Hospitals across the country are being hit with a spike in respiratory syncytial virus (RSV) and influenza cases, while still dealing with a steady flow of COVID admissions, in what’s been dubbed a “tripledemic”. The graphic above uses hospitalization data from the Centers for Disease Control and Prevention (CDC) to show that each disease has been sending similar shares of the population to hospitals across late fall, with flu hospitalizations having just overtaken COVID admissions after Thanksgiving.
These numbers reflect that we’re experiencing the worst RSV season in at least five years, and we’re set to endure the worst flu season since 2009-10.As RSV is most severe in very young children, its recent surge has revealed another capacity shortage in our nation’s hospitals: pediatric beds. From 2008 to 2018, pediatric inpatient bed counts fell by 19 percent, as hospitals shifted resources to higher revenue services.
This strategy has now come to a head in many parts of the country, as RSV has driven pediatric bed usage rates to a recent high. (The Department of Health and Human Services’ pediatric capacity data only dates back to August 2020.) With three straight weeks of declining RSV hospitalizations, there is reason to hope that pediatric care units will soon feel a reprieve. However, flu season has yet to reach its peak, prompting calls for a return to widespread mask-wearing and a renewed emphasis on flu shots, given that more than half of Americans have not yet gotten vaccinated this season.
Surgeons in Ukraine operated on a patient in the dark using only a flashlight after Russia unleashed a missile barrage on the nation’s power grid. (NBC News)
Pharma industry groups and CVS Health expressed skepticism over a plan proposed by the FDA that would allow certain generic drugs to pick up over-the-counter indications. (Endpoints News)
Marketing biosimilars with skinny labels — labels for biosimilars or generics that include a smaller set of indications than the brand-name drugs — saved Medicare $1.5 billion from 2015 to 2020, 5% of what it spent on five biologics during that period. (JAMA Internal Medicine)
Flu hospitalizations are up nearly 30% from last week, as scientists and public health experts express concern about the virus spreading during holiday gatherings. (CNBC)
As the CDC prepares to announce nearly $4 billion to improve public health infrastructure, most of which will be allocated to local health departments, community-based health groups say they’re being left out of funding. (CNN)
A storm of these proportions should demand not only crisis clinical measures, but also community prevention efforts. Yet instead of deploying public health strategies to weather the storm, the U.S. is abandoning them.
Even before the arrival of the so-called tripledemic, U.S. health systems were on the brink. But as the fall surge of illness threatens to capsize teetering hospitals, the will to deploy public health measures has also collapsed. Pediatricians are declaring “This is our March 2020” and issuing pleas for help while public health efforts to flatten the curve and reduce transmission rates of Covid-19 — or any infectious disease — have effectively evaporated. Unmanageable patient volumes are seen as inevitable, or billed as the predictable outcome of an “immunity debt,” despite considerable uncertainty surrounding the scientific underpinnings and practical utility of this concept.
The Covid-19 pandemic should have left us better prepared for this moment. It helped the public to understand that respiratory viruses primarily spread through shared indoor air. Public health practices to stop the spread of Covid-19 — such as masking, moving activities outdoors, and limiting large gatherings during surges — were incorporated into the daily routines of many Americans. RSV and flu are also much less transmissible than Covid-19, making them easier to control with common-sense public health practices.
Instead of dialing up those first-line practices as pediatric ICUs overflow and classrooms close, though, the U.S. is relying on its precious and fragile last lines of defense to combat the tripledemic: health care professionals and medical facilities.
Warnings and advisories recently issued by U.S. public health leaders, clinical leaders, politicians, and the media have consistently neglected to mention masking as a powerful short-term public health strategy that can blunt the surge of viral illness. Instead, recent guidance has exclusively promoted handwashing and cough etiquette. These recommendations run counter to recent calls to build on improved understanding of the transmission of respiratory viruses.
