For months, global health experts have feared the collision of Covid-19 and the seasonal flu. But now, with flu season nearing and Covid-19 surging, averting a “twindemic” appears more challenging than initially predicted.

The coronavirus has rebounded across Europe and continues to rage throughout the United States, overwhelming hospitals in many regions. Pandemic fatigue has set in on both continents, escalating resistance to social distancing and masks. At the same time, nations are plagued by shortages and distrust of the flu vaccine.

“There’s a considerable concern, as we enter the fall and winter months and into the flu season, that we’ll have that dreaded overlap of two respiratory-borne diseases,” warns Anthony Fauci, M.D., director of the U.S. National Institute of Allergy and Infectious Diseases.

Covid-19 and influenza share many symptoms: fever, cough, muscle aches, fatigue, sore throat, and headache. As a result, symptom onset may send a flood of people to emergency rooms, unsure which disease they may have.

Some may even have both, a particularly worrying scenario. Hospitalized adults who contract both diseases face 2.3 times the risk of death compared to those with Covid-19 alone, according to Public Health England. What’s more, influenza infection appears to leave patients vulnerable to a more serious bout of Covid-19.

Both influenza and SARS-CoV-2 can spread via aerosol and before symptoms appear. These two facts point to a single imperative for hospitals and nursing homes: continual air dis-infection.

Air-management strategies are “important protections against spread of infection within healthcare settings,” asserts Australian virologist Ian Mackay, PhD, an expert in influenza transmission.

The same strategies, including air dis-infection with low-energy plasma technology, can be deployed in schools, pharmacies, offices, and restaurants — any indoor space where infectious pathogens are sure to be hovering.

When operated 24/7, air dis-infection units can reduce the transmission odds of both SARS-CoV-2 and influenza. Whether installed on a wall or a shelf, these devices operate safely, unobtrusively, and — of particular importance — without reliance on human effort.

As the population’s energy and patience wanes, low-energy plasma technology has become a critical line of defence against two viruses certain to wreak havoc this winter.

“Frightening” Indifference to the Flu Vaccine

While the world awaits a coronavirus vaccine, we already possess an effective flu shot, —considered a powerful weapon against the feared twindemic. Widespread influenza vaccination, Dr Fauci emphasizes, can “help eliminate at least eliminate at least one” of the two diseases, and the vaccine significantly reduces the severity of symptoms of those who become infected.

Yet vaccination rates are dismal.

Even in the United States, where the flu vaccine is available to everyone and heavily promoted at supermarkets, distrust and disinterest are pervasive. In the flu season that ended just as Covid exploded, just 45% of U.S. adults were vaccinated.

Scepticism abounds: 34% of American adults don’t think flu vaccines work well, and 29% fear side effects. This winter, 17% plan to forego the vaccine for fear of contracting Covid-19 by venturing out.

Vaccination rates are far lower in Europe, where the flu shot is recommended only for high-risk groups, such as the elderly, healthcare workers, and those with chronic health conditions.

Among Europeans ages 65 and older, just 44% are vaccinated, a far cry from the World Health Organization’s target of 75% and far lower than the 60% of American seniors who get vaccinated. Half the countries in the European WHO region vaccinate fewer than 1 in 3 older people, even though flu vaccination reduces the risk of flu-related hospitalization among seniors by 61%.

Just 30% of European healthcare workers get vaccinated annually; in Italy, the rate is just 15%. These paltry figures include healthcare workers at nursing homes, locations highly vulnerable to both influenza and Covid-19 outbreaks.

“Vaccination coverage among high-risk groups has unfortunately been declining in a number of countries in the Region in recent years,” reports the WHO.

Even this year, only half of eligible Germans plan to get vaccinated, a scenario the country’s pharmacists consider “frightening.”

To be sure, the Covid explosion has been a wake-up call for some; globally, the twindemic threat has spiked demand for the flu vaccine. However, distribution and supply problems abound.

Though the United States is well stocked with vaccine, many of the offices, schools, and manufacturing plants that offered free shots on site are closed because of the pandemic.

Europe has bigger problems. Having placed vaccine orders prior to the explosion of Covid-19, most EU countries don’t have enough vaccine to meet demand.

In Belgium, which faces a “tsunami” of Covid cases, offering flu vaccinations to those who fall outside the highest-risk groups is “out of the question,” according to the country’s pharmacists. In Britain, pharmacies have stopped offering flu shots; only 25% of general practitioners expect to have enough flu vaccine to last the winter.

Hospital Flu Outbreaks: “Underdetected and Underreported”

Of course, even if flu shots were universally available and welcomed, the vaccine is not a panacea. Influenza mutates frequently, and some flu strains are especially apt to replicate in the body. The vaccine’s effectiveness in a given year ranges from 40% to 60% and is lower for seniors.

As well, immunity wanes over time; those vaccinated early in the season are less protected at the end.

For plenty of reasons, then, influenza takes a large toll each winter and into early spring. In the United States, about 8% of the population develops a symptomatic infection. In Europe, annual infection rates range between 5% and 15%.

In the coronavirus era, the severity of influenza gets downplayed. Certainly, the flu is far less lethal than Covid-19, but many of the vulnerable suffer severe complications: pneumonia, heart attacks, myocarditis, and strokes.

In the United States, some 740,000 people were hospitalized with the flu during 2019/2020, a mild flu season, and up to 62,000 Americans died from the disease. In the WHO European Region each year, about 44,000 deaths are associated with seasonal flu.

Even without the added threat of Covid-19, a high caseload of even mild to moderate influenza overtaxes medical services and compromises productivity in the workforce. In some years, hospital units are forced to close temporarily because so many healthcare workers become infected.

“Any patient, healthcare worker or visitor is capable of transmitting [influenza] to susceptible persons within hospitals,” French scientists wrote in a review paper of hospital-acquired flu outbreaks. The French team noted that such outbreaks are “probably under detected and underreported.”

Nursing homes, too, are hot spots for influenza outbreaks. The close living quarters and fragile health of residents make these facilities “conducive to the rapid spread of influenza virus.”

Flu outbreaks not only have “devastating consequences for individuals,” the authors wrote, but also place substantial strain on health services. During the flu outbreaks studied, 33% of residents become infected, and 6.5% died. Though staff were considerably younger and healthier, 23% contracted the flu.

Read part two here.