The United Kingdom has recently reported a co-infection between H1N1pdm09 and the novel coronavirus:
My question at this point is, what precisely are the risks this poses?
The first thing that comes to mind is the risk of reassortment or recombination. H1N1 is, for most people, a mild virus that transmits easily H2H. The novel coronavirus is a severe virus (5 of the 10 cases so far have died, with 2 more still in the ICU) that does not appear to transmit H2H efficiently. One could imagine that a hybrid virus might be as severe as the novel coronavirus, but transmit with the efficiency of H1N1. That would potentially be as severe as a H5N1 pandemic. Fortunately, the risk of such mutation between such different viruses is probably very low. We discussed this a bit at:
in which we decided the risk of a flu and rabies combination was low for precisely that reason.
There are at least two other risks I can think of from this co-infection. The first is misdiagnosis. If a co-infected patient presents as a SARI case and tests positive for H1N1pdm09, further testing is likely to stop. The coronavirus infection will not be diagnosed. I wonder if H1N1 patients are still be isolated. It is conceivable that the misdiagnosis of such a case as due solely to H1N1 might produce more spread of the coronavirus.
The second issue is ease of transmission. Even if genetic material from the H1N1 virus does not transfer to the coronvairus, could the coronavirus transmit more efficiently from a co-infected case, perhaps due to increased coughing or the presence of both viruses in the upper respiratory tract instead of just the lower one?
This seems like a very odd coincidence that one of the only 10 known novel coronavirus infections happens to be co-infected with H1N1. Might this co-infection actually have made this case more likely to be detected than simply a coronavirus case? Might this co-infection actually argue that the coronavirus could be more widespread (and thus milder) than previously thought and that we are missing large numbers of coronavirus infections?
Any thoughts on this?
My question at this point is, what precisely are the risks this poses?
The first thing that comes to mind is the risk of reassortment or recombination. H1N1 is, for most people, a mild virus that transmits easily H2H. The novel coronavirus is a severe virus (5 of the 10 cases so far have died, with 2 more still in the ICU) that does not appear to transmit H2H efficiently. One could imagine that a hybrid virus might be as severe as the novel coronavirus, but transmit with the efficiency of H1N1. That would potentially be as severe as a H5N1 pandemic. Fortunately, the risk of such mutation between such different viruses is probably very low. We discussed this a bit at:
in which we decided the risk of a flu and rabies combination was low for precisely that reason.
There are at least two other risks I can think of from this co-infection. The first is misdiagnosis. If a co-infected patient presents as a SARI case and tests positive for H1N1pdm09, further testing is likely to stop. The coronavirus infection will not be diagnosed. I wonder if H1N1 patients are still be isolated. It is conceivable that the misdiagnosis of such a case as due solely to H1N1 might produce more spread of the coronavirus.
The second issue is ease of transmission. Even if genetic material from the H1N1 virus does not transfer to the coronvairus, could the coronavirus transmit more efficiently from a co-infected case, perhaps due to increased coughing or the presence of both viruses in the upper respiratory tract instead of just the lower one?
This seems like a very odd coincidence that one of the only 10 known novel coronavirus infections happens to be co-infected with H1N1. Might this co-infection actually have made this case more likely to be detected than simply a coronavirus case? Might this co-infection actually argue that the coronavirus could be more widespread (and thus milder) than previously thought and that we are missing large numbers of coronavirus infections?
Any thoughts on this?
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