Measures to reduce transmission of SARS-CoV-2 have also been effective in reducing the transmission of other endemic respiratory viruses.¹^, ² As many countries decrease the use of such measures,² we expect that SARS-CoV-2 will circulate with other respiratory viruses, increasing the probability of co-infections.¹^, ³ The clinical outcome of respiratory viral co-infections with SARS-CoV-2 is unknown.

We examined clinical outcomes of co-infection with influenza viruses, respiratory syncytial virus, or adenoviruses in 212 466 adults with SARS-CoV-2 infection who were admitted to hospital in the UK between Feb 6, 2020, and Dec 8, 2021, using the International Severe Acute Respiratory and Emerging Infection Consortium–WHO Clinical Characterisation Protocol.⁴
Details on patient recruitment, inclusion criteria, testing, and statistical analyses are included in the appendix (pp 2–3). Ethical approval was given by the South Central-Oxford C Research Ethics Committee in England (13/SC/0149), the Scotland A Research Ethics Committee (20/SS/0028), and the WHO Ethics Review Committee (RPC571 and RPC572, April, 2013).

Tests for respiratory viral co-infections were recorded for 6965 patients with SARS-CoV-2. Viral co-infection was detected in 583 (8·4%) patients: 227 patients had influenza viruses, 220 patients had respiratory syncytial virus, and 136 patients had adenoviruses. Co-infection with influenaza viruses was associated with increased odds of receiving invasive mechanical ventilation compared with SARS-CoV-2 monoinfection (table). SARS-CoV-2 co-infections with influenza viruses and adenoviruses were each significantly associated with increased odds of death

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