Infectious Disease

US battles flu, RSV and COVID-19

November 21, 2022

3 min read

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Disclosures:
Biddinger, Schaffner and Tan report no relevant financial disclosures.

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A surge of respiratory syncytial virus, an early start to influenza season and the ongoing COVID-19 pandemic have caused a “tripledemic” in the United States, overwhelming hospitals, experts said.

At an Infectious Diseases Society of America briefing, Tina Tan, MD, FIDSAand William Schaffner, MD, FIDSAsaid Americans can reduce their risk for hospitalization or death by getting vaccinated against influenza and COVID-19 and by practicing some of the COVID-19 mitigation measures Americans have grown tired of the last few years.

IDN1122Tripledemic_Graphic_01_WEB

“Both of these vaccines provide protection against the complications of their illnesses,” said Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University and Infectious Disease News Editorial Board Member. “They’re less capable of preventing mild illness, but they do protect against the most serious complications, including hospitalization and dying.”

Schaffner said “masks work,” especially for older, frail or generally immunocompromised people, and that people should consider taking a COVID-19 test before family gatherings this holiday season.

The US reported 280,711 new cases of COVID-19 in the week ending Nov. 18, with a total of 2,222 new deaths and a daily average of 3,341 new hospitalizations, according to the CDC.

During the week ending Nov. 12, 5.8% of outpatient visits in the US were for influenza-like illness (ILI), CDC data showed — more than double the national baseline of 2.5%. Outpatient ILI visits have been higher than the national baseline since the CDC started reporting data for the 2022-2023 season last month — the first time the US has been above baseline at this time of year since the 2009 H1N1 influenza pandemic.

The CDC’s 12-state RSV-NET, which covers about 8% of the US population, on Friday reported an RSV-associated hospitalization rate of 18 per 100,000 people. Since the beginning of the COVID-19 pandemic, seasonal RSV has shifted due to anti-SARS-CoV-2 measures, and patients with severe RSV this year have overwhelmed hospitals since early fall.

“RSV faked us out. It’s come very early — it’s usually a January or February virus. Yes, there’s a tripledemic out there,” Schaffner said.

Tan, a professor of pediatrics at Northwestern University Feinberg School of Medicine and IDSA vice president, said it has become “very apparent that the seasonal pattern of when RSV and influenza would peak is much earlier” because it appears the COVID-19 pandemic shifted the patterns of both viruses. Additionally, early pandemic declines in child vaccination rates because of shutdowns and lockdowns have not been reversed.

“We thought they would bounce back, but they haven’t. There are a lot of unprotected children that are at risk of coming down with vaccine-preventable diseases,” Tan said.

Paul Biddinger, MD, FACEPchief of emergency preparedness at Massachusetts General Hospital, told Healio that the hospital continues to see significant strains on its overall capacity, as it has throughout the COVID-19 pandemic.

The hospital has seen a “specific and dramatic” strain on its pediatric services that started in early September with a surge of children needing to be hospitalized for enterovirus and rhinovirus.

“While those viruses have abated, we have been hit pretty hard by the RSV surge and have had essentially 150% occupancy of our pediatric ICU, providing ICU-level services on the floors because of necessity,” Biddinger said.

According to Schaffner, in addition to the RSV surge among children, there has been a 10-fold increase in RSV deaths among adults this season. Unlike COVID-19 home rapid tests, RSV testing is less widely available, which could make the problem worse.

This year’s influenza vaccine is well matched to the circulating strains, he said, and bivalent booster doses of the COVID-19 vaccines also appear effective. So, although the general public may have vaccine and COVID-19 fatigue, he said “we need to get health care providers to really make strong recommendations” for vaccinations.

A strong recommendation from a trusted health care provider, Schaffner said, is the best way to make sure people get vaccinated and the only way to get back to the “new normal” they crave.

“Vaccines need to be part of that new normal to prevent these individuals from becoming ill with the viruses and bacteria that are going around,” Tan said.

Biddinger said Mass General’s COVID-19 numbers “thankfully are remaining steady, and our wastewater monitoring does not yet show a major uptick in virus prevalence.”

“Although we remain very concerned about capacity and about influenza in particular, we are hopeful that perhaps the worse of RSV may ebb as flu begins, and that any winter surge from COVID-19 may occur later than we may see a peak in influenza. This means that we are definitely seeing major challenges, but perhaps if the peaks of each respiratory virus do not overlap, we might be spared the very worst-case scenario,” Biddinger said.

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