Dual Threats of COVID-19, Influenza Could Have Devastating Effects on Adults with Chronic Conditions


The relationship between the flu and heart disease is of particular concern during the pandemic, as severe COVID-19 outcomes have also been associated with exacerbated cardiovascular conditions.

The National Foundation for Infectious Diseases (NFID) issued a Call to Action report detailing the dangers of co-infection with influenza (flu) and coronavirus disease 2019 (COVID-19) in adults with chronic health conditions and urging the public to get vaccinated against the flu during the 2020-2021 season.

“Amidst the COVID-19 pandemic, patients with chronic health conditions are facing not 1, but 2 viruses that pose a serious threat to their health and independence,” said William Schaffner, MD, medical director at the NFID, in a press release. “While we currently don’t have an approved COVID-19 vaccine in the US, we know that annual flu vaccination can help protect these patients from hospitalization, progressive disability, and even death. It is imperative that health care professionals educate patients with chronic health conditions about their risks and implement strategies to increase flu vaccination rates during the COVID-19 pandemic.”

According to a press release, 6 in 10 adults in the United States have 1 or more chronic health conditions, including heart disease, lung disease, and diabetes. These conditions put them at an increased risk for both flu and COVID-19, and related complications can include the potential exacerbation of underlying health conditions, as well as an increased risk of long-term complications.

Flu vaccinations are more important than ever this year, according to the authors. The CDC emphasizes that annual flu vaccination has been proven to mitigate serious flu-related complications, preventing an estimated 7.5 million flu illnesses, 3.7 million flu-associated medical visits, 105,000 flu hospitalizations, and 6300 flu deaths in the 2019-2020 season alone. Despite these data, a recent survey by the NFID found that nearly 1 in 4 US adults at high risk for flu-related complications said they did not intend to get vaccinated during the 2019-2020 season.

NFID recently convened a multidisciplinary virtual roundtable to explore the risks of co-circulation and co-infection with the flu and COVID-19 in adults with chronic health issues. The resulting Call to Action summarizes the roundtable discussions and includes best practices to administering flu vaccines while maintaining COVID-19 mitigation efforts.

The relationship between the flu and heart disease is of particular concern during the COVID-19 pandemic, as severe COVID-19 outcomes have also been associated with exacerbated cardiovascular conditions and post-infection injury to heart tissue. Over the past 8 flu seasons in the United States, nearly 47% of patients hospitalized for the flu had heart disease, making it the most common underlying health condition associated with flu-related complications.

Flu vaccination is an effective prevention strategy in these patients, with 1 study estimating that the flu vaccine is between 15% and 45% effective in preventing heart attacks and stroke.

“I am greatly concerned for heart disease patients this flu season,” said William B. Borden, MD, an American College of Cardiology representative, in the press release. “It is already well-documented that heart disease is a risk factor for severe flu-related illness, but with COVID-19, we are entering a dangerous and uncharted territory. The most important thing we can do to protect these patients is to ensure they are getting their annual flu vaccine. I am making it a point this season to strongly recommend a flu vaccine to every heart patient I see and urge my colleagues to do the same.”


Public health experts fear devastating impact of flu and COVID-19 on vulnerable adults [news release]. EurekAlert!; October 15, 2020. https://www.eurekalert.org/pub_releases/2020-10/p-phe101420.php. Accessed October 21, 2020.

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