As the holiday season ramps up, health experts are warning the public about a triple threat of respiratory illnesses – RSV, COVID-19 and influenza – that could spread rapidly if precautions aren’t taken. Vaccination rates remain worryingly low even as doctor’s offices and hospitals report a rise in cases. With holiday travel and indoor gatherings providing prime conditions for transmission, there are growing concerns these viruses may overwhelm the healthcare system in the coming weeks.
RSV Cases Hitting Highs Not Seen In Years
Respiratory syncytial virus (RSV) has seen a massive nationwide spike this fall, much earlier than its typical winter peak. Cases are already higher than any point in the past two years according to CDC data, rivaling pre-pandemic levels typically not reached until December or January.
“We’re worried that RSV, in particular, might take off even more than it has,” says José R. Romero, MD, director of the National Center for Immunization and Respiratory Diseases. “It looks a lot like what happened in Australia during their winter.” Australia’s RSV surge strained hospitals and health systems over their winter months.
RSV usually leads to mild cold-like symptoms but can be dangerous, even deadly for infants, older adults, and other high-risk groups. It is the most common cause of bronchiolitis and pneumonia in children under 1 in the US.
State and local health departments are reporting major spikes in pediatric RSV hospitalizations in hotspot regions like El Paso, where the Cook Children facility saw a 1000% increase in admissions this November.
“The RSV surge seems to be the earliest it’s ever occurred,” notes LeBonheur Children’s Hospital infectious disease specialist Dr. Sandy Arnold. “We have seen more positive cases in October and November than we typically diagnose all winter.”
COVID Cases Rising Despite Updated Boosters
While still far below last winter’s peak driven by the Omicron variant, COVID-19 cases have been steadily increasing nationwide since mid-October according to CDC surveillance data. Over 15,000 patients infected with COVID were hospitalized as of December 5th.
The rise comes even as updated bivalent booster shots targeting Omicron subvariants have been available to most Americans since early September. However, uptake of the new boosters remains very low. Only 15 million bivalent booster shots have been administered so far out of the 226 million people eligible.
“We have the capability to prevent COVID-19 cases, hospitalizations and even deaths with our COVID vaccines yet not enough Americans are getting vaccinated and boosted,” said CDC Director Dr. Rochelle Walensky in a statement. “This needs to change.”
Uptake Lags As Boosters Offer Max Protection
Health officials emphasize that maximum protection is reached 1-2 weeks after the new bivalent boosters, offering Americans enough time to bolster their immunity before holiday travel and gatherings likely increase their COVID exposure risk.
But lagging booster uptake remains an issue. Multiple studies found the initial two-dose vaccine regimen offered little defense against infection from newer Omicron subvariants over time. Boosters have proven critical for restoring that protection, suggesting most Americans who got their last COVID shot in early 2022 now have minimal shields against the virus currently spreading.
“Don’t wait until right before that holiday party or that vacation to get boosted,” says UCLA epidemiologist Dr. Robert Kim-Farley. “Get boosted now so that improved protection kicks in before you’re exposed.”
Flu Activity Unusually High So Early In Season
While the RSV and COVID surges are hitting months ahead of schedule, influenza seems to be following its standard playbook nearly to a tee. Flu activity often starts slowly in October before accelerating through November into a typical December/January peak.
The CDC is reporting especially intense flu spread in southeastern states like Florida, Alabama, South Carolina, and Georgia. But cases are rising virtually nationwide, bolstered by an earlier emergence of the most common seasonal flu strains.
Some of the increase may come from lifted COVID precautions and international travel. But another key driver could be waning population immunity according to Emory University infectious disease researcher Dr. Colleen Kraft. The past two flu seasons saw record low case counts as COVID measures inadvertently suppressed influenza as well.
“People have returned to pre-pandemic behaviors and there are no strong public health restrictions in place,” says Kraft. “On top of that, we went two years without a real flu season so population immunity has declined.”
The collision of all three viruses may severely burden hospitals already facing overcapacity issues and healthcare staff shortages. Several children’s hospitals are taking extraordinary measures like opening overflow wards to handle the early onslaught of young RSV patients.
Health Officials Urge Vaccinations Before Holiday Gatherings
With ingredients in place for a potentially catastrophic “tripledemic” ahead, public health agencies are pleading with the public to get vaccinated for COVID and the flu while taking precautions to slow RSV spread.
The ideal timing is around 1-2 weeks before any higher risk activities like holiday travel or large family gatherings. Health officials want to ensure maximum immunity kicks in before potential virus exposure.
“My strongest recommendation for a very happy and healthy holiday season is to receive the new updated COVID booster shot and your annual flu shot,” says Dr. Joseph Gastaldo, medical director of infectious diseases at OhioHealth.
While RSV lacks an approved vaccine, experts emphasize measures like hand washing, masking around vulnerable groups, and keeping sick individuals away from infants or older family members.
“RSV is notoriously very contagious and can remain on hard surfaces for many hours,” Gastaldo notes, adding any family members with cold symptoms should test and isolate before visiting elders or newborns.
What Comes Next? More Questions Than Answers
With so much uncertainty around how these viruses might spread and interact over the next two months, health experts are hesitant to make definitive forecasts. Much depends on whether containment measures prove effective in slowing further acceleration.
“It’s just a little hard to predict,” says Dr. William Schaffner, medical director for the National Influenza Foundation. “Viruses are sneaky and love to fool us.” But he along with others warn the US could be in store for one of its worst respiratory disease seasons if current trends hold.
Making matters more complicated is the looming threat of new COVID variants. No Omicron offshoots have outpaced currently dominant strains like BQ.1.1 or XBB yet, but experts remain vigilant for changes there. The recent eruption of case clusters in China after the country relaxed its strict zero-COVID policies provides fertile ground for new variants to emerge.
“The more opportunities you give a virus to spread and replicate, the more opportunities you give it to mutate,” cautions epidemiology researcher Dr. David Dowdy of Johns Hopkins Bloomberg School of Public Health. “If we want to prevent new variants, we need more people protected from infection through vaccination and other measures, everywhere in the world.”
For now health agencies seem resigned to reacting nimbly as the situation develops over the next critical weeks. They will closely monitor admissions data and genomic surveillance for signals demanding an adjustment in strategy. In the meantime their mantra to the public is a familiar one – get boosted, mask up, test often.
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