.5 subvariants.
The virus is being felt the most across the US south, with Texas, Georgia and New Mexico each suffering ‘moderate’ flu circulation, according to the CDC
Flu cases have slightly increased in recent weeks, with the CDC reporting 378 and 425 confirmed infections in the two previous weeks – up from 257 infections reported during the final week of August
‘We’re in for a rough flu season this year,’ Dr Ostrosky told DailyMail.com
‘We haven’t peaked yet. We are starting to see the numbers rise up very early.’
Experts have urged Americans to both get the flu shot and the new bivalent vaccine ahead of fall in an effort to limit the twindemic.
The American Academy of Pediatrics (AAP) even recommended parents give their children two flu shots this year if they have never received the annual jab before.
While House Covid response coordinator Dr Ashish Jha said at the start of the month that: ‘I really believe this is why God gave us two arms, one for the flu shot and the other one for the Covid shot.’
Experts are on high alert about the virus after it made a resurgence in the southern hemisphere – which typically has a flu season that runs from April to October.
Australia suffered its worse flu season in a half-decade this year, with peak case rates reaching heights three times higher than usual. It also struck unusually early.
In New Zealand, flu cases this year returned to pre-pandemic normal after two years of stark decreases.
‘The Southern Hemisphere has had a pretty bad flu season, and it came on early,’ Dr Anthony Fauci, the nation’s top infectious disease expert, said at the end of August.
‘Influenza – as we all have experienced over many years – can be a serious disease, particularly when you have a bad season.’
This is not the first warning of a twindemic that US officials have issued. Many feared the flu would make an imperious return in 2021 after being near-non-existent in 2020. This was not the case, though.
An uptick of the common flu is already starting to be felt in late September, though. The CDC reported 378 cases during the week ending on September 23, and 425 the week before. Only 257 cases were recorded during the last full week of August, ending on August 26.
It is likely that these figures are significant underreports as many will ride out mild cases at home without seeking medical attention, and never get a confirmed positive test as a result.
Hospitalizations caused by the flu, while rare, are largely among the elderly and children under-four – the groups that usually face the highest risk from the virus.
The beginning of a flu surge could already be erupting in the US south.
Weekly reported cases have surged in Texas in recent weeks, with the state reporting 186 infections during the week that ended on September 17.
This is more than double the 73 cases reported during the week that ended on September 3, and a near five-fold increase from the 40 cases recorded on August 20.
Dr Ostrosky told DailyMail.com that these figures are not usually reached until December – the peak of flu season.
He fears that figures will only continue to rise in the coming months.
Dr Ostrosky says that while the twindemic may have not come in previous years, early data shows this will be the year in comes to fruition.
Less viral interference from Covid, an absence of pandemic mitigation measures and a lack of immunity in the population after little spread of the virus last year and low vaccine coverage have left Americans vulnerable to the flu this year.
As of mid-day Thursday, the CDC also considers neighboring New Mexico and Georgia to be suffering from ‘moderate’ flu activity.
Reported cases of the flu are rapidly rising in Texas, more than doubling over the past two weeks, and quadrupling since late August
Covid cases have remained steady in the US over the past month, though experts fear they will surge in the fall and winter – just as they did in both 2020 and 2021
Florida also recorded an unusual surge of the annual virus over the summer, though it quickly receded.
Dr Ostrosky says that usually the US south is in-sync with the rest of America when it comes to the flu, and is not sure why it is rising in the region faster than others.
Washington D.C. is experiencing ‘very high’ flu circulation, the CDC reports, the worst of any part of the country.
Dr William Schaffner, an infectious disease professor at Vanderbilt University, in Nashville, told NPR: ‘This could very well be the year in which we see a twindemic.
‘That is, we have a surge in COVID and simultaneously an increase in influenza. We could have them both affecting our population at the same time.’
Dr Schaffner fears this surge in the flu, combined with the usual jump in Covid cases associated with the colder weather months could spell trouble for America.
‘If we have a serious influenza season, and if the omicron variants continue to cause principally mild disease, this coming winter could be a much worse flu season than Covid,’ he said.
Officials are reacting to these fears as well. The AAP put out a notice at the start of the month that children between the ages of six months and eight years old who have received less than two flu shots during their life should double up on the jabs this time around.
The two shots should be received around a month apart from one-another.
The AAP recommendations are not totally unprecedented. In 2009, the Centers for Disease Control and Prevention told parents to get their children double-jabbed against the flu if they had not received shots previously.
The guidance has stood since then, but has largely been ignored and gone unannounced each year.
Omicron-tailored Covid boosters – set to prevent infection from the highly transmissive strain – have been pushed by US officials in an effort to curb the pandemic ahead of the cold weather months as well.
Ostrosky told DailyMail.com that a person who has received both an Omicron booster and flu shot should feel safe heading into the twindemic season.