In the U.S.’s efforts to “move on” from thinking about Covid, it has created a “new normal” that is deeply abnormal — one in which we normalize resorting to crisis measures, such as treating patients in tents, instead of using common-sense public health strategies. Treating Covid like the flu — or the flu like Covid — has effectively meant that we treat neither illness as if it were a serious threat to health systems and to public health. Mobilizing Department of Defense troops and Federal Emergency Management Agency personnel to cover health system shortfalls is apparently more palatable than asking people to wear masks.
The tripledemic has already claimed its first child deaths in the U.S., adding to a large ongoing death toll from Covid. Allowing health systems to reach the brink of collapse will lead to many more preventable deaths among pediatric and other vulnerable patients who can’t access the care they need.
By any accounting, these losses are shocking and tragic. But they should strike us as particularly abhorrent and shameful because the tripledemic is a crisis that leaders, health agencies, and institutions have, in a sense, chosen. Over the past year, the Biden administration and its allies have repeatedly encouraged the public to stand down on public health measures, with the President even stating in September that “the pandemic is over.” By moving real risks out of view and failing to push for more robust measures to mitigate Covid, these messages have put the country on a path to its present circumstances, in which pediatric RSV patients are transferred to hospitals hundreds of miles away because there is no capacity to treat them in their own communities.
Living with viruses should mean embracing simple public health measures rather than learning to live with staggering levels of illness and death. Leaders in public health and medicine should issue timely and appropriate guidance that reflects the latest science instead of second-guessing the prevailing winds in public opinion. Instead of self-censoring their recommendations out of fear of political consequences, they should continue to promote the full range of public health strategies, including masking in crowded indoor public places during surges.
The tripledemic should bring renewed urgency to policies that will reduce the toll of seasonal illness on health, education, and the economy. Improvements in indoor air quality in public spaces, including schools, child care centers, and workplaces, can limit the spread of diseases and have many demonstrated health and economic benefits, yet the U.S. continues to lack standards to guide infrastructure or workplace safety standards. Paid leave enabling workers to stay home when they are ill can reduce the transmission of disease as well as loss of income, yet the U.S. is one of the only high-income countries without universal paid sick leave or family medical leave.
Greater effort must also be made to increase vaccination coverage for flu and Covid and bring an RSV vaccine online as quickly as possible. Only about half of high-risk adults under 65 received a flu shot last year, a gap that can be closed with more energetic vaccination campaigns. Reducing annual flu deaths using a broader range of strategies enabled by the pandemic — rather than pegging Covid deaths to them — should be the goal.
Amid the many sobering stories of the tripledemic, there is some good news. As the experience of Covid-19 has shown, it is possible to limit the toll of respiratory viruses like flu and RSV. However, this work requires resources, appropriate policies, and political will. Americans don’t need to accept winter disease surges and overrun health systems as an inevitable new normal. Instead, the country should see the tripledemic as a call to reinvigorate public health strategies in response to these threats to the health of our communities.
Houston Methodist is reporting an early increase in flu cases, with numbers hitting levels not usually seen until the end of the year.
The hospital recorded 100 cases of influenza A and B in the week ending Sept. 21. A week prior, this figure hit 226.
“We experienced an early uptick in mid-September, which relaxed some last week, but still these are the sorts of numbers we usually see in December, not now,” Wesley Long, MD, PhD, a pathologist and medical director of diagnostic microbiology at Houston Methodist, tweeted Sept. 26.
Texas is the only state in the U.S. — outside of Washington, D.C. — that already has a moderately high rate of flu cases, according to the CDC’s latest weekly flu report published Sept. 23.
The early rise in cases comes amid warnings that this season’s flu season may be severe.
Doctors and scientists have been relieved that the dreaded “twindemic”—the usual winter spike of seasonal influenza superimposed on the COVID pandemic—did not materialize.
In fact, flu cases are at one of the lowest levels ever recorded, with just 155 flu-related hospitalizations this season (compared to over 490K in 2019). A new piece in the Atlantic looks at the long-term ramifications of a year without the flu.
Public health measures like masking and handwashing have surely lowered flu transmission, but scientists remain uncertain why flu cases have flatlined as COVID-19, which spreads via the same mechanisms, surged.
Children are a much greater vector for influenza, and reduced mingling in schools and childcare likely slowed spread. Perhaps the shutdown in travel slowed the viruses’ ability to hop a ride from continent to continent, and the cancellation of gatherings further dampened transmission.
Nor are scientists sure what to expect next year. Optimists hope that record-low levels of flu could take a strain out of circulation. But others warn that flu could return with a vengeance, as the virus continues to mutate while population immunity declines.
Researchers developing next year’s vaccines, meanwhile, face a lack of data on what strains and mutations to target—although many hope the mRNA technologies that proved effective for COVID will enable more agile flu vaccine development in the future.
Regardless, renewed vigilance in flu prevention and vaccination next fall will be essential, as a COVID-fatigued population will be inclined to breathe a sigh of relief as the current pandemic comes under control.
“Last night I shared a post on Facebook that said, ‘Hey, the flu shot isn’t about you.’ Sitting here, soaking up every ounce of caffeine before my night shift, I figured I should elaborate.
The flu shot is for Influenza, a severe respiratory illness that can lead to death. Have you ever had it? I have, and it’s awful. You spike fevers, every bone and muscle in your body aches, and no matter how hard you try, you just can’t seem to catch your breath.
You get the flu shot not always for you, but for those around you. For the grandparents, whose bodies are not what they used to be, and they just can’t kick an illness in the butt like when they were young.
For the 30 year old, with HIV or AIDS, who has a weakened immune system.
For the 25-year-old mother of 3 who has cancer. She has absolutely zero immune system because of chemotherapy.
For the newborn baby who was just welcomed into the world, and isn’t quite strong enough to fight off infections on his own.
For the nurses and doctors that take care of you. If they get sick, they can’t go to work and take care of the countless patients that need them.
For the 50-year-old husband who needs a medication for his chronic illness, and that medication also weakens his immune system.
For the pregnant mom that has been trying to get pregnant for years, and now she’s trying to stay healthy for her unborn baby.
For the single dad who can’t take any more sick days and needs to provide for his kids.
For the 7-year-old boy that just wants to play with his friends. But he has a disease that puts him at a higher risk for infection, so he has to stay inside.
The flu shot is NOT always about you. It’s about protecting those around you, who cannot always protect themselves. I have been in the room as a patient has passed away, because of influenza. I have watched patients struggle to breathe, because of influenza. I have busted my butt to provide tylenol, warm blankets, nebulizers, etc. to keep that patient comfortable and fighting a terrible respiratory infection.
Anthony Fauci, MD, says talk about a second wave of the coronavirus is premature because the United States is still dealing with the first one.
The idea of a second wave is based on the 1918 flu pandemic, when many cases were seen in the spring, he says. The spring cases “literally disappeared” and were followed by a spike in flu cases in the fall, he told CNN’s Sanjay Gupta, MD, on Thursday in an online conversation organized by Emory University.
“Rather than say, ‘A second wave,’ why don’t we say, ‘Are we prepared for the challenge of the fall and the winter?’” said Fauci, director of the National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force.
Flu shots are an important measure to help the U.S. get through the winter, he said.
He and other health care professionals have observed that the Southern Hemisphere has had a very light flu season, probably because measures to curb the coronavirus, such as social distancing and mask-wearing, have limited the spread of the flu.
“If we listen to the public health measures, not only would we diminish the effect of COVID-19, we might get away with a very, very light flu season if we combine that with getting the flu vaccine,” Fauci said.
In a separate interview, he said the arrival of the coronavirus vaccine will not stop the need for tried-and-true measures such as mask-wearing, hand-washing, and social distancing.
