Should YOU be worried about a flu and Covid TWINDEMIC this winter?

How concerned should we be about the potential threat to our health this winter, with the UK Health Security Agency (UKHSA) warning last week that we face the prospect of a ‘twindemic’ of flu and Covid-19 over the coming months?

worse, thousands of people could be at risk of catching both infections simultaneously — a combination that ‘poses a serious risk’ to our health, the government agency warns.

The fear is that the twindemic would not only fill our hospitals, but having both infections at the same time can also increase the risk of either proving fatal.

Scotland’s Covid levels remain the highest in the UK. office of National Statistics figures show 117,100 Scots, roughly 1 in 45 people, tested positive in the week ending September 20. The figure for England was one in 65, and for wales one in 50.

Previous warnings of a possible two-in-one outbreak — known as ‘flurona’ — failed to materialise, but over the past two years Covid measures, such as reduced socialising and compulsory mask-wearing in indoor public spaces, kept the lid on flu infections, even if cases of omicron (the milder but highly virulent Covid strain) surged.

Last winter, for example, hospitalisations for flu in England were just 15 per cent of what is seen in a normal year.

The UKHSA says reduced exposure to flu viruses in recent winters means fewer of us will have natural immunity to those circulating this year.

WHAT’S more, the main flu virus in circulation this winter is H3N2, a strain with a reputation for putting more people in intensive care or, worse, proving fatal. And it’s thought the virus will be able to take advantage of the freedom of movement that most of us now enjoy — just as a new wave of Covid also hits.

Professor Andrew Easton, a virologist at the University of warwick, told Good Health that the ‘twindemic’ alert must be heeded, even though many of us feel that the misery of the pandemic is in the past.

Those most at risk — the elderly and those with chronic illnesses such as heart disease, asthma or diabetes, which leave them more vulnerable to complications from viral infections — should take particular care.

Professor Easton warns that although having had flu or a vaccine in the past can prime the immune system, the main flu virus in circulation constantly changes as a result of antigenic drift, where it swaps genes between strains to create variants that can dodge this immunity.

‘It takes about three years for the virus to acquire enough change for immunity to wane completely,’ he explains. ‘So if you missed a year — either because you weren’t infected or vaccinated — your chances of being more ill are significantly increased.’

This antigenic drift is why new flu vaccines have to be manufactured every year, tailored to the strain that’s doing the rounds. This is determined by which strains have been dominant in the winter in the Southern hemisphere.

This year’s flu cases in Australia, where H3N2 was the dominant strain, were above average and peaked much earlier than usual.

‘H3N2 seems to lead to more severe disease, especially in the most vulnerable,’ says Professor Easton. ‘It’s probably due to a complex interaction between different viral genes that may suppress elements of the immune system reaction.’

This year’s world Health organisation-approved vaccine is designed to protect against H3N2, but it is only 60 per cent effective due to mutations that occur between the wHo agreeing the strains to be included and the flu season arriving here.

Meanwhile, there are signs that a new wave of Covid infections is already under way, with hospital admissions in Scotland up by 5.2 per cent from the week ending September 18 to the one ending September 25.. ‘All the modelling suggests there will be a winter surge of Covid and flu, but no one knows how big it will be,’ says Professor Peter openshaw, an immunologist at Imperial College London. A 2021 UK study of 20,000 otherwise healthy people, published in the International Journal of Epidemiology, found that those struck by Covid and flu at the same time were nearly twice as likely to die as those who caught Covid alone. The researchers warned: ‘Coinfection could have a significant impact on morbidity, mortality and demand for NHS services.’ Those unlucky enough to catch both could become very ill, very quickly, warns Professor Easton. ‘If you have a respiratory infection and get another one on top of it, that’s likely to be much more damaging — especially in the very vulnerable groups,’ he says.

A double infection can overwhelm the respiratory system and increase the chance of lifethreatening complications.

‘You won’t necessarily be twice as ill, but it will still be serious and you would probably feel pretty bad,’ says Professor Easton.

SEPArATELY, leading UK virology experts fear this potential double-whammy could be a major problem for the NHS. ‘I am concerned about a possible “twindemic”,’ says Dr Simon Clarke, an associate professor in cellular microbiology at the University of reading. He fears that ‘the NHS could be in for a fairly torrid time this winter’.

Apart from testing with lateral flow tests for Covid, it can be difficult to tell if someone has both infections. Unlike early Covid variants (where the main symptoms were cough, fever and loss of smell or taste), omicron symptoms are more flu-like — runny nose, headache, sneezing, sore throat and fatigue.

‘The symptoms can be quite similar and, unfortunately, if you get both at the same time, you have a higher chance of ending up in intensive care or dying,’ says Professor openshaw.

‘That is why vaccines are essential — and, remember, it takes up to three weeks for (them) to be fully effective, so don’t delay.’

As well as vaccines, some of Britain’s leading infectious disease experts are already taking steps to protect themselves.

‘I am sticking with masks in crowded places,’ says Professor openshaw. ‘I was at a conference recently where there were lots of new data showing they work [in reducing transmission]. But they must be high-grade masks — i.e. N95 masks — and tight-fitting.’

Professor Easton says he and his family still wear masks in public places such as supermarkets.

‘The evidence shows that wearing masks reduces the spread of infections — and they work just as well for flu as for Covid,’ he says.

And Daniel Altmann, a professor of immunology at Imperial College London, will continue to wear masks on public transport and also carry out frequent lateral flow tests for Covid.

He warns: ‘There has been a rather unhelpful narrative that the pandemic has been beaten.

‘Yet Covid cases are rising, with the new BA.5 strain breaking through and in other parts of the world, such as the U.S., even worse variants taking over. So I will continue to take precautions.’