The United States is heading for one of its roughtest winter season in terms of winter illness and infection in decades. Hosptials are already feeling this effect with many across the country nearing full capacity. Health experts are warning of the combined effects of Covid-19, RSV, and the flu which are all simultaneously rising in case numbers. These upticks in infections for all three viruses concurrently is resulting in the so-called “Tripledemic”.

What is the tripledemic?

The term tripledemic refers to the rising cases of 3 different respiratory viruses - Influenza (the flu), RSV, and Covid-19. In the previous seasons, Americans were taking precautionary measures to reduce the spread of Covid-19 which also helped curb the spread of other respiratory viruses like Influenza. These included social distancing, mask wearing, and regular hand washing and sanitizing. With public health policies relaxing and the general public reverting back to pre-covid habits , we are starting to see an aggressive spike with all 3 viruses.

Influenza is rising in cases, with the highest number of hospitalizations for this time of year in a decade, NBC News reported, with the percent of people testing positive for influenza is steadily rising, according to CDC data.

While the majority of cases involving Covid-19, flu and R.S.V. are likely to be mild, there has been an alarming increase hospitalizations, with more than three-quarters of pediatric hospital beds nationwide occupied, many are now starting to reach its capacity as cases continue to rise. Seniors and immuno-compromised are the most at risk of hospitalizations but this season, children in particular are the most at risk.

RSV - What is it?

RSV, or Respiratory Syncytical Virus, has been around for decades and is one of the most common causes of childhood illness. It’s a seasonal infection that impedes the airways, called bronchioles. This year in particular, there has been an alarming amount of kids falling seriously ill to RSV which has led to rising hospitalizations that have been overwhelming pediatric units across the United States.

Covid-19 had a devastating impact on older adults, with seniors being the most at risk. Whereas with RSV and the current tripledemic, kids are the ones who are most susceptible. It’s a complete switch for who’s most affected and pediatric hospitals are already struggling to treat its patients with dwindling supplies while nearly max capacity.

Doctors believe those who would’ve normally been exposed to RSV the past couple of years were sheltered from it by social distancing in the previous years, which is leading to a sharp increase in severe cases that is overwhelming hospitals since the children who would have gotten infected from RSV in the past 2 years are all getting them now.

Dr. Sarah Combs, an emergency medicine physician at Children’s National Hospital in Washington, D.C., said “The immune system works by recognition and repetition. And when you give it a bit of a rest, like we did during the pandemic — and for good reason — we now have a generation of immune-naive children.”

While there are currently no vaccines for for RSV, there are treatments available. Infants with the highest risk are eligible to receive an antibody therapy called Palivizumab. Due to limited supply, it is only offered to specific groups of infants who are at high risk of RSV-related hospitalizations and complications.

Since there is no widely available vaccine for RSV, doctors and public health experts are encouraging parents to do whatever they can to protect their children’s health in other ways (such as wearing masks, getting flu shots, and staying up to date on vaccintations like Covid-19 boosters).

How do all 3 differ?

Dealing with coronavirus and flu simultaneously is already enough of a challenge. However, with RSV in the mix, it’s even more complicated. While the symptoms of all three respiratory infections are similar, there are some differences to look out for. According to UC Davis Infectious Disease specialist Dr. Dean Blumberg, here’s how they break down:

Flu Symptoms:

• Sudden onset fever or chills
• Respiratory symptoms (cough, sore throat, runny nose)
• Muscle aches and pains
• Headaches

Covid-19 Symptoms:

• Fever or chills
• Respiratory symptoms (cough, sore throat, runny nose)
• New loss of taste and smell
• Fatigue
• Sore throat
• Muscle or body aches
• Headache
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Nausea or vomiting
• Diarrhea

RSV Symptoms:

• Runny nose
• Coughing
• Fever
• Wheezing
• Decrease in appetite
• Difficulty breathing
• Grunting in babies, or difficulty speaking in older kids.
• Increased or persistent lethargy, such as a child being difficult to wake.
• Lips turning blue
• Persistent crying or irritability

Of course, with Covid-19, you can always try to take a test (PCR or at home) to determine if you have an infection.

How is each virus spread?:

The tripledemic may be comprised of three respiratory viruses, but there are slight differences in how each is transmitted and spread. For example, cross contamination is much more prevalent with RSV. According to Yale Medicine infectious diseases specialist, Scott Roberts, MD, “RSV spreads much more through contaminated surfaces. A kid rubs snot on their hands and puts the hand on someone else, and then that kid puts their hand in their mouth, and they can be infected. Handwashing and cleaning surfaces are more critical with RSV than with Covid.”

In contrast, Covid-19 infections typically occur through airborne transmissions by spreading in respiratory droplets exhaled from a person infected with the virus. This is why mask wearing is so critical in managing the spread of this disease.

“Flu, on other hand, is somewhere in the middle, and can spread from respiratory droplets, aerosols, and through contaminated surfaces,” - Dr. Roberts.

How to stay safe:

After more than 2 years living with Covid-19, the answer may sound a bit repetitive but the best way to stay safe is to take the same precautions that we did all throughout the pandemic:

• Reduce exposures in public by wearing a mask that fits well
• Avoid large crowds, especially if indoors
• Regularly use hand sanitizer
• Wash your hands frequently
• Ask service workers (such as maintenance and repair technicians) to wear masks if they come into your home
• Avoid long-distance travel
• Avoid large events with family, friends and others outside of social-distancing bubbles at home, school, and work
• Avoiding people who are sick and quarantining if you are sick
• When socializing, try to stay outdoors or somewhere with lots of airflow (near windows or air vents when indoors)

In addition, now is the time to get your flu shots or Omicron boosters if you haven’t already. Health officials advise staying up to date with your shots along with vaccinations for Covid-19 and its booster shots. “The influenza vaccine may not completely prevent you from getting the flu, but it has a really good chance of keeping you from getting seriously ill and being hospitalized and dying,” Dr. Murray, a pediatric infectious diseases physician, says.

While many Americans have started to enjoy what felt like the end of a pandemic with loosened restrictions and little precautions, now is the time to start taking preventive measures again to protect yourself and those around you. By doing our part and taking the above mentioned precautions and actions, you can help to reduce the spread of this tripledemic while still enjoying this holiday season.