The COVID-19 pandemic is entering a new phase with a second wave of infections across the European and other major international regions [1]. There remain serious health policy challenges in dealing with the responsible SARS-CoV2 pathogen [2]. Schools and colleges are now re-opening, with associated risks of increased virus transmission to other children and students, teaching staff, families and their contacts. However, WHO advice on wearing of masks by pupils and students is being ignored and frequent, effective testing of teaching staff is not systematic. Respiratory viral transmission is typically greater in colder weather therefore COVID-19 incidence is likely to increase in the Northern Hemisphere in the coming months. This will coincide with the influenza season. However well-established international influenza immunization programmes are likely to be less effective this winter. A higher incidence of influenza is to be expected due to reduced uptake of influenza immunizations - an unintended consequence of public health restrictions on mobility to control COVID-19. Many older people and others with medical disorders with most to benefit from protection from influenza by immunization now have reduced confidence in leaving home. They are therefore much less likely to be prepared to access community health services to receive an influenza immunization. An epidemic of simultaneous influenza and COVID-19 is therefore a serious concern. This would result in higher morbidity and mortality in vulnerable people and greater pressure on acute medical services.
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