Two viral respiratory diseases – influenza and respiratory syncytial virus (RSV) – have made an unwelcome early appearance this fall, causing cases to rise sharply weeks earlier than normal across the U.S.
And while COVID-19 rates remain low for now, they are expected to rise this fall and winter as well, posing a triple threat – particularly among children – that could overwhelm health care systems, the Centers for Disease Control and Prevention (CDC) warns in a recent health alert.
Though there’s no predicting where this wave of illness is going, it’s already left physicians and health care professionals feeling overworked, says Donald Murphey, MD, a pediatric infectious disease specialist at Dell Children’s Medical Center in Austin.
“The hospital’s full. The ER’s full,” he said. “People are going to the ER and saying, ‘This is crazy – there are a million people here,’ and they’re turning around and going home.”
With so much medical mayhem in the past two years, COVID-19 remains the driving force behind this latest problem, says Keller pediatrician Jason Terk, MD, chair of the Texas Public Health Coalition, which includes the Texas Medical Association. For instance, the medical labor shortage that the pandemic exacerbated helps explain why hospitals and emergency departments have filled up with flu and RSV patients.
“The capacity of our urgent care facilities [in Tarrant County] to handle additional volume in the area is severely compromised by the lack of ability to get fully staffed with respect to nurses, advanced practice nursing staff, and physicians,” Dr. Terk said. “We have lots of openings in our organization for urgent care that are not getting filled, and we’re not finding people who can take those positions.”
Physicians and other health care professionals are still reeling from two years of the COVID-19 pandemic, Dr. Murphey says.
“There are a lot of [health care professionals] who have worked really hard, and they’re kind of tired, and they’re hoping for a little break, maybe take a little vacation,” he said. “And it looks like this is not a good time for that.”
How bad is it? Hospitals and physician offices are very busy but not overwhelmed – yet, Dr. Terk says. That could change quickly based on a number of likely factors:
Peaking – Flu and RSV might peak quickly and go away – or, they might not. COVID is widely expected to peak in the winter months – and it could appear in a more dangerous new variant. Also, other respiratory diseases already are making problems with flu and RSV worse.
“As we are looking into the dark, cavernous tunnel of wintertime, it’s getting pretty worrisome that we’re not going to have the capacity to handle the volume if [illness] increases significantly,” Dr. Terk said.
Timing – The flu-RSV outbreak’s timing also has a direct tie to COVID-19, Dr. Murphey says. Historically, flu and RSV got started each year in November and then peaked in December, January, or maybe February. All that got thrown out of whack during the COVID-19 pandemic, when people wore masks, washed hands, and socially distanced to protect themselves during the previous two winters. Those precautions all but eliminated cases of flu and RSV at the time. But people have increasingly forgone those precautions in 2022, and flu and RSV have returned at unusual times.
“Our whole pattern of viral seasonal infection has been disturbed,” Dr. Murphey said. “Last year, the kids went back to school and day care, which they very much needed. But now they’re getting sick a lot. Flu started early, and RSV was going on in the summer, and there’s almost never RSV in the summertime.”
Vaccines – While there’s some hope for an RSV vaccine, there are none yet, Dr. Murphey says. Physicians should work to educate patients and their parents about the importance of flu vaccination. “This is a great time to say, ‘Go get your flu vaccine,’” he said.
The vaccine skepticism tied to the COVID-19 vaccines continues to affect acceptance rates for other vaccines, including the one for flu, Dr. Terk says.
“We see significant numbers of parents who are refusing flu vaccine for their children who previously consented to them,” he said. “And that seems to be a collateral effect of COVID-19 vaccine hesitancy.”
Other precautions – RSV antibody treatments are reserved for a few high-risk patients, but influenza and COVID-19 can be treated with anti-viral medications like Tamiflu and Paxlovid, respectively, Dr. Murphey says. Physicians should encourage patients to use anti-viral medications where possible to help lessen the severity and duration of flu and COVID.
“If you have a good, safe, effective antiviral, and you can get tested and treated, that’s a good idea,” he said.
The best way parents can protect their children from RSV is to limit person-to-person contact, Dr. Terk says. Preterm babies and babies with underlying health conditions are the most vulnerable to RSV, but other children can easily develop serious cases.
“When you look at the proportion of children who get admitted to the hospital with RSV, and who get admitted to the ICU and get intubated and need ventilation, the majority are otherwise healthy kids,” Dr. Terk said.
In addition to offering prompt vaccination, CDC provides recommendations for physicians and other health care professionals regarding testing and treatment for COVID, flu, and RSV in the latest health alert