Europe’s winter twindemic of flu and Covid

Health experts are warning that flu could pose a serious risk this year while Covid-19 cases rise across Europe, leaving the continent facing a “twindemic”.

After several consecutive winters of low flu infections, due to the Covid-19 pandemic, there is thought to be little immunity against the illness. This is happening at a time when Covid-19 is becoming more prevalent in a number of countries across the continent.

An average winter without pandemic restrictions can result in around 11,000 people in the UK dying from flu, according to Politico. However, this can change according to the particular strain that is circulating – a “bad” flu year will see up to 30,000 deaths, said the BMJ.

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Susan Hopkins, chief medical adviser at the UK Health Security Agency (UKHSA), has warned that while flu and Covid-19 could prove to be unpredictable, there are “strong indications” that the UK this winter “could be facing the threat of widely circulating flu, lower levels of natural immunity due to less exposure over the last three winters and an increase in COVID-19 circulating with lots of variants that can evade the immune response”.

Are Covid and flu cases rising?

Politico’s Brussels Playbook compared the “twindemic” that is forecast to sweep over Europe to the cult low-budget horror film Sharknado, in that it is “a combination of two things you really don’t want to experience by themselves, but somehow they hit at the same time”.

Both flu and Covid-19 are expected to surge this winter as cold weather “drives up infection rates”, and across Europe Covid-19 cases are already rising. “French officials declared the start of the ‘eighth wave’ of COVID earlier in the month, while in Germany the debate over masking is back,” said Politico.

Covid levels are steadily rising in the UK too. More than 1.7 million people were thought to have had the virus in the most recent week, a 31% rise from the week before, according to data from the Office for National Statistics (ONS). That is the highest number of infections since late July, but it is still lower than early July’s summer peak, during which there were 3.8 million.

But the rise hasn’t come as a surprise to health experts as the weather turns colder. Mary Ramsay, head of immunisations at UKHSA, told Sky News: “This is the first year where people are going to be mixing normally so I’m expecting that there is going to be more infection going around.” She added that the “big difference” between now and previous years “is that most people have been vaccinated”.

Vaccinations and exposure to previous strains of Covid-19 mean we are likely to be protected from the worst effects of the virus. But the worry is that after two years of reduced social mixing and masking, people will be more susceptible to infection with flu, which “could make for an explosive mix with the still circulating coronavirus”, said Politico.

How can people avoid the twindemic?

As with previous waves of Covid-19, vaccination is crucial. Peter Piot, the former head of the London School of Hygiene & Tropical Medicine, told Politico that “increasing the number of people in vulnerable categories who have had their second booster dose… will be key”.

Wearing masks also remains important. Piot said that those with respiratory symptoms should avoid contact with vulnerable people and “stay home for at least five days. It doesn’t mean you have to lock yourself in. But when you go and buy groceries, just wear a mask there as well.”

In the UK, the UKHSA is running a campaign urging those in vulnerable groups, including people aged 50 and over, care home residents, health and social care workers, and those in clinical risk groups, to get both their Covid-19 booster jabs and this year’s flu vaccine.

Will there be official or unofficial lockdowns?

There has been no sign from the UK government that it plans to impose any restrictions over the winter. Indeed, as The New Statesman noted, with Liz Truss busy “trying to reassure the Conservatives of her ability to govern, while also making various policy U-turns” there has been little word from frontline politicians on the anticipated twindemic at all, and the prime minister has “not so far acknowledged the developing Covid situation”.

But NHS trusts are predicting a difficult winter, “warning they may be forced to cancel appointments and limit visiting times” in the face of a twindemic scenario, said The Independent.

“I make no bones about this: we know it’s going to be a pressurised time for trusts over the next four months if not longer,” said Saffron Cordery, the interim chief executive of NHS Providers, which represents trusts in England, speaking to the newspaper.

Cordery warned that “there may well be cancellations for either outpatient appointments or routine procedures or operations because there could be staff shortages or rising demand in emergency care”. She added that pressures over the winter could also lead to increased waiting times at A&E and for ambulances.

“That’s one of the enduring pressures we’ve seen over the last few months. And we know that that isn’t a good experience for patients or their families. Indeed, it’s very worrying and also very challenging for staff,” she said.