The United States is already seeing an uptick in new Covid-19 cases, and a slight rise in hospitalizations as winter approaches. To add to our worries, children are getting hit with three types of viral respiratory infections, including Covid-19, leading to what’s now being called a “tripledemic.”
The other two viruses, RSV (respiratory syncytial virus) and influenza (flu) are leading to sharp increases in pediatric hospitalizations from respiratory illnesses throughout the country, something Dr. Bruce Y. Lee reported for Forbes in October. This is getting worse each week.
The first child to die due to complications from influenza was reported in North Carolina on November 2, 2022. According to the Centers for Disease Control, This was the first reported influenza-related death in a child since February 2020. Influenza is certainly not a novel virus, and in years past, prior to 2020, the United States would typically see anywhere from 20,000 to 60,000 annual deaths due to complications of the flu. Vaccines to protect against influenza are tailored each season, based on the prior season’s flu strains, to minimize risks of infections, complications, hospitalizations and flu-related deaths. Most years, fewer than 50% of the population receives a flu shot, which is approved and recommended for all ages 6 months and up.
RSV, or respiratory syncytial virus, is not new either. Children typically develop anything from cold-like symptoms to more severe cough or even trouble breathing. The highest risk infants are eligible to receive RSV prophylaxis called palivizumab. This is not a vaccine, but an antibody therapy offered in limited supply to specific groups of infants at higher risk of RSV-related hospitalization. As I reported for Forbes, the American Academy of Pediatrics has expanded eligibility for palivizumab this year, as we are seeing massive surges of RSV infections, months earlier than in prior years. Despite the expanded use of palivizumab, hospital beds are filled with previously healthy, “low-risk” children suffering from complications due to RSV infections.
And then there’s Covid. With nearly all mitigation measures lifted, especially in schools, kids are getting more Covid infections. Most are mild, but some are not, and kids are landing in the hospital once again. At the end of October 2022, there were 46 children under age 5 years hospitalized in the U.S. with Covid-19. There were fewer than 25 of those ages 5-17 hospitalized that same week. This is likely due to lower vaccination rates in younger children, especially with the newer BA.4 and BA.5 strains being dominant. There has also been a sharp increase in infants under 6 months old being hospitalized with Covid infections, as this group is not yet eligible for Covid vaccination.
Large cities such as Los Angeles are already seeing an early winter rise in Covid-19 infections, which will no doubt translate to rising hospitalizations and deaths in the coming months. With abysmally low uptake of the newer bivalent booster shot nationally, we may be in for another rough winter. Patients with complications due to Covid will not be the only ones filling beds— pediatric beds are already being filled, first with RSV, now with flu, and likely soon more adults and children will be hospitalized with Covid yet again. Recommendations for masking are entering the public health conversation. Yet again. Resuming masking this winter may help tamp down the projected surge of all three infections.
What is a Tripledemic?
We have influenza, RSV and Covid-19 infecting children as a three-virus onslaught, called a tripledemic. None of these viruses are new, as the SARS-CoV-2 virus has now been in circulation for at least three years and RSV and influenza have been around for decades. Some have claimed that the country’s children are suffering an “immune debt”, as their bodies have not been exposed to these viruses due do mitigation measures including early stay-at-home requirements, masking, testing and physical distancing. There is, however, no such thing as an immune debt. The immune system does not become weakened, impaired, or immature due to lack of viral loads. Yes, many of the viruses children are exposed to enable them to develop brief periods of antibody protection, but most of the viruses that kids and adults get keep coming back, with no permanent protection due to infection.
Now that nearly all mitigation measures have been lifted, children from newborns to young adults are being exposed to these three, as well as many other, respiratory pathogens that routinely cause anything from colds to severe lung infections every year.
What’s the Difference Between Covid, Flu, and RSV?
These three respiratory infections can look quite similar. According to UC Davis Infectious Disease specialist Dr. Dean Blumberg, there are several differences to look out for in theses three illness:
- fever or chills
- respiratory symptoms (cough, sore throat, runny nose)
- loss of taste and smell
- sore throat
- muscle or body aches
Influenza (Flu) Infections:
- sudden onset fever or chills
- respiratory symptoms (cough, sore throat, runny nose)
- muscle aches and pains
- runny nose
- decrease in appetite
What Can You Do To Reduce Risks of Illness?
Short of sounding like a broken record, the means to reduce risks of illness remain the same as in years past. Keeping up to date on Covid vaccinations clearly reduce risks of complications from Covid infections. This includes the newest bivalent Covid booster vaccine. All people over age 6 months should receive an annual flu vaccine. This is especially critical for pregnant women, whereby protection from flu can be transmitted to their newborn in the baby’s first six months of life, before they are eligible to be vaccinated themselves. This transmitted protection also applies to Covid-19. Pregnant women who are vaccinated against Covid-19 transfer antibody protection to the fetus. This protection continues in the first months of a baby’s life. As for RSV protection, there is no vaccine for RSV protection, although Pfizer recently released promising data on RSV vaccine administration to pregnant women, which will provide protection to vulnerable newborns.
The other means of protection continue to include consideration for masks in indoor environments this winter. Masks have clearly been shown to reduce risk of transmission of viruses, thereby reducing risk of illness. For those who remain skeptical of masking, thank your healthcare professionals for keeping their masks on while caring for sick people, not getting sick themselves, and showing up to care for the sick during this surge, during ones past, and during ones to come.