Bracing for a collision between influenza and COVID-19

We are more than 10 months into the consequences of the COVID-19 pandemic in the United States, characterized by three outbreak curves with surges of new cases that launch from a progressively higher base of infected Americans. The Centers for Disease Control and Prevention (CDC) estimates that the number of actual cases thus far is 10 times the number confirmed, which would put us at 83 million who have faced COVID-19 and 225,000 who have died.  

This means there are at least another 160 million Americans still trying to escape the illness. The overall mortality rate of 5 to 10 percent of those hospitalized, and around 25 percent for those in intensive care units, is congruent in multiple reports from top institutions. Despite all the technology and treatments, it is clear that hospitalization is not a sufficient safety net. Our goal should be to prevent hospitalization altogether.

Many doctors, clinics and patients are taking matters into their own hands as tensions continue to grow over stalled and delayed vaccine trials. Certainly, people should heed all the prudent CDC advice for wearing face masks, washing hands frequently, practicing social distancing, and avoiding congregate settings, but these measures may not be sufficient to ride out the storm. Recent data from Johns Hopkins University suggest that getting the influenza vaccine now would be wise; it could help reduce the chances of flu confounding a COVID-19 illness. In addition, some data suggest the influenza vaccine may reduce the risk of death from COVID-19. Fortunately, there are combined flu/coronavirus tests that can identify both viruses in the same test when patients present illness to clinics or hospitals. 

Health care workers can, and should, join the Healthcare Worker Exposure Response & Outcomes of Hydroxychloroquine Trial (HERO-HCQ) and take advantage of HCQ in the national protocol to prevent COVID-19. The Data Safety and Monitoring Board released their decision to continue the study with no safety concerns over HCQ. Separately, Harvard Medical School’s Joseph Ladapo and I, with two other colleagues, recently reported that HCQ taken as a preventive measure, or early outpatient treatment in randomized trials, resulted in a statistically significant 24 percent reduction in the risk of COVID-19, hospitalization or death. More positive data on HCQ continue to mount in the early treatment of COVID-19 at home, with 83 peer-reviewed reports all favorable for HCQ. 

Here are some suggested pointers for Americans who may contract COVID-19 this fall. In general, only adults who are over age 50, have one or more significant medical problems, or have developed severe symptoms may need to prompt their doctors for treatment. Treatment principles used in the hospital will be extended to outpatients — prescriptions for a pair of anti-infectives (hydroxychloroquine or ivermectin and azithromycin or doxycycline), steroids (inhaled budesonide, dexamethasone, prednisone in order of potency), and blood thinners. Courses of therapy will range from 5 to 30 days, depending on the severity of illness and underlying medical conditions.  

For individuals who have recovered from COVID-19, it is reasonable to conclude there is clinical immunity, possibly for a few years at least. There have been sparse cases of possible second infections in rare circumstances of viral mutation or immunosuppression; however, most survivors should cautiously proceed as if immune but continue to take prudent measures to prevent the spread of the virus.  

Simultaneous or sequential infection with COVID-19 and influenza could be disastrous for the elderly, particularly the 1.4 million residents of nursing homes and rehabilitation centers. The recovery period from either illness is long and associated with weakness, weight loss and poor nutrition. Nursing home workers who are not immune must take every CDC-recommended precaution not to spread the virus. Nursing homes should plan to keep COVID-19 treatment units open and provide early treatment of COVID-19 with a sequential, multi-drug regimen. Supplemental oxygen and intravenous fluids will be needed, as in the past, and most centers are prepared.   

Until a majority of Americans become immune to the virus, whether through infection or eventual vaccination, we must all bring our “A” game with respect to prevention measures, influenza vaccination, and prompt home treatment of COVID-19 to avoid hospitalization or death.

Peter A. McCullough, MD, MPH, is an internist, cardiologist and epidemiologist in Dallas. He has authored more than 500 cited works in the National Library of Medicine and lectured across the world on contemporary medical issues.