Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mimics the influenza A (H1N1) virus in terms of clinical presentation, transmission mechanism, and seasonal coincidence. Comprehensive data for the clinical severity of adult patients co-infected by both H1N1 and SARS-CoV-2, and, particularly, the relationship with PCR cycle threshold (Ct) values are not yet available. All participants in this study were tested for H1N1 and SARS-CoV-2 simultaneously at admission. Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults hospitalized for H1N1 infection, SARS-CoV-2 infection and co-infection with both viruses. Ct values for viral RNA detection were further compared within SARS-CoV-2 and co-infection groups. Score on seven-category ordinal scale of clinical status at day 7 and day 14 were assessed. Among patients with monoinfection, H1N1 infection had higher frequency of onset symptoms but lower incidence of adverse events during hospitalization than SAR-CoV-2 infection (P < 0.05). Co-infection had an increased odds of acute kidney injury, acute heart failure, secondary bacterial infections, multilobar infiltrates and admittance to ICU than monoinfection. Score on seven-category scale at day 7 and day 14 was higher in patients with coinfection than patients with SAR-CoV-2 monoinfection (P<0.05). Co-infected patients had lower initial Ct values (referring to higher viral load) (median 32) than patients with SAR-CoV-2 monoinfection (median 36). Among co-infected patients, low Ct values were significantly and positively correlated with acute kidney injury and ARDS (P = 0.03 and 0.02, respectively). Co-infection by SARS-CoV-2 and H1N1 caused more severe disease than monoinfection by either virus in adult inpatients. Early Ct value could provide clues for the later trajectory of the co-infection. Multiplex molecular diagnostics for both viruses and early assessment of SAR-CoV-2 Ct values are recommended to achieve optimal treatment for improved clinical outcome.
Highlights
Influenza is a contagious respiratory disease that is widespread worldwide
Demographic, clinical, treatment, and laboratory data were extracted from electronic medical records and compared among adults ( 18 years) hospitalized for H1N1 infection (n = 220), SARS-CoV-2 infection (n = 249) and co-infection with both viruses (n = 36)
Lower initial cycle threshold (Ct) values of co-infected patients was found to be associated with a higher number of adverse events and clinical symptoms
Summary
Influenza is a contagious respiratory disease that is widespread worldwide. Despite the advances in medical technology, influenza causes considerable hospitalizations and mortality [1,2]. The Northern Hemisphere faces the prospect of the COVID-19 pandemic and a simultaneous epidemic of seasonal influenza [7,8], and the management of the disease was complicated by the diversity in “influenza-like” clinical manifestations [9], resulting in enormous challenge in preventing and controlling the influenza epidemic [10]. Both SARS-CoV-2 and influenza viruses are respiratory tract viruses that invade the host through specific receptors, causing pneumonia in severe cases. There is no receptor competition, and viral co-infection occurs without any difficulty [11]
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