Can Covid-19 and influenza be treated simultaneously in a patient positive for both?

Treatment of COVID-19 and Influenza Co-Infection

Yes, COVID-19 and influenza should be treated simultaneously when a patient tests positive for both viruses, with specific targeted therapies for each infection. 1

Diagnosis and Testing

• Separate testing is required for accurate diagnosis of each virus, as COVID-19 tests detect SARS-CoV-2 while influenza tests detect influenza A or B 1
• During respiratory virus seasons, testing for both pathogens is recommended, especially in:
  • Patients with severe respiratory symptoms
  • High-risk patients (elderly, immunocompromised, those with comorbidities)
  • Healthcare settings 1

Treatment Approach

For COVID-19 Component:

• Follow standard COVID-19 treatment protocols based on disease severity
• For confirmed COVID-19 infection:
  • Temporarily discontinue bispecific antibody treatment in patients with hematological malignancies until clinical resolution and RT-PCR clearance 2
  • Consider available COVID-19 therapies based on symptoms and physician assessment 2
  • Avoid routine antibiotics unless bacterial co-infection is suspected 2

For Influenza Component:

• For confirmed influenza:
  • Administer antiviral therapy with oseltamivir or baloxavir as per standard treatment guidelines 2, 1
  • Start treatment as soon as possible after diagnosis for maximum effectiveness

Important Considerations:

1. Do not delay treatment of either infection - treating both simultaneously is associated with better outcomes than treating either alone 3
2. Monitor closely for severe outcomes - co-infected patients have 2.92 times higher mortality risk compared to COVID-19 alone 3
3. Watch for complications - co-infected patients have higher risk of:
   • Acute respiratory failure
   • ICU admission (2.20 times higher odds)
   • Need for mechanical ventilation (2.73 times higher odds) 3

Special Populations

Immunocompromised Patients:

• For patients with hematological malignancies:
  • Temporarily discontinue bispecific antibody treatment until clinical resolution 2
  • Resume treatment after COVID-19 resolution with RT-PCR clearance 2
  • Continue hepatitis antiviral prophylaxis during treatment 2

Critically Ill Patients:

• Consider double antipseudomonal antibiotics if secondary bacterial infection is suspected in ICU patients 2
• Monitor closely for secondary bacterial infections, which are more common in co-infected patients 2

Prevention Strategies

• Influenza vaccination is recommended for all eligible patients 1
• Influenza vaccination may potentially reduce COVID-19 severity - patients without influenza vaccination had 2.44 greater odds of hospitalization and 3.29 greater odds of ICU admission when infected with COVID-19 4

Common Pitfalls to Avoid

1. Assuming a single test covers both viruses - separate testing is required for each pathogen
2. Overuse of antibiotics - do not routinely prescribe antibiotics unless bacterial infection is suspected 2
3. Delaying treatment - co-infected patients have significantly higher risk of severe outcomes and should be treated promptly for both infections 3
4. Missing secondary bacterial infections - be vigilant for secondary bacterial infections, especially in critically ill patients 2

By treating both infections simultaneously with their respective targeted therapies, while monitoring closely for complications and secondary infections, outcomes can be optimized in patients with COVID-19 and influenza co-infection.