As covid, flu and RSV cases collide, CDC warms of a tough winter ahead

As covid, flu and RSV cases collide, CDC warms of a tough winter ahead

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The United States continues to experience an unusually high and early uptick in flu and respiratory syncytial virus infections, straining a health-care system trying to recover from the worst of the coronavirus pandemic.

While new coronavirus cases leveled off in recent weeks, federal health officials warned Friday they are confronting elevated levels of other viruses that are roaring back as pre-pandemic life returns and many Americans, particularly children, lack immunity. The Centers for Disease Control and Prevention issued an advisory about respiratory viruses to thousands of health care providers in an attempt to bolster testing, treatment and vaccination.

At least 4,300 influenza patients were admitted to hospitals in the week ending Oct. 29, the highest for that time period in a decade and nearly double the prior week, according to data released Friday. The flu season began six weeks early this year, at a level not seen since the 2009 H1N1 swine flu pandemic.

After enduring two consecutive winters crushed by an influx of covid-19 patients, American hospitals face the prospect of a third covid winter — this time, slammed on three fronts.

“With increased RSV infections, a rising number of flu cases and the ongoing burden of covid-19 in our communities, there’s no doubt we will face some challenges this winter,” Dawn O’Connell, assistant Health and Human Services secretary for preparedness and response, told reporters Friday. “But it’s important to remember … that RSV and flu are not new, and we have safe and effective vaccines for covid-19 and the flu.”

So far, this flu season is more severe than it has been in 13 years

Respiratory syncytial virus, a common cause of cold-like symptoms in children known as RSV, continues to rise nationally and strain children’s hospitals. Trends vary regionally; RSV appears to be receding in the southeast and mountain west as influenza surges. There is no vaccine for RSV, but Pfizer plans to seek approval for one administered during pregnancy.

Health officials are bracing for the possibility that covid again overwhelms hospitals, depending on which new variants become dominant, because governments have abandoned efforts to limit transmission and few senior citizens who are most susceptible to severe disease are up to date on their shots.

Some health officials have described the confluence of influenza, RSV and coronavirus a “tripledemic.”

“Covid has impacted the seasonal patterns of all these respiratory infections,” said Tina Tan, a pediatric infectious diseases specialist at the Ann & Robert H. Lurie Children’s Hospital of Chicago, where RSV cases are surging and flu cases are starting to rise. “Whether the pattern will go back to the way it was pre-covid, I don’t think anyone really knows, but it does make it more complicated to provide the care that people need when you have three viruses that can cause serious diseases surging at the same time.”

David Rubin, who tracks respiratory viruses for the PolicyLab at Children’s Hospital of Philadelphia, said it’s premature to declare a hospital crisis. A youth mental health crisis and a nationwide shortage of pediatric beds have made it harder for the health-care system to handle the rise in respiratory cases, he said. But adult hospitals are better positioned to respond.

“It depends on when these peaks occur and how significant of a magnitude we are going to see covid come back this winter,” Rubin said. “We have yet to see a real acceleration this year in terms of covid hospitalizations. If you are looking for silver lining, that’s one.”

The U.S. government has medical supplies including personal protective equipment and ventilators available in its stockpile, but officials say no state has yet to request additional personnel or supplies.

“State and territorial public health officials urge parents and families to take precautions now in order to be healthy and to avoid putting strain on hospital systems,” said Anne Zink, a top Alaska public health official and president of the Association of State and Territorial Health Officials, in a written statement.

Those precautions including staying up to date on vaccines, staying home while sick and washing hands regularly. Often missing or downplayed in government recommendations is mask-wearing, a measure rarely adopted during past respiratory virus seasons but proven effective at blunting the spread of coronavirus.

Lynn Goldman, dean of the Milken Institute School of Public Health at George Washington University who serves on a committee that advises CDC Director Rochelle Walensky, asked at a meeting Thursday why agency officials were not recommending masking given the strain on hospitals.

“At this point, nothing can be mandatory,” Brendan Jackson, the CDC’s incident manager on covid-19, replied Thursday.

José Romero, director of the CDC’s National Center for Immunization and Respiratory Diseases, mentioned well-fitted masks at the end of a list of recommended precautionary measures during the agency’s press briefing Friday.

“If a family wishes, they can use masks,” Romero said.

RSV, other viruses making it hard to find a bed in children’s hospitals

The lack of exposure to other viruses when people practiced social distancing and wore masks to avoid coronavirus has contributed to the current situation, experts say.

“All of that regular exposure that usually happens that bolsters immunity year after year didn’t happen,” Walensky said Tuesday during an appearance before the U.S. Chamber of Commerce. “If you go two years without getting that infection, without getting that protection from infection and then all of a sudden, boom, everybody from zero to three years gets RSV, you see the impact on health care.”

While RSV is among the leading causes for hospitalization in young children, the virus also poses a greater threat to senior citizens and immunocompromised adults. Despite the decline in coronavirus cases, doctors say the medically vulnerable should consider taking heightened precautions due to the circulation of other respiratory viruses.

“If you are at higher risk, don’t go into those high-risk areas or mask if you have to go into those areas with an N95,” said Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau in New York.

For the flu season, the strain on hospitals may not be as debilitating to the health-care system if the cases are fairly mild and patients are discharged quickly. Lynnette Brammer, an epidemiologist who heads the CDC’s domestic influenza surveillance team, said officials have yet to see evidence of a more virulent strain of influenza.

“Right now we are not seeing anything that would lead us to believe it’s more severe,” Brammer said Friday. “It’s just early.”

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