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Twindemic - What is it?


On February the 14th 2021, the authorities of Guinea, a country in West Africa, has declared a new act of emergency as a new plausible Ebola outbreak is on its way. With a new possible outbreak of the Zaire Ebola virus in Central and West Africa and the current widespread of COVID-19, health officials around the world are on high alert and highly concerned as the possible Ebola outbreak might manifest into another worldwide Ebola pandemic adding on to the current pandemic, we are all facing today - COVID-19. The idea of having to deal with two large-scale pandemics at the same time might seem ridiculous and something of a fictional movie, however; with the recent COVID-19 and the events we saw throughout the world, this phenomenon is very much possible and it's happening already.

Experts call this a “Twindemic”. As the word might suggest a Twindemic is when there are 2 pandemics going on at the same time. The World Health Organization (WHO) defines Pandemic as “a widespread event of an infectious disease occurring worldwide, or over a very wide area crossing international boundaries and usually affecting a large number of people”.

The Most Recent Twindemic

The most recent Twindemic that we can observe was in 2019-2020, between the yearly influenza outbreak that has infected around 39 to 56 million people and has managed to kill around 24,000 to 62,000 people and the new novel virus - COVID-19, that has managed to infect 111 million people and killed 2 million people. When COVID-19 was first discovered in December 2019, the idea of a pandemic was not yet realized. Many officials were observing the situation. While that took place, the yearly flu swept in. Influenza season usually occurs during the fall and winter from December to May, usually peaking in February. In 2019 to 2020, the yearly influenza virus began in early November and was consistent throughout January, peaking in February. On 30th January WHO declared the outbreak of COVID-19 to be a Public Health Emergency of International Concern and by March 2020, it was declared a pandemic. At that time forward, there existed 2 pandemic - COVID-19 and Influenza A & B (H1N1) pdm09.

Twindemic - A Major Concern to Healthcare System

When there is a Twindemic there are usually multiple concerns. One of the major concerns that it brings is that it overburdens a country's entire healthcare system. With every pandemic, thousands if not millions of people get ill. This causes hospitals to be flooded with patients, placing tremendous pressure on medical equipment, resources and on the medical labor force. Another concern in the 2019-2020 flu season and COVID-19 pandemic is that doctors would have a challenging time to distinguish between each other, as both viruses present similar symptoms. The risk is very real. Even if a healthcare system must deal with a moderate-size flu epidemic, which by itself places huge stress on the system, having to deal with a pandemic like COVID-19 makes it seem nearly impossible with the current system we have. “COVID-19 is causing an incredible stress on the healthcare system in many parts of the country,” said Dr William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University. “Even if we had a mild to average [flu] season, we would all be swamped at the moment.”

However, there is good news. Experts from the Center of Disease Control and Prevention (CDC) have predicted that the 2019-2020 flu season would be one of the most vigorous respiratory virus seasons in recent history, but in March 2020, something exceptional happened. Influenza cases started to drop drastically, ending the flu season six week earlier. During a typical flu season, the number of people getting ill would just be starting to increase. Yet only 0.2% of the 400,000 swabs for the flu have been positive, according to data from the CDC. During 2018-2019, the positivity rate was 13%. There has been a huge drop of flu cases occurring in March onwards.

Public health experts believed that COVID countermeasures had an influence in the sharp decrease of flu cases. Though the flu is also a respiratory virus, it’s not that transmissible as COVID-19. Wearing a mask and social distancing were a great countermeasure to prevent and disrupt the spread of the flu, making the flu nearly non-existent in late 2020.

How Would a Twindemic of COVID-19 and Zaire Ebola Virus Work Out?

Of course, Ebola and Influenza A&B are totally different viruses with different symptoms and different ways to transmit it. If Ebola does become an epidemic or a pandemic, the healthcare system may collapse. In 2014, Ebola made a direct impact on the healthcare system around the world. For example, 881 doctors, nurses and midwives were infected with the virus during the 2014 epidemic in West Africa, and 513 died. This created a shortage of healthcare workers in that region. If Ebola would come back to haunt us again during COVID-19 pandemic, more healthcare workers could possibly die there, reducing the workforce even further. With western countries being squeezedthemself, they themself can’t provide any help in the fight of Ebola, which may lead further to the spread of Ebola.

If that does happen, serious consequences can occur. Nevertheless, there is hope. Right now, there are multiple international health organizations fighting in the front line of both COVID-19 and the Ebola outbreak in Central and West Africa. Furthermore, past experience and communal engagement has made us better equipped to deal with Ebola. In addition, there exists an Ebola vaccine. Combining both past experiences, communal engagement and the vaccine against Ebola, there is a high chance to contain this virus. Furthermore, the new culture and mindset of social distancing will make it harder for Ebola to spread, disrupting its flow of transmission. To beat Ebola, we do not just need technical skills (medical or epidemiological or health education) but also soft community engagement skills. It all comes back to community engagement. We have seen in the past, if the community feels involved, heard, and empowered, then an Ebola response will likely go well.

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