COVID-19: Risk of death more than doubled in people who also
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People infected with both flu and SARS-CoV-2 are more than twice as likely to die as someone with the new coronavirus alone, emerging evidence from England has shown.

An analysis by Public Health England (PHE) of cases from January to April 2020 also found that people with the two viruses were more at risk of severe illness. Most cases of coinfection were in older people, and more than half of them died.

“There is now some emerging evidence which clearly suggests that coinfection with influenza and covid-19 produces bad outcomes. One of these diseases is currently vaccine preventable, and that’s the really important point,” said researchers.

This case-control study compared rates of coinfection and estimated the impact on mortality. It looked at 19256 people who were tested for both flu and SARS-CoV-2. It found 58 people with coinfection, among whom the mortality rate was 43.1% (25). Of those who died, 80% (20) were aged over 70.

“Interaction effect”

The odds of death were 2.27 times as high as in people with SARS-CoV-2 alone and were 5.92 times the odds in people with neither flu nor SARS-CoV-2. The authors said that this suggested “possible synergistic effects” in coinfected people.

The risk of testing positive for SARS-CoV-2 was 68% lower among flu positive cases. Authors said that this was consistent with recent findings from New York, where under 3% of people testing positive for SARS-CoV-2 had coinfection with flu, whereas 13% of those testing negative for SARS-CoV-2 were flu positive.

PHE’s study incorporated intensive care admission and ventilator use as additional indicators of severe disease. When combining ventilator use or death into a composite variable, the odds of death were 6.43 times greater in people with coinfection than in those with neither virus. And when combining intensive care admission or death into a composite variable, the odds of death were 6.33 times greater in people with coinfection (3.57 to 11.23) than in those with neither virus.

The authors said that this showed strong evidence of an interaction effect when compared with the two viruses acting independently. But the findings could not distinguish between a reduced risk of SARS-CoV-2 in people first infected with flu or vice versa.

Source: https://www.bmj.com/content/370/bmj.m3720
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