What Is 'Flurona'? COVID-19 and Flu Co-infections, Explained

California and Texas have reported their first "flurona" cases—and more may follow.

Last week, Israeli authorities announced the country's first-known case of "flurona"—a coinfection of the flu and COVID-19—according to the Times of Israel. Now, the US has reportedly discovered two of its own cases: one in Texas and another in California.

The Texas Children's Hospital on Monday confirmed their first case of flurona in a child who was recovering from the coinfection at home, as reported by KXAN. In California, a teenager who had just returned from a family vacation in Mexico was diagnosed with the coinfection at a coronavirus testing site, the Los Angeles Times said Wednesday.

The term that connects all of these cases—flurona—has sent a shockwave through the internet, but it's neither a true medical term nor a COVID-19 variant. It's not even necessarily a new discovery: This simultaneous COVID-19 and flu infections have been popping up since the early days of the pandemic. One of the first instances of the flu and COVID-19 coinfection occurred in March 2020, according to The Atlantic. Another double infection case was reported in November 2020 by STAT.

Though still unclear how common these coinfections are, we do know they're possible—and we may start seeing more of them in the near future as peak flu season in the US coincides with a surge in coronavirus cases due to the omicron variant. Here's what we know so far about getting COVID-19 and the flu at the same time, and how best to protect yourself from getting the newly-dreaded flurona.

Is Flurona Possible?
Photo by Andrea Piacquadio from Pexels

How Common Is Flurona?

As the newly-reported cases prove, it is possible to contract both COVID-19 and the flu at the same time. However, researchers are still investigating how common cases like this are or how serious they may be, according to the Centers for Disease Control and Prevention (CDC).

That's because only a few cases of the double infection have been reported, William Schaffner, MD, a professor of infectious diseases and preventative medicine at the Vanderbilt University School of Medicine, tells Health. Though there are no solid data as to why it could be because last year's flu season was much milder than past (pre-pandemic) seasons.

Although official estimates of cases have not yet been released, early evidence from the CDC found that only 1,675 of the 818,939 specimens collected by clinical laboratories between September 28, 2020, and May 22, 2021, tested positive for influenza. In comparison, the CDC estimates there were between 39 and 56 million flu cases between October 1, 2019, and April 4, 2020.

Those numbers are expected to jump back up to pre-pandemic levels for the 2021–2022 flu season, according to Dr. Schaffner—and with the ongoing COVID-19 surge from the Omicron variant, that could mean more coinfections. "I anticipate that during this month there will be communities where you have sustained Omicron transmission, and then influenza moves into those same communities, causing an independent influenza outbreak," says Dr. Schaffner. "It's in those kinds of circumstances that, obviously, dual infections might be detected."

Is Flurona More Dangerous Than Only COVID-19 or the Flu?

As for now, there isn't enough evidence to determine whether falling ill to both coronavirus and the flu at the same time is more dangerous than having either disease by itself. Still, Dr. Schaffner says having both the flu and COVID-19 at the same time would not be an ideal experience.

According to the CDC, on their own, COVID-19 and the flu both pose serious complications, including:

  • Pneumonia
  • Sepsis
  • Multiple organ failure
  • Inflammation of the heart, brain, or muscle tissues
  • Respiratory failure
  • Worsening of chronic medical conditions

While it's not clear how contracting both diseases at once increases the risk of these complications, what little research is out there does indicate coinfections may be more serious. A 2021 review of more than 100 studies, published in PLOS ONE, found that patients with coinfections had an increased risk of death and were more likely to stay in the hospital for longer periods of time compared to those only diagnosed with COVID-19.

How Can You Tell if You Have a Coinfection?

Since symptoms of the flu and COVID-19 are so similar, there is no way to tell if you have one, the other, or both based on symptoms alone, according to the CDC. That means the only way to know if you have both coronavirus and the flu is to get tested for each one, Dr. Schaffner says.

Just as a quick recap, the CDC says the overlapping symptoms of both COVID-19 and the flu include:

  • Fever and chills
  • Fatigue
  • Cough
  • Shortness of breath or difficulty breathing
  • Sore throat
  • Muscle pain and body aches
  • Headache
  • Vomiting and diarrhea
  • Change in or loss of taste or smell (although, this is more common with COVID-19)

Currently, there is no official recommendation for when someone should get tested for COVID-19 and the flu at the same time, Anita Gupta, DO, an adjunct assistant professor of critical care medicine and anesthesiology at Johns Hopkins University School of Medicine, tells Health. Therefore, she recommends that if you're experiencing symptoms of either COVID-19 or the flu, you should call your healthcare provider, who can then determine the best course of action for you and your unique health situation.

"I think what's important is that if you're concerned about having a coinfection [you should] get tested," Dr. Gupta says.

What Should You Do if You Have Flurona?

If you test positive for both COVID-19 and the flu, you should immediately quarantine yourself to prevent spreading the viruses to others. Then, you should reach out to your health care provider.

"We don't want you to go to the waiting room and spread what you've got to others," Dr. Schaffner says. "So, contact them through telemedicine, email, or the old-fashioned phone, and they will advise you what the next steps are for your particular circumstance."

Fortunately, there are treatment options available for both COVID-19 and the flu, but which options your doctor chooses will depend on your unique situation, Dr. Gupta says. For example, if you are at high risk of complications from either COVID-19 or the flu, your healthcare provider may prescribe one or more antiviral medications.

Antivirals are drugs that keep a virus from multiplying in your body, thereby reducing its symptoms and length of illness, according to the Food and Drug Administration (FDA). There are currently four antivirals approved for treating influenza—the most common being Tamiflu—and two for treating COVID-19—Paxlovid and molnupiravir. There is no research into the safety of taking both an influenza and COVID-19 antiviral at the same time, Dr. Gupta says.

Most people with a mild case of COVID-19 or the flu will be able to recover with at-home treatment options, which, according to Dr. Gupta include:

  • Staying hydrated
  • Getting adequate amounts of rest
  • Taking over-the-counter medications to reduce fever

How Can You Protect Yourself From a Coinfection?

First and foremost, you should get your flu shot and complete a full course of COVID-19 vaccines to protect yourself and your community from either disease, Dr. Schaffner says. Those who are eligible for a booster should also get one as soon as possible.

If you have yet to get your flu shot and your COVID-19 shot (no, it's not too late for either one), the CDC says it's completely fine to get both vaccines at the same time, to save an extra trip. If you're worried about extra side effects, the CDC attempts to quell those fears, by pointing out that data from past vaccines indicate side effects are similar, whether shots are given separately or together.

But protective measures don't stop at vaccines: "The best way to prevent all of this is just to continue to hand wash, wear masks, and just really social distance," says Dr. Gupta, especially if you live in an area of high coronavirus or flu transmission. "That's the best way for us to just get through this period of time."

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