Can the U.S. avoid a ‘twindemic’ of coronavirus and flu?

What’s happening

Public health experts have feared for months that the United States would see a “second wave” of coronavirus cases in the fall as temperatures drop across the country. Now that autumn has officially begun, warnings that the U.S. could be heading for a catastrophic health crisis have become more urgent.“We are entering into a risk period,” Dr. Anthony Fauci, the nation’s leading infectious diseases expert, told CNN on Tuesday. The U.S. has seen two distinct surges in coronavirus cases so far: the initial outbreak that reached its peak in April and another over the summer after lockdown measures were lifted. The United States recently passed 200,000 total coronavirus-related deaths.Cases of respiratory viruses like the one that causes COVID-19 tend to rise in the fall and winter months as temperatures drop and people spend more time indoors. Most pandemic models predict a surge starting in the fall and worsening into the winter that could rival or even surpass the worst days of the spring. One well-regarded forecast sees a “most likely” scenario of more than 3,000 deaths a day in December and nearly 400,000 cumulative coronavirus-related deaths by the end of the year.That timeline coincides with the typical course of flu season, which on its own causes about 37,000 deaths a year in the U.S. The combined risk of the coronavirus and flu virus has led some experts to warn of a “twindemic” that could overwhelm the country’s health care capacity.Why there’s debate

Health experts see many reasons to predict that the next several months could bring what CDC Director Robert Redfield called “the worst fall, from a public health perspective, that we’ve ever had.” Many experts say the U.S. hasn’t done enough to suppress the virus during the months of favorable weather and is still lagging behind in terms of testing, contact tracing and mask-wearing to prevent a major outbreak. The flu and coronavirus present very similar symptoms, which can be a problem for doctors trying to determine the best course of treatment, particularly in areas where coronavirus tests are in short supply.

Despite warnings about the risks of the coming months, many parts of the country are lifting lockdown restrictions on businesses and welcoming children back to schools. At the same time, the odds that the federal government might take significant steps to curb infections — like a nationwide mask mandate or another round of economic stimulus — seem slim.

As the weather starts to turn, many outdoor activities that have allowed people to socialize safely will become impractical in parts of the country. This may force people to choose between isolating or meeting up with people indoors, where the virus spreads more effectively. Experts worry that a combination of science skepticism and “quarantine fatigue” will lead many to abandon safe practices, especially during the holiday season.

While these circumstances point to a dire scenario over the coming months, there are some reasons for optimism. Doctors have learned a lot about how to treat COVID-19 since the start of the pandemic, which could mean that death rates won’t increase much even if more people become infected. Though a vaccine is unlikely to make much of an impact in 2020, other scientific innovations like rapid-results tests and better treatments could be widely available in the next few months.

The public has also learned what needs to be done at an individual level to limit the spread of the virus. Experts hope that, outside of a vocal group of dissenters, most people will step up their safety measures when another spike appears to be occurring. There are also hopeful signs that this year’s flu season may not be as bad as in previous years. Precautions put in place to contain the coronavirus have led to record-low flu seasons in several countries in the southern hemisphere. Concern about a “twindemic” may drive more people to get flu shots than in a typical year.

What’s next

After declining steadily for the past two months, coronavirus cases in the U.S. are rising again. While it’s too early to say whether this uptick in cases is the start of a predicted fall surge, it’s a troubling sign for experts who are hoping to get the country’s baseline level of infections down.



We haven’t done what’s needed to prevent a worst-case scenario in the fall and winter

“It’s hard for me to think of a positive scenario where things are going to get better in October and November. I don’t see behavior changing adequately. I don’t see testing ramping up. I see political winds continue to be oppressive to doing the right things.’’ — Dr. John Swartzberg, infectious diseases expert, to USA Today

The U.S. missed its opportunity to get the virus in check over the summer

“Human coronaviruses, the distant cold-causing cousins of the virus that causes COVID-19, circulate year-round. Now is typically the low season for transmission. But in this summer of America’s failed COVID-19 response, the SARS-CoV-2 virus is widespread across the country, and pandemic-weary Americans seem more interested in resuming pre-COVID lifestyles than in suppressing the virus.” — Helen Branswell, Stat

Simultaneous coronavirus and flu epidemics could overwhelm our health care system

“The combination of COVID-19, influenza and a panoply of acute and chronic illnesses such as heart attacks, strokes, cancer and accidents may, and likely will, paralyze our existing health care system.” — Dr. Lipi Roy and Dr. L. Brett Jaggers, NBC News

Parts of the country may reopen right when the risk is greatest

“If things are moving in the correct direction, then we could have reopening, and that might actually coincide with the middle of the flu season — you could actually have increased transmission from that. It really behooves us to do as much as possible to prevent any flu cases we can with the traditional tools.” — Dr. Geoffrey Leung to Los Angeles Times

A dual outbreak will highlight societal disparities

“Ultimately, the flu season may shake out much like the pandemic itself — unevenly. … When flu season begins, essential workers already exposed to the coronavirus in their workplace will be at risk of contracting two viruses. And people who are able to stay home, who otherwise may have caught the flu, will be less likely [to] catch the flu and COVID-19.” — Soumya Karlamangla, Los Angeles Times

Americans won’t listen to the warnings from experts

“Scientists have a much better understanding of how coronavirus is transmitted now, compared with when it first emerged. But they are fighting a tidal wave of mistrust from people who think shifts in messaging are something to be skeptical of, instead of a sign of evolving knowledge, and others who are pushing misinformation.” — Dominic Rushe and Amanda Holpuch, Guardian


We still have time to prepare if we’re honest about what’s coming

“The virus is here to stay. At best, it would fade away gradually, but that would happen after, not before, the winter. The sooner we can accept this, the more we can focus on minimizing the losses of the bleak and grisly coming months. Some of our fate is now inevitable, but much is not. There are still basic things we can do to survive.” — James Hamblin, Atlantic

Many people will brave the cold to avoid risky indoor social gatherings

“If Summer 2020 made best-sellers out of such backyard pleasures as potting soil, inflatable pools, and sidewalk chalk, Winter 2020 should see a run on long underwear, fire pits, and faux-fur cushions.” — Alexandra Lange, Bloomberg

Some parts of the country are well prepared to avoid the worst 

“As localized outbreaks are detected, shutdowns will be needed. Restrictions on everything from nursing home visits to haircuts to large indoor gatherings will have to be implemented. The scope and duration of these measures will depend on how quickly health officials respond, which in turn depends on the area’s testing and contact tracing abilities. They will also depend on how faithfully individuals abide by such edicts.” — Jeneen Interlandi, New York Times

A combination of factors may mean the fall and winter aren’t as bad as feared

“There are reasons to believe it might not get so bad. Since so many people in the U.S. have gotten sick, that could offer some element of population immunity in some places as long as people continue social distancing and masking. After seeing two large waves of the coronavirus across the country, the public could act cautiously and slow the disease, even if local, state, and federal governments don’t. Social distancing due to COVID-19 could keep the spread of the flu down too.” — German Lopez, Vox

Coronavirus mitigation strategies could lead to a mild flu season

“The 2020 coronavirus pandemic has better prepared us for flu season. The emergence and global spread of the novel coronavirus have provided six months of hard practice in the basics of viral defense — washing hands and keeping them away from the face, wearing a mask, staying socially distant, tucking sneezes and coughs into the elbow.” — Anne Saker, Cincinnati Enquirer

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