Is It Possible To Be Sick With Two Infections At The Same Time?

This winter illness season has been a rough one. States across the country have experienced high levels of respiratory viruses, like COVID-19, flu and RSV. And that’s not to mention the colds, stomach bugs, throat infections and a variety of other bugs that have been going around. Some people have reported their symptoms seem to be lasting longer than usual.

If you’ve been sick a lot recently or have had severe or long-lasting symptoms, you may be wondering: Is this just a really nasty bug? Or could I actually have had two overlapping viruses?

We talked to doctors about the likelihood and signs you may have two illnesses at the same time. Here’s what to know:

Most of the time ― even if you have multiple symptoms ― it’s likely you only have one infection, Dr. Stuart Ray, a professor of medicine in infectious diseases at Johns Hopkins, told HuffPost.

But that said, it can be possible to have more than one infection simultaneously. “Oftentimes we don’t know if we have two infections because there is such an overlap in symptoms,” said Dr. Larissa Pisney, an associate professor in the division of infectious diseases at the University of Colorado Anschutz Medical Campus.

For example, cough, fever and sore throat can all be symptoms of respiratory illnesses, like COVID-19, RSV and flu. And the only way to really tell if you have one or more of these is to get tested.

It can be easier to tell if to tell if you have co-infections if they’re specific to a type of tissue or part of the body, like if you have throat pain and white patches on your tonsils and then also develop itchy, red eyes.

So if a patient comes in with what looks like strep throat and also pink eye, Ray explained, “there’s a fair chance that they have both of those, simply because those are both fairly common problems and they don’t overlap much in their symptoms.”

But the same illness can actually have varying effects, and patients may perceive their symptoms differently.

If you seem to be getting better and then all of a sudden come down with a fever, facial pain, sinus drainage, worse cough or intense fatigue, this could be an indication that you caught a bacterial infection during or right after a viral illness. After fighting a virus, like COVID-19, influenza, RSV or colds, you’re more susceptible to these secondary bacterial infections.

Why does this happen? After any virus, you generally get inflammation in the surfaces of your airways, explained Dr. Joseph Khabbaza, a pulmonary and critical care physician at the Cleveland Clinic.

“While the infection is being fought and the surfaces are trying to heal, the disease surface gets taken away… so that a healthier new surface can occur once the infection is gone,” he said. “But when that happens, sometimes our regular bacteria in our airways now have an opportunity to enter and get a little bit deeper.”

A week or two later, this can turn into sinusitis, pneumonia or other types of bacterial infections.

“The likelihood that someone will catch two things close together is not very high… simply because in order to get a transmissible illness, you have to be exposed to it. And we’re not being exposed to everything every day,” Ray said.

But if you spend a lot of time in crowded spaces — like childcare centers, airports or large indoor gatherings — you are more likely to get a co-infection, according to Pisney.

“The likelihood of having more than one infection at a time has more to do with behaviors that lead to exposure to illnesses, rather than the infections themselves,” she said.

Co-infections are also more likely when multiple viruses or bacterial infections are spreading in the community at high rates, and in colder weather (when people are spending more time indoors).

There are issues that can lay dormant in our bodies for a long time and then reappear later on, such as the herpes viruses, according to Ray. (These include the viruses that cause chickenpox/shingles, mononucleosis, and mouth sores and genital sores.)

“When you are run down with another illness, then the herpes virus can get the upper hand and start causing trouble,” Ray said. “Then it gets knocked back down again by the immune system, but you can’t get rid of it.”

So if you’ve previously had cold sores around your mouth, they may come back suddenly when you’re fighting a cold. In this case, you are not contracting both infections at the same time. But catching a new illness is causing the one you already have to flare up.

“When we have an infection, the immune system can set off alarm bells and muster resources that help fight that infection,” Ray said. “These infection-fighting mechanisms tend to work for the same category of ‘bugs,’ making co-infections by similar organisms less likely.”

In other words, if you have a viral respiratory infection, you are less likely to get another viral respiratory infection at the same time because the infected cells are already fighting against a virus.

“Cells send out a signal to their neighbors that helps protect them from getting infected,” Ray explained.

But if you have a viral infection in one part of your body like your respiratory tract, it’s not likely to protect a different part like your skin or gut.

When you do get a co-infection, your immune system knows exactly what to do: “The immune system’s very smart, it’s very strong and it’s got a lot of troopers,” Khabbaza said. “When you’re fighting multiple infections, it’s going to make antibodies and target whatever’s going on.”

If you have a compromised immune system, it may be harder or take longer to fight off two infections. (High-risk patients who have COVID-19 and influenza are more likely to have severe disease, including symptoms serious enough to hospitalize them, Pisney added.)

So what can you do to prevent co-infections and getting sick in general? Here are some tips from our experts:

• To prevent severe illness, get vaccinated. (There are now vaccines for COVID-19, influenza and RSV.)
• Ventilation, masking and proper handwashing are effective ways to prevent the spread of illness, especially when transmission rates are high.
• If you eat a healthy, balanced diet, you probably don’t need to take vitamins. “We’ve studied vitamins many times and have never found an important role for [them] when we’re sick,” Ray said.
• If you catch influenza or COVID-19, there are antiviral therapies available, especially for those who are at higher risk for severe disease.
• Eating healthy foods, getting enough rest and staying hydrated are key to recovery when you do get sick.
• Maintaining healthy lifestyle habits longer term can also make a difference. As Khabbaza explained: “People who eat healthy and exercise get less sick because they have less inflammation in their body, and they’re more primed to handle any kind of infectious insult.”