Health experts in conundrum over best way to avoid winter ‘tripledemic’

Dr Jason Newland, a pediatric infectious disease doctor at St Louis children's hospital, is just waiting for his cold to start. "I can list off about 10 people right now that have had some sort of illness in the past five days," Newland said.

That's because the respiratory syncytial virus (RSV) and influenza seasons started months earlier than usual, amid the continuing spread of Covid-19 and the common cold. The flu hospitalization rate is the highest it's been in a decade, according to public health officials. Scientists have described the collision of viruses as a "tripledemic".

"This is an extraordinary event, and it is stressing the health care resources in many parts of the country very, very substantially," said William Schaffner, an infectious disease expert at Vanderbilt University School of Medicine.

Fortunately, despite their concerns, public health officials are not calling for people to socially distance and avoid holiday gatherings, as many of them did earlier in the Covid-19 pandemic, which led to increased isolation and sometimes harmed people's mental health. Instead, they say there are other measures individuals should take to avoid spreading the viruses and becoming severely ill as meeting outdoors becomes harder in the winter.

"I think the vast majority of people can gather and do it safely, and there are tools available to make it safer," said Jennifer Nuzzo, an epidemiologist and director of the Pandemic Center at Brown University School of Public Health.

The populations that are most at risk from the viruses are babies, young children and older adults, the infectious disease experts said. The unseasonal spike in cases of flu and RSV, likely due to the social distancing and masking employed during the pandemic, have overwhelmed children's hospitals around the country, according to public health officials.

At the University of Texas Health Science Center at San Antonio, there has been an influx of babies and young children with one or more of the viruses who are struggling to breathe and need supplemental oxygen to stay safe and sometimes must be admitted to the hospital, said Dr Rachel Pearson, assistant professor of pediatrics.

In addition to the viruses, pediatric hospitals must also treat adolescents who end up in the emergency room because of self-inflicted injuries, and the numbers have increased significantly over the last decade, according to the New York Times.

That volume of pediatric patients due to viruses and self-harm has forced healthcare providers to get creative with space at the hospital, Pearson said.

"Usually when you get admitted, you go upstairs from the ER to a regular hospital room, but if all the regular hospital rooms are full, then the kid will stay" in the emergency room under the care of hospitalists such as Pearson and her team, who would normally see them elsewhere, she said. "Every hospitalist I've talked to anywhere is dealing with" pediatric bed shortages.

As for adults over age 65, Nuzzo is concerned because of the low uptake of the second Covid-19 vaccine booster. Only about one-third of that population has received the most recent booster, according to the Centers for Disease Control and Prevention.

"It's surprisingly low for that age group, despite the fact that that age group has typically had high vaccination coverage," Nuzzo said.

And getting the latest Covid-19 vaccine booster and the flu vaccine is one of the best ways people can protect themselves from the viruses, the experts said.

"Neither of these vaccines is perfect," Schaffner said. "Both of them are very good. They do their best in preventing the complications, the most serious aspects of these illnesses, so they are clearly of value to the individual. Both of them also, to a degree, diminish transmission, so they contribute to the general health of families and communities."

Still, public health officials are not urging people to socially distance to avoid overwhelming hospitals as they often were during Covid-19 surges.

But to gather more safely, they recommend that people use rapid Covid-19 tests.

"In addition to obliging everybody to be vaccinated who attends, ask people to take a rapid test the morning of the get-together and say, 'If you're negative, come celebrate. If you're not, we'll contact you on FaceTime,'" Schaffner suggested.

The idea of staying home when sick also, of course, applies to flu and RSV.

"If the grandchildren become snotty-nosed kids - that is they get sick with a respiratory infection - that's not the time to visit grandma," Schaffner said. "If you do become ill, please do not go to work, school, the gym, religious services or other communal gatherings because you will be a dreaded spreader."

The infectious disease experts also recommended that people frequently wash their hands. Unlike Covid-19, RSV lives on surfaces.

Masking can also be a helpful tool. But Nuzzo recognizes that a lot of people don't want to mask around their families any more.

On a ferry ride to a Thanksgiving gathering, Nuzzo sat indoors because it was cold and wore a mask because it was crowded. But once there, she and her family did not wear masks.

Masking "adds safety for sure. As does opening the windows, as does testing, as does having air filtration devices running, as does gathering outdoors instead of indoors", Nuzzo said. "Those things all still help, but I think people are making decisions differently about whether that feels worth it to them."

Fortunately, there are indications that the RSV season could soon reach its peak and begin falling, according to the infectious disease experts. And for Covid-19, there is less vulnerability because of the number of people who have been vaccinated against it and contracted the virus, Nuzzo said.

"If people want to be as safe as possible, wear masks," Newland said. "We know that will protect people. And so I really think we have to come to individual decisions and choices and then respect one another."

If someone says, 'I have some high-risk people in my home, I would prefer that you wear a mask,' then that's what we should be doing," Newland added.