Fears of a Triple Whammy: Influenza, Delta, and Omicron

Don’t look now, but influenza is making a comeback. What if it joins forces with COVID-19 variants?

The first known case of a person who’s been hit with the double whammy of influenza and COVID-19 has been reported in Israel, according to the Times of Israel. The dual infections were found in a pregnant woman who had not been vaccinated. The article notes that though some reports call it the first such case in the world, reports of people having flu and COVID-19 simultaneously had been documented in the United States as early as 2020.

However, the “twindemic” that health experts feared would overrun hospitals last year during flu season didn’t happen. That’s because the nonpharmaceutical COVID-19 mitigation tools—hand hygiene, masking, social distancing—had beaten back a flu surge, experts say. Those mitigation efforts have been relaxed and the results might be flu and COVID-19 combined.

Or even worse.

“We could get a triple whammy, with people getting the flu, on top of Delta, on top of Omicron,” says Linda Spaulding, RN-BC, CIC, CHEC, CHOP, a member of Infection Control Today®’s Editorial Advisory Board, who has written extensively about the dangers that flu and COVID-19 combined present to already overburdened health care systems.

Spaulding wrote ICT®’s cover story in October about influenza with the title: “Surging or Shackled? Flu Season Could Go Either Way.” Well, judging by data from the Centers for Disease Control and Prevention (CDC), at the moment it seems to be surging (see the chart below). “The number of influenza-associated hospitalizations [last flu season] was the lowest recorded since these data were first collected in 2005,” Spaulding wrote.

That was then, this is now.

Spaulding’s been giving advice to infection preventionists throughout the pandemic about the double threat.

In a Q&A with ICT® in August 2020, Spaulding said that infection preventionists have “been dealing with COVID enough, so they know that they have to isolate, they have to wear PPE. For flu, we wouldn’t be suggesting the same PPE as we do for COVID. But you’re not going to have a flu ward, a COVID ward, say like in long-term care, because you’re not going to know if it’s COVID or flu.”

About facing a double or triple whammy of flu and some COIVD-19 strain, Spaulding says that “there’s nothing special that IPs can do except just continue monitoring. There’s no way to prevent, unless people would just put a darn mask on.”

In June 2021, ICT® interviewed Lynnette Brammer, who heads the CDC's Domestic Influenza Surveillance team. Brammer was asked if the fact that COVID-19 resulted in a flu season with the lowest number of cases since records had been kept—2,038 from September 27, 2020, to April 24, 2021—might make it more difficult to make a flu vaccine for this year. Flu vaccines are based on the data collected from the preceding year.

“We haven’t had as much data as we did in previous years, but we did still have a good bit of data,” Brammer said. “There weren’t a lot of influenza viruses circulating anywhere, but there were some.”

Spaulding says that she’s not surprised that the flu has rebounded this year. The CDC’s Weekly Influenza Surveillance Report for the week ending December 25, 2021, states that “most of the H3N2 viruses so far are genetically closely related to the vaccine virus, but there are some antigenic differences that have developed as H3N2 viruses have continued to evolve.”

Spaulding contends that the CDC “got it wrong” when it created the flu vaccine for this year, and not because of a lack of data. “I think it just happened,” Spaulding says. “They do their best to try to determine what flu is going to affect people from year to year and sometimes they make a good guess and sometimes they just miss it.”