October 25, 2022 — Just when we thought this holiday season would finally be back to normal, some infectious disease experts are warning a so-called triple pandemic — influenza, COVID-19 and RSV — could be in the forecast.
The warning is not unfounded.
It’s difficult to predict exactly when cases will peak, says Justin Lessler, PhD, a professor of epidemiology at the University of North Carolina at Chapel Hill. Lessler is on the coordination team for the Center for COVID-19 Scenario Modeling, which aims to predict the course of COVID-19, and the flu scenario modeling hub, this also applies to influenza.
For COVID-19, some models predict some spikes before Christmas, he says, and others see a new wave in 2023. For the flu, the model predicts an earlier start than usual, the CDC has reported.
While flu activity is relatively low, the season is starting early, according to the CDC. For the week ending October 21st 1,674 patients were hospitalized for flu, more than in the summer months but fewer than the 2,675 hospitalizations in the week of May 15, 2022.
As of October 20, COVID-19 cases are down 12% nationwide over the past 2 weeks. But hospital admissions are up 10% across much of the Northeast, The New York Times reports, and the improvement in cases and deaths has slowed.
From October 15th fifteen% of the nationally reported RSV tests were positive, compared to about 11% at this point in 2021, the CDC said. The surveillance collects information from 75 counties in 12 states.
Experts point out that the viruses – all three respiratory viruses – are simply catching up.
“They spread in the same way and with many other viruses, and you tend to see an increase during the cold months,” says Timothy Brewer, MD, professor of medicine and epidemiology at UCLA.
The surge in all three viruses “is almost predictable at this point in the pandemic,” says Dean Blumberg, MD, professor and chief of pediatric infectious diseases at the University of California Davis Health. “All respiratory viruses are out of whack.”
RSV cases have also increased over the past year and have appeared very early, he says, in the summer rather than in the cooler months. The flu also appeared in early 2021, like this year.
This is in contrast to the 2020-2021 flu season, when COVID precautions were near universal and cases were falling. At UC Davis, “We did not have a single pediatric admission for influenza in 2020-2021 [flu] season,” says Blumberg.
The number of pediatric flu deaths typically ranges from 37 to 199 per year, according to CDC records. But in the 2020-2021 season, the CDC recorded a pediatric flu mortal in the USA
Both children and adults have had less contact with others over the past two seasons, Blumberg says, “and they’re not getting the immunity that those infections got them.” [previously]. That’s why we see off season, early season [viruses].”
Eventually, he says, cases of flu and RSV will return to previous levels. “It could be as early as next year,” says Blumberg. And hopefully COVID-19 will become like the flu, he says.
“RSV has always appeared in the fall and winter,” says Elizabeth Murray, DO, physician of pediatric emergency medicine at the University of Rochester Medical Center and spokesperson for the American Academy of Pediatrics. This year, the children are back in school and mostly unmasked, she says. “It’s a perfect storm for all germs to spread now. They were just waiting for their opportunity to come back.”
Self care vs. not
RSV can pose a risk to anyone, but those most at risk are children under the age of 5, particularly infants under the age of 1, and adults over the age of 65. There is no vaccine against it. Symptoms include a runny nose, decreased appetite, coughing, sneezing, fever, and wheezing. But young infants may just experience decreased activity, crankiness, and breathing problems, the CDC says.
Keep an eye on breathing if RSV is suspected, Murray tells parents. If your child cannot breathe easily, cannot lie down comfortably, cannot speak clearly, or is contracting their chest muscles to breathe, seek medical help. Most children with RSV can stay home and recover, she says, but often need to be checked out by a doctor.
She advises against buying an oximeter to measure oxygen levels for home use. “They’re often not accurate,” she says. If you’re in any doubt about how serious your child’s symptoms are, “don’t wait,” she says, and don’t hesitate to call 911.
Flu, COVID, and RSV symptoms can overlap. But anyone can bring breathing problems, which can be an emergency.
“It’s important to see a doctor for any worrisome symptoms, but especially severe shortness of breath or difficulty breathing, as these could indicate the need for supplemental oxygen or other emergency response,” said Mandy De Vries, respiratory therapist and training director at the American Association for Respiratory Care. Severe breathing problems may require inhalation therapy or mechanical ventilation.
To avoid the triple pandemic — or any single infection — UCLA professor of medicine and epidemiology Timothy Brewer, MD, suggests some well-known measures: “Stay at home if you feel sick. Make sure you are up to date on your vaccinations. Wear a mask indoors.”