Triple threat of flu, covid and RSV

CNN
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The United States is facing a triple threat, with a combination of viral infections caused by respiratory syncytial virus, influenza, and Covid-19. Many children’s hospitals were overwhelmed after the waves RSVwhile flu level it is the largest at this time of year in more than a decade. And after a lull in cases, new ones coronavirus infections are on the rise also throughout the country.

All this is happening at the start of the holiday season, with more people traveling and congregating indoors, possibly with fewer precautions than in the previous two years.

How worried should people be? Which individuals should be most cautious? Can people get all three viruses at the same time? What steps can be taken to reduce risk and stay safe? And should provisions such as masking and social distancing be reinstated?

To guide us through these questions, I spoke with CNN medical analyst Dr. Leana Wen, an emergency room physician, public health expert and professor of health policy and management at the George Washington University Milken Institute School of Public Health. She is also the author of the book “Lifelines: A doctor’s journey in the fight for public health.”

CNN: Why should people be concerned about the convergence of RSV, flu and Covid-19?

Dr. AS Leana Wen: There are several reasons for concern about this so-called triple epidemic.

One is the impact on the social level. Already, children’s hospitals across the United States are overflowing with children infected with viruses, including RSV and the flu. Some experts speculate that this is because lack of immunity as a result of the mitigation measures taken in the last two years. The situation is so bad that child health leaders requested an official declaration of a state of emergency from the Biden administration to better help those hospitals. (The administration has not declared a state of emergency, but the U.S. Department of Health and Human Services sent a letter to governors last week saying it “stands ready to continue assisting you with resources, supplies and personnel.”)

When hospitals exceed capacity, patient care suffers. People who come to the emergency room wait much longer because there are not enough staff to take care of them. Patients who need to be hospitalized can wait days for a bed to open up. Some patients, especially in rural areas, may have to be moved hours away for the care they need.

These delays can be harmful, even deadly. And it doesn’t just affect patients with respiratory diseases; this leads to delays in care for broken bones, asthma attacks and appendicitis, among other medical emergencies.

Another consequence is for particularly vulnerable individuals. While most people who contract RSV, influenza, Covid-19 and other respiratory illnesses will have mild symptoms, those most at risk could become seriously ill, require intensive care and even die. The higher the infection rates in their community, the more dangerous it becomes for vulnerable people.

Of course, nobody wants to be sick. Even a minor viral illness can cause inconvenience, such as missing work or school. Even if someone does not need to be hospitalized, they could feel unwell and be contagious to others. So, the high level of infection with these viruses is something that worries us all.

CNN: Which people should be most cautious during this period?

Wen: The individuals who should be most cautious are those who are at greatest risk of serious illness. This includes the elderly, newborns and people with multiple chronic diseases. These are the people most susceptible to viruses, and what is a mild infection for someone who is a healthy young adult could result in hospitalization for them.

Another group that should consider caution are those in direct contact with high-risk individuals. The spouse of someone who is immunocompromised, family members living with the elderly, parents or caregivers of a newborn — these are all people who should reduce their own risk of infection to prevent transmission to someone vulnerable in their immediate household.

CNN: Can people get infected with all three viruses?

Wen: In theory, yes. Someone can certainly be infected with all three viruses over the course of a year. Generally, however, they don’t get them all at the same time. The term “triple epidemic” refers to all three viruses growing in the population at once, not necessarily (and not usually) in the same person at the same time.

CNN: What steps can be taken to reduce risk and stay safe?

Wen: There are Covid-19 and flu vaccines to prevent serious illness and death. People should follow the guidelines from the US Centers for Disease Control and Prevention about keeping up to date with theirs coronavirus and flu vaccine.

The coronavirus is transmitted through the air. Good ventilation helps reduce the spread, so gathering with others outdoors will be safer than indoors. Indoors may be less of a risk if there is improved ventilation, for example through open doors and windows and the use of HEPA filters.

Influenza and RSV are primarily spread by droplets. People should stay away from those who are coughing and sneezing (and people with symptoms should avoid public places). Everyone should wash their hands often – and wash them well. This is especially important for small children who often put their hands in their mouths.

There are other important tools, including testing and masking. Testing for Covid-19 before gathering can reduce risk, as can wearing a high-quality N95 or equivalent mask (KN95 or KF94).

CNN: Is a cloth mask or a regular medical mask enough?

Wen: Not. The virus that causes Covid-19 is spread by microscopic droplets that can pass through fabric and ordinary medical masks. The N95 mask is the gold standard and will offer the best protection against respiratory viruses.

There will be some people who cannot tolerate the N95. These persons can wear two medical masks or a cloth mask on top of the medical mask. But these options still aren’t as protective as a well-fitting N95 or equivalent.

CNN: Should regulations like face masks and social distancing be reinstated?

Wen: I think it will be very difficult to ask everyone to go back to masking, distancing and avoiding spending time indoors with loved ones – especially during the holidays. My view is that top-down mandates from any level of government should be reserved for truly dire situations where there are no other options—for example, if a new highly transmissible variant emerges that is far more dangerous and resistant to existing vaccines. This is not the situation at the moment.

That said, just because mandates in all areas are unlikely doesn’t mean people shouldn’t take care of themselves. Individuals—especially those susceptible to severe illness and their household contacts—should choose a well-fitting N95 or equivalent while in crowded indoor spaces. They may choose additional protective measures, including staying outdoors or in well-ventilated areas when possible. And everyone should make sure, again, that they are vaccinated with the currently available Covid-19 and flu vaccines.