{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:56:40Z","timestamp":1790693800723,"version":"4.1.0"},"reference-count":71,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T00:00:00Z","timestamp":1638489600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>As in past pandemics, co-circulating pathogens may play a role in the epidemiology of coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In particular, experimental evidence indicates that influenza infection can up-regulate the expression of ACE2\u2014the receptor of SARS-CoV-2 in human cells\u2014and facilitate SARS-CoV-2 infection. Here we hypothesized that influenza impacted the epidemiology of SARS-CoV-2 during the early 2020 epidemic of COVID-19 in Europe. To test this hypothesis, we developed a population-based model of SARS-CoV-2 transmission and of COVID-19 mortality, which simultaneously incorporated the impact of non-pharmaceutical control measures and of influenza on the epidemiological dynamics of SARS-CoV-2. Using statistical inference methods based on iterated filtering, we confronted this model with mortality incidence data in four European countries (Belgium, Italy, Norway, and Spain) to systematically test a range of assumptions about the impact of influenza. We found consistent evidence for a 1.8\u20133.4-fold (uncertainty range across countries: 1.1 to 5.0) average population-level increase in SARS-CoV-2 transmission associated with influenza during the period of co-circulation. These estimates remained robust to a variety of alternative assumptions regarding the epidemiological traits of SARS-CoV-2 and the modeled impact of control measures. Although further confirmatory evidence is required, our results suggest that influenza could facilitate the spread and hamper effective control of SARS-CoV-2. More generally, they highlight the possible role of co-circulating pathogens in the epidemiology of COVID-19.<\/jats:p>","DOI":"10.7717\/peerj.12566","type":"journal-article","created":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T04:37:13Z","timestamp":1638506233000},"page":"e12566","source":"Crossref","is-referenced-by-count":16,"title":["Estimating the impact of influenza on the epidemiological dynamics of SARS-CoV-2"],"prefix":"10.7717","volume":"9","author":[{"given":"Matthieu","family":"Domenech de Cell\u00e8s","sequence":"first","affiliation":[{"name":"Infectious Disease Epidemiology Group, Max Planck Institute for Infection Biology, Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean-Sebastien","family":"Casalegno","sequence":"additional","affiliation":[{"name":"Laboratoire de Virologie des HCL, IAI, CNR des Virus \u00e0 Transmission Respiratoire (dont la grippe) H\u00f4pital de la Croix-Rousse F-69317 Lyon Cedex 04, France, Lyon, France"},{"name":"Virpath, Centre International de Recherche en Infectiologie (CIRI), Universit\u00e9 de Lyon Inserm U1111, CNRS UMR 5308, ENS de Lyon, UCBL F-69372, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Lina","sequence":"additional","affiliation":[{"name":"Laboratoire de Virologie des HCL, IAI, CNR des Virus \u00e0 Transmission Respiratoire (dont la grippe) H\u00f4pital de la Croix-Rousse F-69317 Lyon Cedex 04, France, Lyon, France"},{"name":"Virpath, Centre International de Recherche en Infectiologie (CIRI), Universit\u00e9 de Lyon Inserm U1111, CNRS UMR 5308, ENS de Lyon, UCBL F-69372, Lyon, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulla","family":"Opatowski","sequence":"additional","affiliation":[{"name":"Universit\u00e9 Paris-Saclay, UVSQ, Univ. 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