After peaking in late December and early January, cases of COVID-19, flu and respiratory syncytial virus (RSV) are showing signs of retreat across much of the United States, according to data from state health agencies and hospital systems. However, cases remain significantly elevated compared to past years and continue straining healthcare systems.
The decline over the past two weeks marks a tentative turning point in what has been an unrelenting months-long swell of respiratory illnesses that slammed emergency departments and wards from coast to coast. Dubbed a “tripledemic,” the simultaneous strikes of all three viruses have packed hospitals beyond capacity and resulted in long wait times and treatment delays.
Though offering a glimmer of hope, health officials caution that it is too early to declare an end to the crisis. “I wouldn’t breathe a sigh of relief yet,” said Dr. William Schaffner, a Vanderbilt University infectious diseases expert. “It looks encouraging but there are too many moving parts to be confident this decline will continue.”
The latest surveillance data from the Centers for Disease Control and Prevention (CDC) shows that after rapid acceleration from October onwards, positive tests for flu fell for the second week running while RSV positivity also declined for the second straight week.
As of January 14, RSV hospitalization rates have fallen for two weeks in a row among children under 5 years where the virus typically takes its biggest toll. Flu hospitalization rates decreased as well last week after a marked rise, especially among those 65 years and older. Meanwhile, new weekly COVID-19 cases have also been edging down nationally though different variants continue spreading.
“[The data shows] what we believe is a genuine decline in cases,” said CDC Director Dr. Rochelle Walensky at a Wednesday news briefing, while underscoring it was still too early to say activity was subsiding. On January 14, nearly 78,000 Americans were hospitalized for flu, according to the CDC, while 35,000 were hospitalized for COVID-19 based on a weekly average.
State health agencies are reporting similar case trends. New York, which endured among the worst of the tripledemic surge, said statewide COVID-19 cases declined 30% last week compared to the average two weeks prior. Flu hospitalizations also fell 14% week-over-week. “The number of flu and COVID-19 cases are starting to show early signs of slowing down,” New York Health Commissioner Dr. Mary Bassett, said Wednesday.
What Led To The Surge
The confluence of all three viruses at once has not occurred previously during the pandemic. The unexpected severity caught many health systems off guard and short on supplies, staff and beds for managing high patient volumes.
Several factors set the stage for the crisis, experts say. Immunity from prior exposure to both flu and RSV had ebbed significantly. Flu seasons in 2020 and 2021 were exceptionally mild thanks to COVID-19 mitigation measures like masking and distancing. RSV circulation also remained low.
That left more people susceptible this season, especially children. With precautions lifting, the viruses came roaring back. Moreover, some COVID-19 variants like BQ.1.1 and XBB.1.5 proved adept at dodging immunity. Adding to the strain, another respiratory virus called human metapneumovirus has also been wide-spread.
“This was the ‘perfect storm’ driving increased susceptibility across the board,” Schaffner said. “When multiple viruses strike all at once with fewer people having background immunity, you get slammed.”
Impact and Effects
The fallout has been extensive with overburdened hospitals from Rhode Island to Alaska reporting long emergency room delays, exhausted workforces, strained bed capacity and difficulty transferring patients.
In hard-hit spots like Los Angeles County, ambulance operators have had to ration oxygen. Some hospital systems report using conference rooms and cafeterias for overflow patient accommodations. Meanwhile, pharmacies faced medication shortages like the flu treatment Tamiflu and antibiotics to treat secondary infections.
Perhaps most distressingly, the crisis has interrupted care for many seriously ill patients. Heart attack and stroke victims experienced higher mortality rates in December amid overwhelmed ERs, according to researchers at the University of Pittsburgh. Cancer surgeries and organ transplants were delayed.
“The convergence of these viruses put unprecedented strain on a healthcare system already stretched thin,” Walensky said. “The downstream consequences have really laid bare longstanding frailties.”
Pediatric units were especially overwhelmed by a crush of young RSV patients with many babies requiring oxygen support. Though RSV is typically mild, it can become serious in infants and lead to pneumonia or bronchiolitis. At least 140 children have died this season, mostly from RSV.
Overall, the CDC estimates at least 140,000 Americans have been lost to flu and pneumonia this season and around 450,000 hospitalized. Estimating COVID-19’s full toll is more difficult though at least 30,000 deaths were recorded over the two weeks ending January 7. CDC models indicate as many as 100,000 Americans could ultimately die over the course of the season spanning the fall and winter.
What To Expect Next
Though activity seems to be slowing, infectious disease specialists caution it remains too early to forecast how the rest of the winter may unfold given COVID-19 has proven notoriously unpredictable.
If the current downtrend holds, newly emerging COVID-19 subvariants like XBB.1.5 – which is swiftly gaining dominance nationwide – appear unlikely to drive another major wave on the scale seen last month at this point.
Seasonal flu waves likewise typically peak in December or January then subside by early spring. Most pediatric flu deaths occur in February however, underscoring the need to remain vigilant. RSV hospitalization rates normally decline sharply by March or April as well.
Barring an unforeseen twist, experts believe healthcare facilities should gain some respite over the coming weeks though volumes will remain heavier than average through winter’s end. How precisely events unfold will depend on whether new immune-evading virus mutants emerge and how faithfully individuals adhere to prevention basics like masking, distancing and hand hygiene.
“My hope is that barring a significant change in the virus, this [downslope] will be sustained,” said Dr. Allison Arwady, Commissioner of the Chicago Department of Public Health, while cautioning it is impossible to let down our guard. “But I have seen over the past three years these rises and falls enough to know we just can’t count anything out.”
Though showing early signs of easing, infectious disease experts urge the public to remain vigilant about prevention given viral spread remains aggressive nationwide and the ultimate trajectory over the rest of winter is uncertain. They emphasize continuing common sense precautions like:
- Getting updated COVID-19 boosters and annual flu shots
- Wearing well-fitted masks in indoor public areas
- Regular hand washing
- Staying home when sick
- Getting tested for both flu and COVID-19 when symptomatic
Health officials also encourage getting timely treatment. Newly updated CDC guidelines advise doctors prescribe antiviral medications like Paxlovid to COVID-19 patients more proactively. Seeking medical attention quickly for flu or RSV can also help mitigate severity.
“This has been a wake up call showing we need to respect these viruses and double down on basic protections,” said White House Medical Advisor Dr. Anthony Fauci. “Though it appears activity may be moderating, we cannot take our foot off the gas.”
While offering a tentative signal of hope, latest surveillance figures showing potential early-stage declines in flu, RSV and COVID-19 must be interpreted cautiously and not as invitation to abandon precautions, experts say. Even if the back may be breaking on the months-long tripledemic swell, viral spread remains aggressive nationwide and the ultimate winter trajectory is uncertain.
“I urge the public not to underestimate these viruses – we must stay vigilant,” Walensky said. “Though this data is encouraging, significant flu, RSV and COVID-19 will continue circulating across the country in the weeks ahead and our healthcare heroes need our continued help mitigating spread.”
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