‘Flurona’ co-infection of flu, COVID-19 surfaces in Southern California

It promises a special kind of hell — the misery of both flu and COVID-19 crashing down at exactly the same time.

“Flurona,” as it has been dubbed, was detected in a teenage boy who tested positive for both flu and COVID-19 at a privately operated site near the Getty Center in the Brentwood section of Los Angeles. The boy had recently returned from Cabo San Lucas, but had only mild symptoms.

“Testing volume is up over 600% in just the last four weeks,” said Steve Farzam, chief medical officer for 911CovidTesting.com, which has several testing sites in the area. “The positivity rate went from 1.9% to just over 30% as of last night, which is just alarming. This massive blizzard known as COVID has just swept us up and knocked us to our knees.”

Cases of the twin respiratory infections — “double trouble” — aren’t terribly unusual, health officials said. Cases have been reported here in the United States, as well as in Israel, Hungary, Brazil, the Philippines and China. Cedars-Sinai Medical Center has seen at least one mild case among its patients.

“It has not been a big issue for us because of the low levels of influenza circulating in the community,” said Dr. Jonathan Grein, director of hospital epidemiology at Cedars-Sinai, in a prepared statement.

“It’s obviously not good to be infected with two viruses rather than one, but there’s no clear indication that this is a particularly bad combination.”

Treatment for mild combination symptoms would be the same as home treatment for either virus individually, he said.

LA County doesn’t track

While the Los Angeles County Department of Public Health does not track or investigate individual cases of influenza, “concurrent infection with more than one respiratory virus is exceedingly common and there is no reason to expect that SARS-CoV-2 should be an exception to this rule,” a spokeswoman said by email.

“We have seen SARS-CoV-2 and Influenza multiplex test results where both influenza and SARS-CoV-2 were positive. We are not tracking these occurrences systematically and cannot tell you how frequently they have occurred. CDC reports that influenza vaccination rates are lower this year than in previous years.

“The best way to prevent concurrent infection with Influenza and SARS-CoV-2 is to get vaccinated with both influenza and COVID-19 vaccines, which are both highly effective and can be administered at the same time.”

Orange County also has seen occasional cases of flu and COVID-19 co-infection, though it doesn’t gather data systematically on the trend either, said Dr. Matthew Zahn, deputy health officer for the Orange County Health Care Agency.

“The symptoms caused by these viruses overlap, and the cases in general have had respiratory viral symptoms such as cough, fever, and sore throat. Infection with two different viruses is thought to potentially cause more severe disease, so we hope that Orange County residents get both their COVID-19 and influenza vaccinations,” he said by email.

As of Jan. 5, Riverside County had not recorded any simultaneous infections of both the flu and coronavirus, but its public health team is on the lookout for those cases, said Shane Reichardt, a spokesman for the Riverside County Emergency Management Department.

No cases have been reported to the San Bernardino County Public Health Department either, said spokeswoman Martha Guzman-Hurt’ado.

It’s coming’

MemorialCare facilities haven’t yet seen “flurona” cases, but flu season is just starting, said Dr. James Leo, chief medical officer for the chain of hospitals and health groups in Los Angeles and Orange counties, by email. The biggest concern is that patients with both infections may have more severe illness and are at higher risk for respiratory complications, he said.

To stay healthy, people should stick with the preventative measures used since the pandemic began, including masking, social distancing and hand-washing, which are even more effective against the flu than they are against COVID, Leo said.

“People adhered more closely to these recommendations last year and the flu never really took off. This year, our communities are more open with people going out, attending social events and holding bigger family gatherings. People are not being as strict with the preventative measures … and perhaps have not been as adamant around getting their flu vaccine because we had such a mild flu season last year.

“This makes it critical that, in addition to receiving the COVID vaccine and booster, people should get vaccinated against the flu,” he said.

Dr. Nancy Gin, vice president and chief quality officer for Kaiser Permanete Southern California, agrees.

“We have always had the risk of ‘flurona’ or flu and COVID-19 infecting someone at the same time,” she said by email. Last winter, there was almost no flu activity because of pandemic precautions, but that’s changing this winter as people tire of precautions and forgo flu vaccines.

“As a result, we now have flu on the East Coast and Central United States surging, along with the omicron variant for COVID,” Gin said. “The West Coast typically lags behind the East Coast a few weeks in flu cases, but we know it’s coming. With the current high prevalence of COVID, we anticipate a number of cases of ‘flurona’ in the Southland.