Management of Influenza in COVID-19 Positive Patients

Diagnosis and Treatment

The American College of Physicians recommends testing for influenza coinfection using PCR or rapid testing of nasopharyngeal secretions when influenza is clinically suspected in any COVID-19 positive patient, as coinfection rates of 0.5-2% have been documented 1
For confirmed influenza coinfection, administer oseltamivir or baloxavir according to standard influenza treatment guidelines, and continue COVID-19 specific therapies concurrently without modification 1
Consider empirical antibiotics if bacterial superinfection cannot be ruled out, as bacterial coinfection occurs in approximately 40% of viral respiratory infections requiring hospitalization 2, 3

Maintain bispecific antibody or immunosuppressive dosing during influenza prophylaxis if the patient is on such therapies 1
Monitor for drug interactions, particularly if the patient is on multiple medications 5
Follow standard isolation protocols for both infections until clinical resolution 1

Influenza vaccination is strongly recommended for all COVID-19 patients and their close contacts to reduce the risk of coinfection and simplify clinical management 1, 7
Paracetamol is preferred over NSAIDs for fever management in COVID-19 until more evidence is available 6