With the southern hemisphere's winter coming to an end, its countries have reported a milder than average influenza season. But are these reports enough to reassure the northern hemisphere, now approaching the onset of autumn, that it might see a similar pattern of decreased transmission of seasonal respiratory viruses and avoid a much-feared double epidemic of COVID-19 and influenza?
Seasonal respiratory virus transmission in the southern hemisphere is largely thought to have been quenched by physical distancing and hygiene measures implemented to combat the COVID-19 pandemic. But most countries in the northern hemisphere have now relaxed the interventions that they had enforced in earlier phases of the pandemic. And as children are due to return to school and the impending drop in temperatures can be expected to drive social interactions from open-air spaces to indoor settings, the risk of co-circulation of seasonal respiratory viruses and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) looms.
Although COVID-19 outcomes have been improving in Europe—probably a result of multiple factors, including an increase in the proportion of younger patients and improved understanding and clinical management of the disease—how these outcomes might be affected in the case of co-infection with another respiratory virus, remains unknown. Few data are available from the southern hemisphere's virtually non-existent influenza season on the interaction between SARS-CoV-2 and seasonal respiratory viruses, only leaving space for hypotheses. On one hand, viral interference—a desirable effect by which infection with one virus inhibits another virus from infecting the same host—might exist between SARS-CoV-2 and other seasonal viruses and dampen the spread of either. On the other hand, co-infection with seasonal respiratory viruses and SARS-CoV-2 might affect, and potentially worsen, the course of COVID-19.
In England, one measure that will lessen the risk of co-infection is its extended influenza vaccination programme. While this plan is welcome and will help to protect vulnerable groups from influenza virus infection, there is considerable concern around the measures to control the continued spread of SARS-CoV-2. Since the incremental relaxation of lockdown measures throughout summer, the number of COVID-19 cases has started rising again, with a 7-day average of about 1000 new daily cases in the UK at the time of writing. The National Health Service (NHS) Test and Trace service, which has been afflicted by several mishaps since its launch, has been heavily criticised for only managing to successfully reach 78% of cases in England and 57% of their contacts, from its inception to August 5. In a move that is likely to further destabilise this service, on August 18, the UK Secretary of Health and Social Care Matt Hancock announced the dismantlement Public Health England (PHE) and its replacement with a new agency, the National Institute for Health Protection (NIHP), which will incorporate PHE's infectious disease unit, NHS Test and Trace, and the Joint Biosecurity Centre.
The mission of NIHP will be to protect people from external threats (eg, biological weapons, pandemics, and infectious diseases in general), implying that during the COVID-19 pandemic PHE proved not to be up to the job. It should, however, be noted that during the 7 years since PHE's creation, its funding saw deep cuts; additionally, as an executive agency of the Department of Health and Social Care (DHSC), PHE's agenda was primarily dictated by this governmental department. A DHSC letter in March, 2019, clearly outlines PHE's public health targets for the following fiscal year, and they did not include pandemic preparation. This agenda is reflected in PHE's 2020–25 strategy, which only includes a focus on potential influenza pandemics, but not other emerging viruses.
The limitations of PHE and other health agencies and their consequences on the management (and outcomes) of the pandemic should have been assessed through a transparent public inquiry, the results of which could have guided the strengthening of existing departments and their collaboration, as well as their communication with local public health departments for the management of local outbreaks. Scrapping institutions that are already in place is bound to cause administrative disruptions, delays, loss of expertise, and unnecessary public expenses, not to mention diversion of accountability. Is this what the UK really needs in the midst of a pandemic, and at the doors of a potential double epidemic?
© 2020 Municipalidad de Miraflores/Flickr