When the mask becomes necessary again
Press release of the French National Academy of Medicine (*)
November 2, 2022
While the eighth wave of Covid-19 seems to stabilize at a high level [1], the prospect of an early seasonal influenza epidemic is becoming clearer in mainland France given the increasing incidence of influenza-like syndromes and confirmed sporadic cases [2], and bronchiolitis in children under 2 years is now in its epidemic phase throughout the territory [3].
The possibility of an epidemic co-circulation of influenza viruses and SARS-CoV-2 was feared during the last two winter seasons [4]. During the 2020-2021 season, no active circulation of influenza viruses was observed, the strict implementation of barrier gestures, in particular wearing a mask and washing hands, having led to a spectacular decrease in the incidence of influenza, gastroenteritis, and bronchiolitis. In contrast, the 2021-2022 season saw the return of influenza, with an epidemic that lasted 9 weeks with a late peak in April 2022. Many cases of “influenza + Covid-19” co-infection were notified worldwide, either before the implementation of the restriction and distancing measures, or after the lifting of these measures. Thus, a prospective study carried out in the United Kingdom on 6965 Covid-19 patients detected a viral co-infection in 583 (8.4%) of them (227 influenza viruses, 220 respiratory syncytial viruses and 136 adenoviruses), these co-infections being significantly associated with an increased risk of death [5].
This possibility of double infection, exposing vulnerable people to the most severe forms and hospital services to the risk of saturation, must therefore be taken into consideration for the 2022-2023 season. It imposes a strong reminder of the vaccination recommendations coupling the Covid-19 booster shots and the influenza vaccination [6]. It also justifies a rehabilitation of barrier measures, abandoned since the end of the state of health emergency on July 31, 2022.
Although the health situation does not currently require to come back to mandatory measures, the French National Academy of Medicine recommends:
– the wearing of an FFP2 type mask in enclosed public spaces for the elderly or carriers of comorbidities, for the entourage and health professionals in contact with vulnerable people, and for pregnant women, even when they are up to date with their vaccinations;
– the wearing of a surgical-type mask in hospitals, dispensaries, health centers and pharmacies, and in closed spaces open to the public, such as public transport during busy periods;
– the systematic use of hydroalcoholic gel in places open to the public.
References:
1. Santé Publique France. COVID-19 epidemiological update of October 20, 2022.
2. Santé Publique France. Flu, weekly bulletin week 41, October 19, 2022.
3. Santé Publique France. Bronchiolitis, weekly bulletin week 41, October 19, 2022.
4. French National Academy of Medicine. Press release “Facing Covid-19, let’s get the flu shot! » May 13, 2020.
5. Swets MC et al. SARS-CoV-2 co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses. Lancet. 2022; 399(10334):1463-4.
6. Haute Autorité de Santé. Press release “Covid-19: HAS includes bivalent vaccines in the vaccination strategy for the fall”, September 20, 2022
(*) Press release from the Academy’s Rapid Communication Platform validated by the members of the Board of Directors on October 31, 2022.
