Respiratory illnesses including COVID-19, flu, and RSV are spiking across much of the country, with 15 states now experiencing “high” or “very high” levels of respiratory disease activity according to the latest data from the CDC. As families prepare to gather for the December holidays, health experts are concerned this confluence of viruses could strain hospital capacity in many regions.
Flu Cases Reach Sky-High Levels In Some Areas
Flu activity continues to rise substantially, with some regions reporting skyrocketing case numbers. According to the CDC’s latest flu view report, cumulative hospitalization rates for flu are now higher at this point versus every season since 2010-2011 other than the severe 2017-2018 flu year.
The Pittsburgh area is getting hit especially hard by influenza, with Allegheny County reporting over 1,600 confirmed flu cases so far this season compared to just 71 cases at the same time last year. The county’s positivity rate sits at an alarming 33%.
| Season | Confirmed Flu Cases in Allegheny County as of Week 49 |
|---|---|
| 2022-2023 | 1,628 |
| 2021-2022 | 71 |
“Our flu numbers are sky high and it’s very concerning,” said Dr. Debra Bogen, director of the Allegheny County Health Department. She urged residents who have not yet gotten vaccinated to do so immediately, warning “it’s not too late but it’s getting late.”
Similarly, California has logged one of the highest influenza attack rates nationally over the past few weeks. State health officials say 13 people under age 65 have died from the flu so far this season, with thousands more winding up hospitalized. They expect flu activity to intensify further heading into the new year.
RSV Continues Upward March, Straining Children’s Hospitals
Much like flu, RSV continues a sharp upward trajectory according to the CDC and state health agencies. Cases of the common respiratory virus have risen steadily since October, though health officials say infections may finally be plateauing at very high levels nationally.
“While RSV may be peaking at the national level, different areas of the country are seeing different bursts of RSV activity at different times,” explained the CDC’s deputy incident manager Dr. Jose Romero. So even as RSV eases in some regions, case spikes could still overwhelm children’s hospitals in other communities.
In Pennsylvania, RSV hospitalization rates have soared over 11-fold versus the same six-week period in prior seasons. Almost 1,300 confirmed RSV hospitalizations have occurred to date, versus roughly 100 or less at this time in 2020 and 2021.
| Season | RSV Hospitalizations in PA Weeks 40-45 |
|---|---|
| 2022-2023 | 1,291 |
| 2021-2022 | 96 |
| 2020-2021 | 58 |
The crush of RSV patients is creating massive capacity challenges for pediatric facilities in the state and across the region.
“The emergency departments are very crowded with kids who are struggling to breathe with this virus,” said Dr. Patrick Gavigan at Children’s Wisconsin hospital system. His hospital’s pediatric ICU recently hit 100% occupancy for the first time ever due to the influx of young RSV patients.
Doctors urge parents to take infected infants and toddlers seriously and watch carefully for any signs of labored breathing, as RSV can quickly become life-threatening. “Don’t take the chance of watching them overnight,” Gavigan warned. “Go straight to the ER.”
COVID Also Picking Up Steam
While flu and RSV have dominated headlines recently, COVID-19 activity is likewise accelerating according to the latest surveillance data.
The country is now averaging over 65,000 new reported COVID cases per week, up 20% versus the prior month. Test positivity rates and virus levels in wastewater are also rising in multiple areas.
These trends have health experts concerned COVID could intensify further amid increased indoor gatherings around the holidays.
“As we enter the winter months, with the holidays coming up, gathering together with family and friends, and spending more time indoors, we are expecting continued increases in COVID-19 cases as well as other respiratory illnesses like flu and RSV,” said Dr. Sandra Adams of the Tennessee Department of Health.
Adams noted more immunity from vaccinations and prior infections should prevent COVID hospitalizations from reaching the massive peaks seen during past winter surges. Still, she and others caution that combined pressure from all three viruses could severely strain capacity at many hospitals in the coming weeks or months.
Mitigation Measures Still Critical To Slow Spread
To reduce virus transmission and ease strains on healthcare systems, experts emphasize residents should get vaccinated and boosted against both COVID and flu as soon as possible.
Those sick with any respiratory symptoms – even mild ones – should also stay home from work, school, holiday gatherings, and other activities where they may infect others.
“Don’t tough it out and go to work sick or send your children to school if they are ill,” advised Health Commissioner Cheryl Bettigole of Philadelphia, one of 15 jurisdictions now seeing “very high” flu activity per the CDC.
Beyond vaccination and isolation when sick, officials recommend additional virus mitigation precautions over the holidays and winter months like masking, improved ventilation, and testing before gatherings.
While some express fatigue over ongoing public health measures, health leaders stress combined viral threats remain dire enough to warrant persistence.
“I know folks are tired of hearing about transmissions and infections and vaccines,” acknowledged California’s state epidemiologist Dr. Erica Pan during a recent briefing. “But the reality is we are still in a pandemic.”
Uncertain Outlook Through Winter and New Year
With all indicators showing accelerating spread of flu, RSV, and COVID, experts say the full impact of the so-called “tripledemic” remains uncertain at this stage. Projections vary on whether one virus or another will dominate ultimately, or if all three could circulate at very high levels simultaneously.
Most health officials do expect hospitals to face major capacity challenges over the next several weeks to months across broad swaths of the country as viral activity intensifies further post-Thanksgiving. Pediatric facilities and ICUs could experience particular strain given heavy volumes of young flu and RSV patients already occurring.
Beyond mounting viruses, hospitals also continue struggling with widespread healthcare staffing shortages, which creates additional risk of overcrowded ERs and inability to accept new patients. Nurses unions in some states like Pennsylvania and California say understaffing issues have already reached “crisis” stage even before the brunt of winter respiratory virus waves.
With so many variables in flux, experts emphasize mitigation measures like masking and vaccination remain vital to slow virus spread to the greatest degree possible. “Our best protection against a ‘tripledemic’ is prevention,” said CDC Director Dr. Rochelle Walensky, urging diligence from both individuals and communities. That combined with sound hospital pandemic plans will be key to navigating the uncertain but likely turbulent viral landscape this holiday season and into 2023.
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