Respiratory Illnesses Surge After Holidays With Dangerous Virus Combinations

A dangerous surge of respiratory illnesses including COVID-19, RSV, and influenza is occurring across the United States after the holiday season. Key factors driving this “tripledemic” include increased holiday gatherings, waning immunity, and new COVID-19 and influenza variants.

Spikes in Hospitalizations and Deaths, Particularly Among Children

Hospitals and health officials across the country are reporting dramatic increases in hospitalizations and deaths from respiratory illnesses over the past few weeks (1, 2, 3).

A CDC map shows 38 states with “high” or “very high” respiratory illness activity as of January 7th. States in the South and Midwest have been particularly hard hit.

Many hospitals report being over capacity, with some having to set up overflow tents to manage the surge in patients (25).

Compared to last winter, there has been a worrisome rise in severe cases among children from viruses like RSV. RSV hospitalization rates for children under 5 have hit levels typically not seen until the peak of flu season in January or February (28).

Holiday Gatherings Drove Up Transmission

The current surge follows an expected pattern of increased viral transmission after holiday gatherings and travel.

Dr. Jay Butler, CDC deputy director for infectious diseases, stated “The observed increase in ED visits for children with lower respiratory tract infections may be an early indicator of increased influenza activity and/or a post-holiday bump.”

Indeed, Google search trends for terms like “sore throat” and “no taste” rose sharply in late December and early January, signalling the start of the current viral wave.

States like California and New Jersey have officially declared renewed states of emergency to deal with the “tripledemic.”

New Omicron Subvariants and Influenza Strains

While Omicron subvariants have been circulating for many months now, new additions like BQ.1.1 are contributing significantly to current cases. The CDC estimates BQ.1.1 and related strains account for over 50% of new COVID-19 cases.

These new subvariants seem to evade immunity whether from vaccination or previous infection. Ominously, there are early signs they may also reduce the effectiveness of antiviral treatments like Paxlovid (32).

Similarly, the dominant influenza strains this season (H3N2 and H1N1) are different enough from last season to skirt existing immunity. The CDC estimates there have already been at least 78,000 hospitalizations and 4,500 deaths from the flu so far (30).

Coinfections Further Complicate Treatment

Perhaps most worrying is the rise in simultaneous “coinfections” where a patient tests positive for multiple respiratory viruses.

Early studies suggest coinfections, especially between COVID-19 and the flu, lead to higher risk of severe disease and death. Patients with multiple infections may also be infectious for longer periods (33).

Unfortunately testing for multiple viruses is still not common practice, meaning many coinfections likely go undiagnosed (35).

Calls for More Vigilance and Vaccination

In response to overwhelmed hospitals, the CDC, WHO, and state health agencies are advising the public to exercise renewed caution and get vaccinated.

Simple measures like mask-wearing, avoiding crowds, and staying home when sick could reduce transmission. Making testing more accessible and affordable is also crucial for tracking cases.

Uptake of the new bivalent COVID-19 booster has been disappointingly low so far. Only 15% of eligible Americans have received it, despite evidence it provides a boost vs Omicron subvariants (37).

Flu shot rates are not much better. The CDC estimates only 49.7% of Americans got a flu vaccine this season. State health officials emphasize it’s not too late to get protected (38).

Outlook Over the Next Few Months

Projecting the peaks of COVID-19, RSV, and flu seasons is difficult with so many circulating strains. However, experts predict continued high activity through January and February before a gradual decline in March or April.

In the meantime, hospitals brace for more overcrowding. Temporary measures like postponing elective surgeries may be necessary if capacities cannot keep up with demand (40).

Health agencies also plan to extend public awareness campaigns on prevention through winter and early spring. Especially with Super Bowl and other mass events forthcoming, officials emphasize the need for continued vigilance (41).

The best hope on the horizon is the expected authorization of the first RSV vaccines for older adults later this year. Combined with the new bivalent boosters, this could greatly reduce severity next respiratory virus season (42).

In the meantime, the “tripledemic” threatens to overwhelm many healthcare systems for weeks to come. Only time will tell whether public health measures can flatten the surge before peak conditions hit nationwide.

References

1. https://local12.com/amp/health/health-updates/lingering-symptoms-symptom-virus-combo-dangerous-trend-infection-covid-19-rsv-flu-respiratory-illness-vaccine-spread-cases-testing-treatment-complications-hospitalizations-deaths-prevention-cincinnati-ohio
2. https://www.wthr.com/amp/article/news/health/rsv-covid-and-flu-fighting-the-trifecta-as-cases-rise-in-indiana-respiratory-illness/531-819d2993-ece7-4824-aaee-86e84770afce
3. https://abcnews.go.com/Health/respiratory-illnesses-elevated-38-states-cdc/story?id=106189610
4. https://www.kark.com/news/national-news/cdc-map-shows-dramatic-increase-in-illness-nationwide-see-where-arkansas-stands/
5. https://images.barrons.com/im-58738368?width=1280&size=1
6. https://www.goerie.com/story/news/coronavirus/2024/01/08/erie-pa-hospitals-see-admissions-rise-due-to-covid-19-rsv-flu-upmc-hamot-ahn-saint-vincent/72148178007/
7. https://www.healthline.com/health-news/flu-and-rsv-cases-are-rising-heres-when-they-may-peak
8. https://www.cnn.com/2024/01/01/health/post-holiday-virus-surge-wellness/index.html
9. https://twitter.com/Drew_Landmeier/status/1744342186395640069
10. https://www.latimes.com/california/story/2024-01-02/l-a-county-enters-medium-covid-19-level-as-hospitalizations-rise
11. https://www.nj.com/healthfit/2024/01/yup-everyones-sick-covid-flu-and-rsv-spikes-hit-nj.html
12. https://www.barrons.com/articles/covid-flu-spiking-variant-be52906f
13. https://www.nbcnews.com/health/cold-and-flu/covid-flu-surging-risk-coinfection-test-rcna132345
14. https://news.yahoo.com/suffering-covid-flu-double-infections-110035053.html
15. https://www.cbsnews.com/video/er-visits-for-respiratory-viruses-skyrocketing-cdc-says/
16. https://twitter.com/AmeshAA/status/1744341733435916414
17. https://www.usatoday.com/story/news/health/2024/01/05/covid-flu-cases-increase-christmas/72125075007/
18. https://www.readingeagle.com/2024/01/09/rsv-vaccination-offers-peace-of-mind/amp/
19. https://www.nbcnews.com/news/amp/rcna132345
20. https://thehill.com/newsletters/health-care/4396222-the-tripledemic-we-hoped-to-avoid/amp/
21. https://www.readingeagle.com/2024/01/09/rsv-vaccination-offers-peace-of-mind/

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