Older Adults Vulnerable to 'Twindemic' of Flu and COVID-19

This year, flu season is coinciding with the ongoing COVID-19 pandemic. Many people are wondering if it's possible to get influenza and COVID-19 at the same time.

Those who are caregivers for older adults or others who are extra vulnerable to both viruses are especially concerned about a possible “twindemic”—the term now being used to describe a COVID-19 and influenza coinfection.

According to the Centers for Disease Control and Prevention (CDC), around 50-70% of hospitalizations linked to influenza, and 70 to 85% of deaths caused by influenza occur in people aged 65 and older.

The risk of being hospitalized for COVID-19 is 5 times higher for people aged 65 and older than it is for younger people, and the risk of death from COVID-19 is 90 times higher for the older adult age group.

“It is possible to get the flu and COVID-19 together at the same time,” Supriya Narasimhan, MD, MS (Epi) at Santa Clara Valley Medical Center tells Verywell. “There have been multiple such cases reported. Co-infection with two or more respiratory pathogens does increase the risk for more severe illness, more complications, and a longer recovery period.”

A National Concern

The coexistence of the flu and COVID-19 is a major concern for caregivers and providers. Experts are still trying to figure out how often the coinfection actually happens. A study published in June found that influenza/COVID-19 coinfection can occur and has the potential to result in severe illness.

Narasimhan says that when it comes to COVID-19 and flu coinfection, healthcare providers and organizations must remain vigilant for a few reasons including:  

• Increased probability of more serious illness
• Potentially longer hospital stays 
• Possibly higher complication rates

These factors can overwhelm the healthcare system and place additional strain on resources, such as staff and available hospital beds. Caregivers should make every effort to ensure their loved ones are not hospitalized because of COVID-19 and/or the flu. 

Why Older Adults Are High-Risk

Many people get the flu and only have mild symptoms that last 1 to 2 weeks. For older adults, the flu can be life-threatening—even fatal. Older adults are at a higher risk for serious illness because as the body ages, the immunity system takes longer to respond. In addition, chronic conditions (such as high blood pressure or diabetes) can decrease immunity even more.

General Protection Strategies 

In addition to staying home as much as possible, practicing frequent and proper handwashing, and wearing a face mask, Narasimhan says there are a few other steps older adults can take to reduce their risk:

• Avoid contact with people who are sick.
• Clean and disinfect surfaces you touch often, such as door handles, faucets, keyboards, phones, handrails, and toilets.
• Set up remote care options, such as telemedicine consultations, home delivery of groceries, and mail-order prescriptions.

The strategies we can use to prevent COVID-19 and influenza are similar because both are respiratory viruses.

Should Older Adults Get the Flu Shot?

The misconception that the flu shot can cause the flu has led some people to be skeptical of the vaccine. However, the CDC reminds everyone that influenza is a potentially serious illness that can be mitigated by getting a flu vaccine. It's also important to remember that because immunity to flu viruses wanes each year, people need to be vaccinated annually.

Narasimhan strongly recommends the flu vaccine this season more than ever. "On average, the flu vaccine is about 40-50% effective in protecting against flu. But even if it does not prevent influenza, it does decrease the probability of serious influenza, hospitalization due to flu and complications from flu.”

Safeguarding Nursing Facilities

If your loved one is in a nursing home or assisted living facility, you might be worried about them catching COVID-19 and the flu. Fortunately, some nursing homes are taking increased measures to protect residents from both viruses. 

“All residents are encouraged to receive the flu vaccine annually before influenza season begins unless it is contraindicated,” John Mastronardi, MPA, LNHA, executive director of Nathaniel Witherell, a nursing and short-term rehabilitation facility in Greenwich, Connecticut, tells Verywell. 

Mastronardi says the facility has already incorporated several safety measures to prepare for a possible “twindemic" including:

• Educating and training staff on infection control and prevention.
• Mandating that all staff members wear a facemask at all times while in the facility.
• Performing weekly COVID-19 testing on residents and staff. 
• Requiring residents to wear a facemask, if tolerated, whenever they leave their room. 
• Taking staff temperatures and documenting whether they have symptoms consistent with COVID-19. If a staff member is ill, they must leave the facility immediately.

Visitors are limited, but when they are allowed, they must wear a face mask and the facility screens them for any COVID-19 symptoms or known exposure to someone with the virus. Mastronardi says they are encouraging families to use alternative methods of communication with their loved ones, such as video conferencing.

In addition to proactively conducting COVID-19 testing on all residents and staff, Mastronardi says they perform flu testing on residents who exhibit symptoms—even when it's not flu season.

However, Mastronardi says that the best prevention against serious COVID-19 and flu illness is close monitoring of any physical or mental changes. "It’s extremely important for our staff to know our residents, their preferences, personalities, and routines to ensure that we recognize even subtle nuances in one of our resident’s behavior or routine," he says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.