Twindemic Trouble

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With the approach of winters, an increase in respiratory diseases, especially seasonal flu, is witnessed. Nowadays, it is seen that many patients who manifest with respiratory symptoms have seasonal flu combined with Covid-19. This condition has come up as a big challenge for the overburdened medical fraternity and overwhelmed health structures. As the signs and symptoms of both the infections are similar, experts opine that the diagnosis gets difficult. This co-infection of seasonal flu and Covid-19 is being termed as Twindemic.

While there is no respite in the rise of Covid-19 cases globally, worldwide deaths due to Covid-19 have crossed ten lac mark and new cases are rapidly mounting. It took about ten months to reach the first ten lakh Covid-19 related fatalities. However, because of wintertime and co-infection of Covid-19 and seasonal flu, some virologists project the second ten lakh Covid-19 deaths in approximately another two and a half months arriving at the end of 2020.

There is a difficult situation ahead; the winter will not be an easy one. A significant part of the population with underlying lung diseases are at a higher risk of Twindemic related mortality and morbidity. Symptoms of Covid-19, seasonal flu and other respiratory diseases are likely to overlap, causing mix-up in the diagnosis. Regarding influenza, it has a vaccine and is advised to be administered yearly during the autumn season. There has been a lot of confusion regarding influenza vaccination, popularly known as flu shot. However, infectious disease experts strongly recommend flu shot this season and emphasize the importance of flu shot to at least mitigate seasonal flu. As such, everyone from children to elderly should get vaccinated for seasonal flu.

As Covid-19 cases continue to rise, guidelines have been modified and all mildly to moderately symptomatic patients have been advised strict home isolation. However, there is a low willingness of the home isolated patients to adhere to the guidelines. Because of less severity of their infection, most of the people who have otherwise been advised for strict home isolation move around freely, mix up with people, hide their Covid-19 status and do their routine chores. This challenge is going to be the turning point. The virus is spreading in a different way. Lackadaisical approach, especially of young people who experience mild symptoms, is becoming a critical factor in the transmission of this disease. If the isolation is effective, it can contain the virus and stop forward transmission to a large extent.

Decision making by the authorities has some diversity. Consequently, it is somewhat losing its coherence. Unfortunately, we are following the guidelines framed for the majority of the population that lives in coastal and plain areas of India. These guidelines need to be modified keeping in view the difference in population structure, topography, weather and various other significant social parameters. For example, reopening of schools during the end of September was the guideline that was adopted in Kashmir also knowing the fact that it is the time when we have final exam season followed by winter vacations here.

With a high population density and controversial reporting of Covid-19 cases and deaths, India at present is the biggest concern for the global virologists. In its editorial, the world’s reputed medical journal The Lancet observes, “Most crucially, the rapidly growing case numbers, alongside the continuing relaxation of restrictions, are creating an atmosphere of fatalism mingled with false optimism… Without clear and honest communication of the risks of Covid-19 to the population, stemming the epidemic will be impossible. The Indian Council of Medical Research (ICMR) has been singled out by experts for straying from scientific evidence, appearing at worst politically motivated and at best overly optimistic. India has expertise in medicine, public health, research, and manufacturing to lead the nation through the COVID-19 pandemic. To capitalize on these attributes, the country’s leaders must respect scientific evidence, expert commentary, and academic freedom, and not provide false optimism” (Covid-19 in India: The Dangers of False Optimism, 26 September, 2020).

Bottomline: Sadly these are the atrocious uncertain times we all are going through. It is the mishmash of denial, deception and defiance. At all levels. On one hand, decision making by public health experts is severely influenced by politics. As of now, at least the authorities should have made flu shot readily available for the public, either free or at a subsidized price. On the other side, most of the people are playing indifferent and dishonest to society by violating advisories and concealing their Covid-19 status. Flu shot, Mask wearing, Social Distancing and Hand Hygiene—let’s conform to these for guarding ourselves against Twindemic this winter. God willing.