With input from Dr Monica Vasudev

1088:    Flu, COVID-19 or Both? Dont Ignore Co-Infection

• When a patient presents with acute respiratory symptoms this winter, the CDC says that clinicians should consider three options: influenza, COVID-19, or co-infection.
• Co-infection with both influenza and COVID-19 has been documented in case reports as well as case series.
• The differentiating feature is loss of smell and loss of taste, which has not been reported with influenza virus infection.
• Timothy Uyeki, MD, of the CDC, discussed the largest case series of patients with influenza and SARS-CoV-2 co-infection which included 93 adult patients hospitalized with COVID-19 in Wuhan, China, where 49.5% had serologically diagnosed influenza infection.
• Co-infection, or even distinguishing SARS-CoV-2 from influenza, is of particular significance because of the implications of treatment. For instance, dexamethasone is recommended for severe COVID-19 infection in hospitalized patients; however, corticosteroids tend to prolong viral replication in influenza.
• Testing therefore becomes vital when it comes to distinguishing the viruses.
• There are different types of multiplex assays that have received FDA emergency use authorization (EUA). These include multiplex nucleic acid detection assays that can identify both influenza A and B viruses and SARS-CoV-2 simultaneously in respiratory samples. Turnaround times for results within the lab vary from 20 minutes to 8 hours.
• Patients having a high risk for influenza complications, and who may benefit from early antiviral treatment, depict those at higher risk for SARS-CoV-2: Adults >65; Pregnant/postpartum women; People with underlying medical conditions, such as pulmonary, cardiac, and neurologic problems, and those who are immunosuppressed or have a body mass index >40; and Residents of nursing homes/chronic care facilities.
• Children aged 18 and below receiving long-term aspirin therapy, as well as children below age 2, may also be considered for early antiviral treatment.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA