After two tough Covid winters, the current respiratory disease season already rivals some of the worst cold and flu seasons on record – and it started about two months earlier.
RSV, or respiratory syncytial virus, has sickened so many young children this fall that weekly pediatric hospitalizations for RSV are the highest on record. The flu, which normally peaks in February, has pushed hospitalization rates to the highest level for this time of year in more than a decade, surpassing Covid-19 hospitalizations. And although Covid disease is lower than it was the last two Decembers, it too is climbing.
Public health officials have been warning for weeks that a “triple outbreak” of Covid-19, influenza and RSV would strain an already strained health care system. Hospitalizations from the three viruses have increased together. Nationally, RSV appears to have peaked and influenza is peaking in a few areas of the country, but infections from both viruses are expected to plateau at high levels.
Weekly hospitalizations for Covid-19, RSV and influenza
Source: Centers for Disease Control and Prevention
Note: The most recent weeks of data are usually off when reports arrive. Weeks ending December 3 and December 10 are excluded due to this under-reporting.
Experts say it’s difficult to estimate the severity of the remainder of this season as the coronavirus pandemic has disrupted somewhat predictable patterns of other respiratory illnesses.
“There’s a lot of winter left,” said Richard Webby, a virologist at St. Jude Children’s Research Hospital in Memphis. “There is certainly plenty of time for another wave of Covid, and even potentially enough time for another version of the flu.”
The country has already faced two record-breaking seasons under Covid, which have disproportionately affected older Americans, but the return of RSV and influenza this year means some of the disease burden has shifted to the country’s youngest – and their families.
Weekly hospitalizations for RSV in children are the highest since the Centers for Disease Control and Prevention began monitoring in the 2018-19 season. According to preliminary estimates, about one in 70 babies aged 6 months and younger have been hospitalized since the beginning of October.
With flu rising and the circulation of Covid-19, respiratory illnesses have overwhelmed pediatric units across the country, shifting the pressure to emergency rooms and children’s hospitals.
“You ask people involved in emergency departments or hospitalizations and they’ll tell you this is the worst season they can remember,” said Dr. Daniel Rauch, chief of pediatric hospital medicine at Tufts Medical Center.
“We are scared enough for the winter,” he added. “I don’t know if our staff can continue.”
RSV cases and hospitalizations appear to be peaking — particularly in the South, where the disease first arrived — but some experts predict they will level off and remain high for some time.
Hospitalizations for RSV among the elderly are also much higher than those recorded at this time of year in previous seasons.
Older Americans remain extremely vulnerable to serious illness from Covid-19 and influenza, and with the early return and dramatic increase in influenza, public health officials are concerned about this age group.
“Covid has not gone away,” said CDC infectious disease specialist Dr. Fiona Havers. ”
Flu hospitalizations among the elderly are expected to increase in the coming weeks as families continue to travel and gather indoors for the holidays. The predominant type of flu currently circulating, an influenza A subtype known as H3, also tends to lead to increased flu hospitalizations among older adults, according to the CDC.
The agency estimates there have been at least 150,000 hospitalizations and 9,300 deaths from the flu alone so far this season. It also reported 30 childhood flu deaths, a fraction of the estimated 199 pediatric flu deaths for the 2019-20 season.
Experts say the available flu and Covid-19 vaccines match well with the strains circulating. This means that the injections should offer some protection against infections, although they are most effective at protecting against serious illnesses. For those who have had the flu before, the vaccine may protect against another strain to which they have not been exposed.
But vaccination rates are low across the country. Only 36% of people aged 65 and over received an updated Covid-19 reminder this fall, and rates are lower for all younger age groups. About 15% of adults 65 and older and about 46% of children have received the flu vaccine.