In a Facebook Live conversation with New Jersey Gov. Phil Murphy, Fauci said the coronavirus vaccine will not be 100% effective and won’t be taken by the entire population. That means the virus could still spread.
“So when a vaccine comes, we look at it as an important tool to supplement the public health measures that we do,” he said. “It will allow us to more quickly and with less stringency get back to some degree of normal. But it is not going to eliminate the need to be prudent and careful with our public health measures.”
Fauci said that vaccinating 75% to 80% of the population “would be a really good accomplishment.” He expects 700 million doses to be produced by the end of this year or early 2021.
With the coronavirus still spreading widely, it’s time to start thinking seriously about influenza, which typically spreads in fall and winter. A major flu outbreak would not only overwhelm hospitals this fall and winter, but also likely overwhelm a person who might contract both at once.
Doctors have no way of knowing yet what the effect of a dual diagnosis might be on a person’s body, but they do know the havoc that the flu alone can do to a person’s body. And, we know the U.S. death toll of COVID-19 as of Aug. 17, 2020 was 170,000, and doctors are learning more each day about the effects of the disease on the body. Public health officials in the U.S. are therefore urging people to get the flu vaccine, which is already being shipped in many areas to be ready for September vaccinations.
But there’s reason to be concerned that flu vaccination rates could be lower this year than in past years, even though the risk of getting seriously ill may be higher because of widespread circulation of the coronavirus.
In an effort to avoid getting sick, millions of Americans avoided seeing their health care provider the past few months. Social distancing and stay-at-home orders have resulted in a decreased use of routine medical preventive services such as vaccinations. Many employers that often provide the flu shot at no cost to employees are allowing employees to work from home, potentially limiting the number of people who will get the flu shot at their jobs.
As a health care professional, I urge everyone to get the flu vaccine in September. Please do not wait for flu cases to start to peak. The flu vaccine takes up to two weeks to reach peak effectiveness, so getting the vaccine in September will help provide the best protection as the flu increases in October and later in the season.
Data on flu vaccination rates from 2018-2019 show that only 49% of Americans six months of age and older received the flu vaccine. The vaccine’s effectiveness varies each season, with early data from the 2019-2020 flu season indicating a vaccine effectiveness rate of 50% overall, and 55% in youth.
It is now quite apparent that COVID-19 will still be circulating during flu season, which makes getting a flu vaccine more important than ever. As schools, our communities and our economy continue to reopen, it is vital to get the flu vaccine for personal, family and community protection.
A flu camp in Lawrence, Maine during the 1918 influenza pandemic. Nurses and doctors tried desperate measures to stop the spread of the disease, which ultimately killed more than 675,000 people in the U.S. alone.Bettmann/Getty Images
Severe cases of both COVID-19 and the flu require the same lifesaving medical equipment. This highlights the importance of getting the flu vaccine for not only your own personal health but also the health of your community. Receiving the flu vaccine will help reduce the burden of respiratory illness on our already very overstretched health care system. By increasing flu vaccination rates, we can reduce the overall impact of respiratory illnesses on the population and hence lower the resulting burden on the health care system during the COVID-19 pandemic.
Because flu vaccination protects against one of these respiratory illnesses, the CDC recommends everyone (with few exceptions) six months of age and older get an annual flu vaccine. While the flu vaccine will not protect you against COVID-19, the flu vaccine will reduce your risk of developing the flu as well as reduce your risks of flu-related complications including hospitalization and even death.
While it may seem like there is so much out of our control during this pandemic, getting the flu vaccine, practicing proper hand washing, social distancing and wearing face coverings are within our control and will protect not only you but also your family and community.
If you are not getting the flu vaccine from your employer, think about alternative sources now. Vaccines should be available in most areas by Sept. 1.
Call you doctor’s office to ask how you can get a flu shot.
Call your local public health department.
Consider getting a vaccine while you are grocery shopping or picking up prescriptions.