Professor of Medicine, University of East Anglia Norwich (UK) (The Conversation) Although COVID infections are currently low or on the decline in most Western countries except the UK, there is still a long way to go before the threat of a pandemic is over. A major concern this winter is whether there will be a resurgence of COVID with other respiratory illnesses coming back in force especially the flu. In both the southern and northern hemispheres, influenza infections receded rapidly and largely disappeared soon after turning into a pandemic. Social distancing measures used to contain COVID have been more effective in reducing the spread of influenza. But unfortunately, that means we now need to prepare for the flu to be particularly bad this year.

In some ways, the immune responses to COVID and influenza are the same. A relatively recent vaccination or infection provides good protection against subsequent infection, but that protection soon begins to wane. However, early cases are generally asymptomatic or relatively mild. But the longer the gap between immune generation and re-infection, the more severe the subsequent infection is likely to be. This is particularly evident when looking at how influenza affects people living on remote islands. Because they can survive long periods of time without exposure to the flu, when they do eventually encounter it, their death rates are higher.

One study that looked at people living on Tristan da Cunha, a group of isolated islands in the South Atlantic, found that spending just a few years between exposures to influenza appeared to increase the risk of disease. So the concern is that with COVID control measures that have almost completely reduced people’s exposure to influenza over the past 18 months, natural immunity will decline in the population. We have all been essentially living on remote islands since the start of 2020 thanks to the lockdowns, travel restrictions and work-from-home measures that have been posted.

When the flu returns, it may affect more people and cause more severe illness than we usually see in a typical flu season. The same is likely to also apply to other respiratory viruses. In fact, this may actually happen recently, there have been many anecdotal reports of people catching particularly severe colds in the UK. However, it is not easy to predict exactly when the flu will return, nor how much worse or more common it will be. For now, flu rates are still very low in the UK, but this could change very quickly if the virus starts spreading.

Fortunately, we have safe and effective flu vaccines that reduce the risk of infection and severe illness. But it is not as effective as most current COVID vaccines. In addition, how well they work varies from year to year. Influenza viruses mutate more quickly, which means that multiple strains end up spreading and changing every year. If the dominant viral strain each winter is not included in the vaccine, its effectiveness will be lower. Recommendations for viruses to be included in annual influenza vaccines created separately for the winter in the northern and southern hemispheres by the World Health Organization, which evaluate strains previously circulated. But with flu cases so low in the past 18 months, predicting which viruses will dominate this winter is more difficult than usual. So, in addition to the possibility that you might catch the flu, there’s also a higher-than-normal risk this year of getting a vaccine that isn’t as effective as usual.

How does this combine with COVID Even before the pandemic, the winter flu added significant pressures to both GP services and hospitals each year. Dealing with it now, at a time when there are so many COVID patients occupying hospital beds in the health service, will be especially difficult and will increase the pressure on the health service even more. Ultimately, more pressure on the NHS is putting people’s health at risk. But there’s also an additional risk: co-infection. It is possible to catch COVID at the same time as another bacterial, fungal, or viral infection. In fact, one study that looked at hospitalized COVID patients estimated that 19% were also carrying other infections. It found that patients with co-infection were more likely to die.

Early in the pandemic, when influenza was still circulating, UK-based researchers were able to compare outcomes for people with COVID alone versus co-infection with COVID. People with co-infections were twice as likely to be admitted to intensive care, twice as likely to need ventilation, and nearly twice as likely to die than those who had just contracted COVID. It is not possible to say whether we will see a major flu pandemic in the UK this year, but if not, it will almost certainly happen soon. And when the flu returns, it will likely infect more people than in most pre-COVID years and cause more deaths than usual. The number can be large. In a bad winter, the flu kills more than 20,000 people in England.

Because of the immediate threat and increasing pressure that influenza will place on health services that may still be struggling to deal with COVID, it is doubly important that people accept the offer of influenza and the COVID booster vaccines if and when they are introduced this fall. (Conversation) SCY SCY 101611007 NNNN.

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