Infectivity and fatality of influenza in pre- and post-COVID-19 pandemic year

Abstract

The COVID-19 pandemic and related non-pharmaceutical interventions (NPIs) significantly alter the transmission dynamics of non-SARS-CoV-2 infectious diseases, with respiratory infections such as influenza being disproportionately affected. We aim to compare influenza’s epidemiological characteristics between pre-pandemic and post-pandemic periods to inform public health responses. We develop two influenza transmission models incorporating age structure and multi-strain dynamics, featuring time-varying transmission and mortality rates. Using publicly available U.S. data, we calibrate these models to evaluate age- and strain-specific transmission patterns and mortality rates across different pandemic eras. Our analysis reveals that during the final pandemic year, influenza transmission among adults (≥ 18 years) initially declined but rebounded to pre-pandemic levels within the first post-pandemic year following NPI relaxation and behavioral normalization, while transmission stability persists in the <18 cohort. All-age influenza mortality rates exhibit a transient elevation during the pandemic’s final year before returning to baseline levels pre-pandemic. Furthermore, after the COVID-19 pandemic, the transmission rate of influenza A decreases alongside peaks in new cases, while the transmission of influenza B fluctuates without a decline. Our findings indicate that while the COVID-19 pandemic has induced significant transient modifications in influenza’s epidemiological profile, key transmission and mortality characteristics regain pre-pandemic equilibrium within one year following pandemic resolution.