After an intense start to the 2024 viral respiratory illness season with high levels of flu, RSV, and COVID-19, new reports this week suggest that cases may be starting to decline across parts of the country.
According to figures from the Centers for Disease Control and Prevention (CDC) , levels of flu and RSV have fallen for the second straight week. While still elevated, COVID-19 hospitalizations have also started to decrease in certain regions.
“We’re in what looks to be a decline from the peak,” said Dr. William Schaffner, an infectious diseases expert at Vanderbilt University.
The recent surge, described as a “tripledemic” by health experts, has stressed hospitals and medical resources over the last couple of months. Doctors hope this downward trend continues but warn that cases could still fluctuate, particularly if new COVID-19 and flu variants emerge.
Details on Key Viruses
The CDC estimates there have been at least 13 million flu illnesses, 120,000 hospitalizations and 7,300 deaths from flu so far this season .
Flu activity is still high across much of the country but dropped for the second week in a row along with other respiratory viruses . As of January 14, the national flu hospitalization rate was 8.3 per 100,000 people, down from 9.2 the previous week.
|Flu Hospitalization Rate per 100K
The CDC says influenza A(H3N2) viruses are predominating so far. These flu strains often lead to more severe illness especially in older people and young children .
The flu vaccine is a key prevention tool but effectiveness has been limited this year. The vaccine is estimated to cut a person’s risk of needing medical care for the flu by 30-40%, health officials said.
Respiratory syncytial virus (RSV) remains at very high levels nationwide , though cases also declined for the second week according to CDC surveillance.
RSV is especially dangerous for infants and young children. As of January 14, the RSV hospitalization rate for children younger than 5 was about 39 per 100,000 – substantially above normal for this time of year.
“For RSV we are still seeing high levels of activity,” said Dr. José R. Romero, director of the National Center for Immunization and Respiratory Diseases. “Although it looks like we’re turning the corner, we have high hospitalization rates occurring.” 
|RSV Hospitalization Rate per 100K (age <5 years)
While RSV and flu appear to be declining nationally, the COVID-19 situation remains varied across different regions. Areas like New York and New Jersey are still seeing elevated hospitalization levels, while parts of the South and West are experiencing decreases.
Nationwide, new reported COVID cases are down about 40 percent since mid-December . Hospitalizations have fallen by 10 percent nationwide over the past two weeks.
The XBB.1.5 omicron subvariant, also called Kraken, now makes up over 70 percent of new COVID-19 cases. The variant appears more transmissible but not more severe. Health officials continue monitoring for new concerning viral mutations.
“I don’t think we’re completely done with COVID just yet,” said Davidson Hamer, a specialist in infectious diseases at Boston University. “The big question is whether another variant will emerge that has greater immune evasion.” 
Impact on Hospitals
The influx of flu, RSV and COVID-19 has overwhelmed children’s hospitals and medical centers over the last couple months.
In early January, Seattle Children’s declared an emergency after reaching maximum capacity with rising respiratory illnesses. Facilities in many other regions like Milwaukee, Cincinnati and Memphis have been pushed to their limits as well.
“The volumes we’re seeing both in our emergency department and our urgent cares are unprecedented,” said Dr. Mark Cleveland, Seattle Children’s executive medical director, earlier this month.
While the situation remains serious in many areas, there are tentative signs the hospital crunch could be easing.
The latest surveillance shows pediatric bed occupancy decreasing slightly, though facilities are still stressed. As of January 18, 79 percent of pediatric hospital beds were full nationwide compared to over 80 percent in prior weeks. 
What Happens Next
Health experts hope virus activity continues to decline but warn the end of the current surge is hard to predict. Another spike could still occur – particularly if people drop their guard on precautions.
“We may see more ups and downs over the months,” said Dr. William Moss, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health.
The path of the viruses will depend on several key factors:
New COVID-19 variants
Emergence of new concerning omicron subvariants would risk increased transmission and immunity evasion from vaccines and prior infection. Continued viral evolution is likely but the implications remain uncertain. 
Fluctuations in precautions
Prematurely dropping precautions likes masks and social distancing raises odds of fuelling further viral spread. Many experts emphasize the need to continue common sense measures like staying home when sick.
Timing of peak activity
If flu and RSV peak earlier in the season rather than later, overall virus impact could lessen. However peak timing is hard to predict.
Increased flu and COVID-19 booster shots can curb spread and severity. But vaccine rates are lagging typical seasons so far. Ongoing efforts targeting vaccination of high risk people remains vital. 
New flu strains
If different or additional flu strains start circulating widely, it could lengthen the flu season and burden from influenza illnesses. 
While virus activity appears to be slowing currently, health agencies emphasize people should keep guard up and continue mitigation measures:
- Get flu and COVID-19 vaccine shots, plus boosters when eligible
- Wear well-fitting masks in indoor public areas
- Wash hands frequently and use alcohol sanitizer
- Stay home, isolate when sick; test for COVID-19
- Seek medical attention for severe symptoms
- Keep infants and those at high-risk away from sick contacts
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