| Summary: | In this paper, a two-strain model with coinfection that links immunological and epidemiological dynamics across scales is formulated. On the with-in host scale, the two strains eliminate each other with the strain having the larger immunological reproduction number persisting. However, on the population scale coinfection is a common occurrence. Individuals infected with strain one can become coinfected with strain two and similarly for individuals originally infected with strain two. The immunological reproduction numbers Rj, the epidemiological reproduction numbers Rj and invasion reproduction numbers Rji are computed. Besides the disease-free equilibrium, there are strain one and strain two dominance equilibria. The disease-free equilibrium is locally asymptotically stable when the epidemiological reproduction numbers Rj are smaller than one. In addition, each strain dominance equilibrium is locally asymptotically stable if the corresponding epidemiological reproduction number is larger than one and the invasion reproduction number of the other strain is smaller than one. The coexistence equilibrium exists when all the reproduction numbers are greater than one. Simulations suggest that when both invasion reproduction numbers are smaller than one, bistability occurs with one of the strains persisting or the other, depending on initial conditions. © 2021, The Author(s), under exclusive licence to Society for Mathematical Biology.
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