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What is ‘flurona?’ Coronavirus and influenza co-infections reported as omicron surges

A youth gets a shot of a COVID-19 vaccine at the vaccination center in La Paz, Bolivia on Jan. 4, 2022. The center is using Sinopharm, Sputnik and AstraZeneca.  (Associated Press)
A youth gets a shot of a COVID-19 vaccine at the vaccination center in La Paz, Bolivia on Jan. 4, 2022. The center is using Sinopharm, Sputnik and AstraZeneca. (Associated Press)
By Jennifer Hassan Washington Post

New year, new coronavirus term?

Many people around the world kicked off 2022 by searching for more information about “flurona,” after Israel reported that two young pregnant women had tested positive for both the coronavirus and the flu.

Doctors have long been concerned about the potential impact of a “twindemic” – with influenza cases rising as COVID-19 cases threaten to overwhelm hospitals – and called on people to get flu shots and coronavirus vaccinations. On the other hand, “flurona” refers to when one person has both respiratory infections at the same time – which health officials say is a possibility as cases of the highly contagious omicron variant of the coronavirus surge this winter across the world.

Here’s what we know so far.

Are cases of flurona new?

After two young pregnant women tested positive for both the coronavirus and influenza in Israel, many local and global media outlets dubbed it “flurona” in headlines. The Sun, a British tabloid, swiftly branded the co-infection “double trouble.”

While the word is relatively new and rising in popularity, cases of flu and COVID-19 co-infections are not. And flurona is not a distinct disease, but refers to when a person has been infected with both viruses. Flurona instances have been detected in countries including the United States, Israel, Brazil, the Philippines and Hungary, some even before the term was coined.

Instances of the co-infection were reported in the United States almost two years ago, according to a report from the Atlantic. In February 2020, a man entered a New York hospital with a severe cough and fever. At the time, the city had not officially reported any cases of the coronavirus. The patient tested positive for influenza and was then tested for the coronavirus. Weeks later, results confirmed that he, along with three family members, had contracted both viruses.

Where has flurona been reported?

There have been other recent occurrences in the United States. A Houston teenager was forced to spend Christmas Day isolating in his bedroom after contracting the coronavirus and the flu at the same time. Alec Zierlein, who had been vaccinated against the coronavirus but not the flu, was also tested for strep throat, but results confirmed he had just the former two infections, which he described as being “like a mild cold.” After his diagnosis, Zierlein told ABC News that he was not aware the coronavirus and the flu could stack “up on one another” and that he would, in the future, get a flu shot as a precaution.

A health official in the Philippines has also said that such co-infections are not unusual. Edsel Salvana, a member of a technical advisory group to the national health department, said the country’s first COVID-related death stemmed from a joint case in early 2020. Salvana told reporters that the early pandemic patient, a Chinese national, had COVID-19 and influenza B, as well as streptococcus pneumonia, according to local outlet ABS-CBN.

An initial case report showed that the patient, who was the world’s first known COVID-19 death outside of China, had a fever, cough and chills. “It’s an unfortunate confluence of events that you are exposed to two pathogens,” said Salvana, who reminded the public to get vaccinated for the flu and pneumonia.

Hungary has also identified at least two flurona instances in recent weeks, broadcaster RTL reported Monday. As was the case in Israel, both patients were described as young and about 30 years old.

And Brazil is battling an out-of-season flu outbreak just as omicron cases are starting to rise. Health officials there have confirmed six instances of flurona across three states. Rio de Janeiro’s municipal health secretary, Daniel Soranz, told Spanish news agency EFE that 17 more cases were also under investigation. In one occurrence, a 16-year-old tested positive for both viruses but had light symptoms, which his mother attributed to his being fully vaccinated against both viruses, she told Brazilian media.

Is flurona more common this year?

In Israel’s Beilinson Hospital, where doctors recently diagnosed the two pregnant women with both infections, cases of the coronavirus are rising amid the omicron outbreak along with cases of influenza A, according to Arnon Vizhnitser, the director of gynecology.

In an interview with The Washington Post, Vizhnitser said that while cases of the flu were scarce last year, perhaps because of more stringent lockdown measures and social distancing, they are roaring back.

“This year is different from last year. Now we have another challenge,” he said, predicting that co-infections would probably continue to occur.

Some countries are on track to be hit much harder by the flu this year, while strict measures to control the spread of the coronavirus appeared to have largely prevented the “twindemic” scenario in 2020.

That’s the case in the United States, which had record lows as COVID surged last winter but is now seeing rising flu cases. Europe’s flu season is also just starting – and likewise expected to be worse this year.

Vizhnitser said both pregnant women had the same symptoms and were given treatment to reduce their fevers. Both were immediately placed in isolation before they eventually returned home with healthy babies. According to Vizhnitser, only one of the women had been vaccinated against the coronavirus. She had also been boosted. The other patient had not received any form of inoculation against either virus.

Pregnant patients visiting Beilinson, the Israeli hospital, are being tested for both viruses if they have symptoms on arrival. Some medical workers, along with people over 60, in Israel, which is aggressively ramping up its vaccination program, are being offered a second booster.

Are flu and COVID together more dangerous?

While many countries track coronavirus and flu cases, there appears to be little data on how many people have them at the same time. As more reports surface about co-infections, health experts and doctors stress that coronavirus and flu vaccines remain the best way to protect against severe infections.

“If you are vaccinated, the disease is very mild,” Vizhnitser said of both the coronavirus and flu. “Women who were not vaccinated (against COVID) were very sick.”

It’s also a possibility that some patients will not be offered tests for both infections, with hospitals around the world using different approaches to treating and diagnosing patients.

What are the symptoms of flurona?

The coronavirus and influenza are respiratory infections, which can cause similar symptoms such as fever, coughing, fatigue, runny nose, sore throat and diarrhea, along with muscle and body aches. Both infections can be fatal, although the severity of each diagnosis depends largely on an individual’s immune system. Health workers, the elderly and those with underlying health conditions are more at risk for each virus.

The World Health Organization notes that the viruses are also transmitted in similar ways, through droplets and aerosols that can be passed on by coughing, sneezing, speaking, singing or breathing – which is why masking to protect others is widely encouraged by officials.

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