(Author’s note: Due to technical difficulties with the email server, subscribers stopped getting their regular blog posts by email on 11/11/22. Therefore, I am re-publishing those posts not received by the subscribers from then until Dec. 8 when the problem was corrected. My apologies to those who have been able to read these posts by going directly to my web site.)
There’s a new word being bandied about these days – the tri-epidemic. What does it mean? It refers to the three viruses plaguing our country at this time; Covid, Influenza, and Respiratory Syncytial Virus, or RSV. How did we get to this point? We’re still paying the price for the Covid pandemic and the way healthcare officials bungled its management.
Covid-19 remains a concern, especially if you are elderly and never got vaccinated, although the current strains of the virus are not as virulent. The number of Covid cases has been relatively stable for several weeks, with an average of 4,200 daily hospitalizations the week ending November 29, CDC data show. But for those who did get vaccinated, it represents only a modest concern unless you have significant co-morbidities such as diabetes, heart disease, lung disease, or obesity.
Influenza is rearing its head after a couple of years of lower than usual number of cases. A typical year of influenza produces 40,000 to 60,000 deaths, mostly in the elderly and immunocompromised. Some years are much worse. But during the worst of the Covid pandemic, the number of influenza cases dropped significantly, perhaps because of the mitigation efforts imposed to prevent Covid, or perhaps because many cases were undiagnosed because of the focus on Covid.
The newest virus of concern is RSV because of its heavy predilection in infants and the elderly. Brianna Abbott, writing in The Wall Street Journal, says pediatric hospitals have been strained for weeks by an early surge in common seasonal pathogens including RSV. Hospitalizations for RSV among kids under age five are outpacing those for Covid-19, according to the CDC. Public-health experts said the crush of patients is likely due in part to a larger pool of susceptible children compared with prior seasons, giving the virus more room to spread as people mingle indoors.
“We’re seeing really unprecedented levels of hospitalizations for this time of year, “said Fiona Havers, who is a lead official in tracking RSV at the CDC. The CDC estimates 6.2 million flu cases, 53,000 hospitalizations, and 2,900 deaths have occurred this season including 12 pediatric deaths. Flu-related hospitalizations are at the highest rate for this time of year in a decade, the CDC said. The agency started collecting data in a 14-state surveillance network starting in 2003 for children and 2005 for adults.
RSV hospitalizations are much lower, but there were 1.7 RSV-related hospitalizations for very 100,000 people for the week ended November 26 within the CDC’s 12-state RSV surveillance network, a drop from 4.8 hospitalizations per 100,000 two weeks ago. The CDC said the decline is likely due to a reporting lag because of the high surge volume and the Thanksgiving holiday. There are other signs RSV cases might have peaked in parts of the U.S., including a decline in reported cases from some labs, but Dr. Havers said that it is too early to say whether the virus is in decline for the season.
In a tragic medical irony, the draconian lockdown measures instituted to prevent the very-low risk Covid-19 infections in infants and young children has now made them more susceptible to the higher-risk RSV infection. This is because these mitigation measures, including masking and distancing, appeared to have had a marked effect on the circulation of other viruses, suppressing their spread and throwing them off their seasonal pattern. That likely left lower levels of immunity in the population.
“It reflects the pool of children who hadn’t experienced their first RSV season,” said Maria Asuncion Mejias, a principal investigator in the Center for Vaccines and Immunity at the Research Institute at Nationwide Children’s Hospital. “They’re kind of catching up.” This doesn’t mean their immune systems got weaker; only that they weren’t exposed.
What should people do now to prevent infection with these viruses?
Health officials recommend that people stay updated on Covid-19 and flu shots, stay home if sick, frequently wash their hands, consider wearing masks if you are especially vulnerable, and get tested early.
There is no RSV vaccine, although several are currently in trials. Older adults and infants, especially those under 6 months old, are at the highest risk for severe infections with RSV, a common virus that nearly all children catch by their second birthday. Children and adults commonly get reinfected throughout their lives.
“Once you’re older than 6 months, the rate of severity declines significantly, even when it’s your first infection,” said Diego Hijano, a pediatric infectious disease specialist at St. Jude Children’s Research Hospital in Tennessee. “Your airway and your pulmonary development are in a better position to handle it.”
Good advice to heed for those parents with infants who are considering flying this Christmas season.
