As influenza season gears up at a time when assisted living communities and other long-term care facilities are still reeling from a global pandemic, the Centers for Disease Control and Prevention is offering practice guidelines on handling a co-infection outbreak.

The agency has posted testing and management guidelines for long-term care settings when SARS-CoV-2 and influenza viruses are found to be co-circulating.

Although the guidelines are geared toward nursing home residents with acute respiratory illness symptoms, the CDC noted that some practices can be adapted for use in other long-term care settings, including assisted living communities.

“Because some of the symptoms of influenza and COVID-19 are similar, it may be difficult to tell the difference between these two infections based on symptoms alone,” the guidelines read, noting that medically fragile adults and those with neurological or neurocognitive conditions “may manifest atypical signs and symptoms” of both illnesses. 

Any resident with symptoms of COVID-19 or influenza should be tested for both viruses and then isolated accordingly, the CDC recommends. Residents confirmed to have coronavirus should be moved to a dedicated COVID-19 unit, whereas those with influenza should be placed in a single room, if available, or housed with other residents who only have influenza. Residents with co-infections should be housed together as well, the agency said. 

The guidelines cover types of testing to be used for both viruses, as well as clinical management of both illnesses.

Earlier this week the CDC’s Advisory Committee on Immunization Practices voted to prioritize healthcare personnel and long-term care residents in assisted living communities and skilled nursing facilities in the first phase of a national vaccine rollout program.

At the same time, the White House Coronavirus Task Force is urging adults aged 65 or more years, or those with significant health conditions, to avoid public places, if possible, and to have groceries and medications delivered. CDC Director Robert Redfield said that 200,000 more deaths could occur due to COVID-19 in the next three months and warned that this winter could be “the most difficult time in the public health history of this nation.”