As Europe Sees Wave of Seasonal Flu – What are the Risks for ‘Flurona?’
Influenza virus
Influenza virus

The world’s first case of “flurona” – a co-infection with both seasonal influenza and COVID-19 was reported in Israel last week, as the Omicron variant sweeps across the world. Since then, small numbers of people co-infected with both viruses have been identified in other European countries as well, a World Health Organization official in the European Regional Office confirmed.

“Small numbers of co-infections of influenza and SARS-CoV-2 have been seen elsewhere and have been reported internationally during the pandemic to date,” Dr. Dorit Nitzan, WHO European Regional Emergency Director, told Health Policy Watch. “Experience and understanding needs to build further whether there are clinical differences in the presentation, management and outcome of these cases.”

WHO so far has not provided any reports on the numbers.


Fears of a widespread flu and COVID twindemic did not materialize last year, as masking and social restrictions apparently kept flu cases unusually low.

There are fears that the European region and other parts of the northern hemisphere could now be vulnerable to a “Flurona” wave – as the highly infectious Omicron variant sweeps through the world. And at the same time, many vulnerable people also didn’t get a seasonal flu jab.

Although WHO’s Geneva Headquarters also said Tuesday that the current Omicron symptoms indeed appear much milder than previous waves, largely affecting the upper respiratory tract.

“We are seeing more and more studies pointing out that Omicron is infecting the upper part of the body. Unlike other ones, the lungs would be causing severe pneumonia,” WHO Incident Manager Abdi Mahamud said in a Geneva press briefing.

Seasonal Flu on rise

Already, the number of flu cases detected in the WHO European region was “above what we would normally expect to find in the population,” Nitzan said.

According to WHO European Region,, in any given year 5% to 15% of the population is affected by influenza – around 3 million to 5 million cases resulting in 650,000 deaths.

“With COVID-19 also in high transmission across our region, there is the risk that this so-called twindemic could put excessive pressure on already overstretched health systems,” the WHO website said.

The impact could be especially acute on the most vulnerable populations, such as the elderly or people with underlying medical conditions, explained Prof. Cyrille Cohen, head of the immunology lab at Bar-Ilan University, as both flu and COVID-19 on their own can be lethal for older people.

“One virus might weaken you and the second one could be the straw that breaks the camel’s back,” he said. “You might end up with the Omicron variant that is not so tough but then get the flu and that gives you a high fever and the combination could put your life at risk.”

First case of flurona reported in Israel

The first case reported by Israel was a young woman in her 38th week of pregnancy. The woman was treated with a drug combination that targets both coronavirus and flu, according to Dr. Arnon Wiznitzer, head of the Women’s Hospital at Beilinson Hospital in Petah Tikva, Israel. She and her baby were in stable condition on Monday.

“We did not have any kind of influenza all year last year,” Wiznitzer said, “but this year is different.”

He said that a significant number of pregnant women are presenting in the delivery room with flu-like symptoms and it is difficult to know whether they have influenza or COVID-19. As such, these women are put into special isolation rooms for labor and delivery, where they are tested for both viruses.

Until now, the majority of cases have turned out to be the flu, but he expects the balance will shift as COVID cases rise in the country. Israel is reporting more than 10,000 new cases per day and is expected to reach up to 50,000 – around the same number per capita as some of the hardest hit European countries, such as Denmark.

‘Flurona’ symptoms

When it comes to the symptoms of flu, COVID or flurona, it can be difficult to tell the difference, according to Dr. Richard Peabody, who leads the High-threat Pathogen team and the Surveillance and Laboratory pillar of the COVID-19 Incident Support Management Team at WHO/Europe.

In a WHO Q&A, he explained that “both viruses are highly infectious respiratory diseases and share many of the same symptoms, such as coughing, fever, shortness of breath, and/or loss of taste and smell. Because of the difficulty in distinguishing the diseases from symptoms alone, if you are symptomatic, you should isolate yourself from other people to reduce the risk of the infection spreading, particularly to vulnerable people, and get tested for COVID-19 as soon as possible.

“While both diseases can cause serious illness, COVID-19 is more likely to lead to health complications, admission to hospital and, in some cases, death – so getting tested is essential,” Peabody said.

Flu vaccines important – and so far vaccine rates in European Region appear lower than usual

It is also important to get vaccinated, Peabody stressed.

In Israel, where there are around 2,000 people hospitalized for flu, vaccination rates against influenza are down, in comparison to past years. And this is likely to be reflective of the broader situation in WHO’s European Region, Nitzan said – although WHO’s regional influenza vaccine uptake rates for the 2020/21 season are not yet available.

Until now, the region is mainly seeing three strains of influenza viruses, including: A(H3N2) viruses and some influenza A(H1N1)pdm09 or influenza B viruses, according to WHO’s European Regional Office.

“People at increased risk of severe disease from [flu] infection include older people, pregnant women, young children, immunocompromised people and people with chronic underlying medical conditions,” WHO said. ”These groups represent a sizable proportion of the population in the WHO European Region. Therefore, WHO/Europe recommends that everyone at risk of severe disease from infection with influenza, as well as health-care workers, be vaccinated.”

Although there is limited evidence about people who have received both the COVID-19 and the influenza vaccines at the same time, WHO said that doing so does not show any increase in adverse effects.

Wiznitzer said that in Israel these high-risk groups, especially pregnant women, are encouraged to get both shots, because flu and COVID can have adverse effects on mom and baby.

“Fighting both flu and COVID can be very dangerous,” he said. “I can ensure that both vaccinations are safe during pregnancy and on the baby.”

Image Credits: Flickr.

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