This year's flu season could be a severe one when combined with the ongoing coronavirus pandemic, a Northwestern University pulmonologist warns. 

"Humans have suffered from influenza for millennia, and we can expect that the new reality of COVID-19 will only complicate the next influenza season," Benjamin Singer writes in an editorial for Science Magazine.

Four factors will need to be addressed that could prevent a severe influenza season he said:  

• Transmission: Both flu viruses and COVID-19 are spread through respiratory droplets transmitted during close contact, so social distancing policies are effective against both. But if COVID-19 cases spike again this fall, re-tightening social distancing measures could flatten the case curves for both illnesses. 
• Vaccination. Efforts should be made to increase influenza vaccinations especially among older adults who have higher susceptibility to both influenza and COVID-19, writes Singer. Currently, however, only about 45% of adults in the United States get flu shots.
• Co-infection: More than 20% of COVID-19 patients experience co-infection with other respiratory pathogens, including influenza, which underscores the need for more rapid diagnosis tools for both diseases. 
• Disparities in coverage: African Americans, Latinos and Native Americans have had higher rates of COVID infections, and public health efforts must be underway to limit viral transmission while increasing vaccination rates, deploying diagnostics, and expanding health care services for vulnerable communities, including older adults, wrote Singer. 

Benjamin Cowling, a professor of epidemiology and biostatistics who with colleagues studied influenza in Hong Kong, told the South China Morning Post that working from home, closing schools, cancelling mass public gatherings and wearing masks, had an effect on flu. 

Schools were also closed in 2009 and 2017-18 in Hong Kong for the flu seasons, reducing influenza transmission by 10-16%, said Cowling, and a 44%  reduction in transmission in 2020 far exceeded expectations, according to Cowling.

“Most likely we won’t see much flu in 2020, because a lot of parts of the world will be trying hard to stop COVID-19, and the knock-on effect of that would be definitely stopping the flu, and hopefully stopping COVID-19 as well,” Cowling said.

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