During the most recent respiratory virus season, the risk of hospitalization was higher for influenza than for COVID-19, per a US Department of Veterans Affairs (VA) study of nearly 13,000 patients.
The authors, from the VA Saint Louis Health Care System, noted that while COVID-19 was tied to a substantially greater risk of hospitalization than flu early in the pandemic, data showed an increase in flu cases and hospitalizations in 2025-26 compared with previous seasons.
The findings were published last week in The Lancet Infectious Diseases.
“However, population-level metrics reflect both infection frequency and disease severity and cannot alone determine the relative clinical severity of one pathogen versus another,” they wrote. “A head-to-head comparison of hospitalisation risk among infected individuals—which isolates disease severity from differences in infection frequency—has not been undertaken for the 2025–26 influenza season.”
43% higher likelihood of admission with flu
In total, 9,363 patients tested positive for flu, and 3,298 were diagnosed as having COVID-19. After adjustment, the risk of hospitalization per 1,000 people was 160.4 for flu and 112.1 per 1,000 for COVID-19 (relative risk, 1.43), which translates to roughly 48 more hospitalizations for flu per 100,000 people. This held true across subgroups based on demographic and clinical factors.
The higher severity… likely reflects a combination of factors, including the increased virulence of circulating influenza strains, mismatch between vaccine composition and dominant circulating influenza variants, and the continued attenuation of SARS-CoV-2 severity over successive waves.
“The higher severity associated with seasonal influenza during this season likely reflects a combination of factors, including the increased virulence of circulating influenza strains, mismatch between vaccine composition and dominant circulating influenza variants, and the continued attenuation of SARS-CoV-2 severity over successive waves,” the researchers wrote.
They cautioned that the VA population is older and made up mostly of men, which could limit generalizability to other populations, and that because only people with infections confirmed through testing were included, the findings may not reflect risks for untested people.