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HomeSciencePossible RSV, Covid-19 and flu collision has doctors worried. What to know

Possible RSV, Covid-19 and flu collision has doctors worried. What to know

Flu cases are rising earlier than usual, and pediatric hospitals are seeing surges of respiratory syncytial virus, commonly known as RSV. There are also signs that Covid-19 cases are increasing in parts of the country as Americans head into the cooler months.

Covid-19 precautions earlier in the pandemic—and their near-disappearance lately—are a big part of the reason flu and RSV are staging a comeback, doctors say. Measures such as masking and social distancing suppressed rates of other viruses, too, leaving those of us who haven’t had a recent infection with lower levels of protection now.

“It’s very clear that because people are relaxing Covid precautions that it’s very likely we will also see an increase in influenza at the same time,” says Jay Varma, director of the Cornell Center for Pandemic Prevention and Response in New York City and a physician and epidemiologist at Weill Cornell Medicine.

All three viruses share similar symptoms, such as cough, sore throat, runny nose and fever, making it hard to tell what you have without a test. You can test for Covid-19 at home, and most health professionals can test for flu and RSV.

Worries Ahead for Covid-19

Protection from vaccines and prior infection have dramatically reduced the severity of Covid-19 infections since earlier in the pandemic. Yet the virus remains dangerous, especially for people who are older or have certain health conditions. Less-severe cases can still make you feel ill for a week or more, and ripple through your household, disrupting work and school. And even mild infections can cause longer-term symptoms associated with long Covid-19, such as brain fog, extreme fatigue and racing heartbeat.

“Particularly for people who are over the age of 50 and who are immunocompromised, Covid remains a very real threat,” says Celine Gounder, a senior fellow at the Kaiser Family Foundation and an infectious-disease specialist and epidemiologist.

The most recent Centers for Disease Control and Prevention data show decreases in nationwide numbers of Covid-19 cases, hospitalizations and death.The 21-day average of new weekly cases decreased about 31% as of Oct. 19 compared with the previous 21-day moving average. The seven-day average for hospitalizations fell 4% to 3,156, and the 21-day moving average of new deaths declined 13% to 388.

However, it is difficult to accurately monitor Covid-19 cases as most people use at-home rapid tests, which are typically not reported. The CDC is also reporting Covid-19 cases less frequently, issuing weekly rather than daily updatesas of October. The most reliable indicator of Covid-19 cases is hospitalization data, says Dr. Varma, but hospitalizations tend to lag behind cases by about two to three weeks.

“We think this is the calm before the storm,” says Katelyn Jetelina, an epidemiologist who writes the popular “Your Local Epidemiologist” newsletter. “We think in November it will really start taking off on a national level.”

Newer Omicron subvariants are staking a claim around the world, with some driving surges in other countries. Weekly data from the U.S. CDC indicates that the BQ.1.1 and BQ.1 subvariants—descended from BA.5, the dominant Omicron subvariant in the U.S.—make up more than 16% of cases as of Oct. 21, up from 11% the week before. Another subvariant, XBB, is driving a surge of cases in Singapore.

Case numbers and hospitalizations in some Western European countries are starting to rise, which often is a harbinger of what is to come in the U.S. Wastewater monitoring in the Northeastalso indicates that cases are starting to climb. Doctors worry that few people so far have gotten the updated version of the booster shot.

Flu Season Starts Early

At the same time, flu is rearing its head sooner than usual with the CDC citing increased activity in most of the country, particularly the Southeast and south-central states.

Rick Zimmerman, a professor of family medicine at the University of Pittsburgh, has been doing flu surveillance for more than a decade and says he hasn’t seen activity this early since the 2009 influenza pandemic.

Public-health officials recommend that everyone 6 months and older get a flu vaccine ideally by the end of this month, and say that it is safe to get a flu shot and Covid-19 booster at the same time. The dominant influenza strain is a H3N2 and appears to be well-matched to this year’s vaccine, says Dr. Zimmerman.

“It takes about two weeks for really good immunity postvaccination, so get your flu vaccine now because we’re seeing the start,” he says.

Last flu season, approximately half of people ages 6 months and older in the U.S. received the flu vaccine, the CDC estimates. Projections are similar for this year, according to a National Foundation for Infectious Diseases survey.

It remains unclear if the U.S. influenza season, while starting earlier, will be more severe in hospitalizations and deaths. The season was bad in some parts of the Southern Hemisphere such as Australia, which already had its winter, but not so bad in other parts such as South Africa.

RSV rebounds

Rates of another common virus—respiratory syncytial virus—are also surging earlier than usual, filling beds in pediatric hospitals.

RSV is a virus that infects the respiratory tract. Typically a mild cold in healthy people, RSV can be dangerous and even deadly in the very old and young, particularly babies under the age of 1.

The only way to get immunity to RSV is exposure because there is no vaccine, notes Dr. Gounder. RSV cases dropped during the first year of the Covid-19 pandemic. The respiratory virus that typically circulates in the fall and winter then resurged in the summer of 2021. Young children who haven’t been exposed to the virus over the past few years are getting hit now.

Public-health experts say the same precautionary measures that protect against other respiratory viruses help prevent transmission of RSV: washing your hands thoroughly often, covering coughs and sneezes or wearing a mask, staying home if you’re symptomatic, and improving ventilation in indoor spaces.

Parents should seek medical attention if a child is having trouble breathing, gasping and wheezing or coughing so hard they can’t breathe, says Dr. Gounder. Difficulty feeding and sinking in of the soft tissues around the clavicles and between the ribs are also concerning signs.

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