Respiratory Infections, Influenza, COVID-19: Triple Pandemic Expected in US This Winter

For more than two years, closed schools and offices, social distancing and masks have given Americans a respite from the flu and most other respiratory infections. This winter is likely to be different, reports Yahoo.

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With few or no restrictions, and travel and communication in full swing, the expected winter rise in COVID-19 cases looks set to collide with a resurgent flu season as well, causing a so-called twindemic (double pandemic) or even tripledemia ( triple pandemic).

Influenza cases have started to rise earlier than usual and are expected to rise sharply in the coming weeks. Children infected with RSV (respiratory syncytial virus, which has symptoms similar to flu and COVID-19), rhinoviruses and enteroviruses are already putting pressure on pediatric hospitals in several states.

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"We're seeing everything coming back with a vengeance," said Dr. Alpana Wagmare, an infectious disease expert at the Fred Hutchinson Cancer Center and a physician at Seattle Children's Hospital.

Most cases of COVID-19, flu and RSV are likely to be mild, but together they could cause millions of Americans to become ill, flooding hospitals, public health experts warn.

“You have waning immunity to COVID that coincides with the effects of influenza and RSV,” said Andrew Reed, an evolutionary microbiologist at Pennsylvania State University. “We are in uncharted territory here.”

COVID-19 and flu vaccines, while not preventing infection, still provide the best protection against severe illness and death, experts say. They urged everyone, and especially those at risk, to get vaccinated as soon as possible.

The elderly, immunocompromised people and pregnant women are most at risk, and young children are very susceptible to influenza and RSV. Many infected children become seriously ill because their immunity is low, either because it is weakened or because they were not exposed to these viruses before the pandemic.

RSV causes about 14 deaths in adults 000 years of age and older and up to 65 deaths in children under 300 years of age each year.

There is no vaccine, but at least two candidates are in the late stages of clinical trials and appear to be very effective in the elderly. Pfizer is also developing an antiviral drug.

“Today, we are seeing the same amount of COVID, influenza and RSV, and this is really worrisome because we are detecting influenza and RSV activity very early,” said Dr. Diego Higgiano, pediatric infectious disease specialist at the St. Jude.

“The winter will be harsh,” he said.

Another wave of COVID-19?

The incidence of coronavirus is low, but in some parts of the country it is starting to rise. Several European countries, including France, Germany and the UK, are seeing a surge in hospitalizations and deaths, leading experts to fear the US will follow suit, as it did with previous waves.

Some of the variants of the coronavirus that are gaining momentum are able to evade immunity and drugs such as Evucheld and Bebtelovimab, which are especially important in protecting immunocompromised people.

“People with weakened immune systems remain at risk even though they receive all the recommended or even additional doses of the vaccine,” Wagmare said.

Public health experts are particularly concerned about a range of omicron options that appear to be better than previous options at evading vaccine immunity.

The latest booster vaccines made by Pfizer and Moderna were developed for the variants that dominated last summer, but not for these new variants. However, they raise antibody levels in general and should help prevent severe symptoms and shorten the duration of illness, says Aubrey Gordon, a public health researcher at the University of Michigan.

The BA.5 variant was the most immune evasive variant until recently, but it is rapidly being replaced by others, including two that show even greater ability to evade immunity.

One of these, known as BQ.1.1, is a prime candidate for causing the winter wave of illness and has already caused a spike in cases in Europe. Although it and a closely related variant called BQ.1 together account for only about 11% of cases in the United States, their proportion has risen rapidly from just 3% two weeks ago.

The combination of two omicron sub-variants, called XBB, has caused a wave of cases in Singapore, one of the countries with the highest vaccination rates in the world. Its sub-variant XBB.1 has just appeared in the US. Another variant, named BA.2.75.2, also has a high degree of immune evasion and causes more severe disease, but is currently responsible for less than 2% of cases nationwide.

Experts believe that most other variants do not cause more severe symptoms than earlier versions of the virus, but the trend towards immunity evasion is likely to continue.

“Now everything has changed thanks to the huge degree of immunity of people to previous options,” said Cornelius Roemer, a computational biologist with Richard Neher’s group at the University of Basel.

The Food and Drug Administration has approved boosters designed for BA.5 for all Americans aged 5 and over, but so far only a small subset of people who qualify for the vaccine have received them. Less than a third of children aged 5 to 11 have even received the primary series of COVID-19 vaccines.

That could change as people see a rapid rise in cases, Gordon said.

Bad flu season sign

Before the coronavirus hit the world, influenza viruses infected millions of people every winter and killed tens of thousands of Americans. In the 2018-19 season, the flu was responsible for 13 million doctor visits, 380 hospitalizations and 000 deaths.

This year, the flu started a few weeks earlier than usual in Australia and New Zealand, and the number of cases and hospitalizations was noticeably higher.

Gordon tracks flu rates among children in Nicaragua, where the flu season is in June and July and is more active in late autumn. By last January, more than 90% of the population was considered fully vaccinated against COVID-19, and many people have also acquired immunity from one or more infections.

However, the country saw high rates of both COVID-19 and influenza in the first half of this year. Influenza rates among children were higher than during the 2009 influenza pandemic and, on average, children became more ill than in previous years. "We've seen a lot of hospitalizations," Gordon said.

In the United States, the flu usually starts in October and lasts until March, peaking sometime between December and February. But in some states, the season is already underway.

As of October 8, about 3% of tests nationwide tested positive for the flu, according to the Centers for Disease Control and Prevention, but the rate is over 10% in some southeastern states and above 5% in the southeast. central region. . In Texas, the flu test positive rate jumped to 5,3% in early October from 3,7% a week earlier.
New York City health officials said this month that the flu is already widespread in the state.

Public health experts have urged Americans, especially those at high risk, to get vaccinated against the flu before cases rise significantly. Like COVID-19 vaccines, the flu vaccine may not be ideal for the circulating option, but even so, it roughly halves the risk of hospitalization in children and adults.

Antibodies begin to take effect about two weeks after vaccination, so the vaccine now may actually extend protection against the winter wave better than the vaccine received in September.

Influenza vaccination rates fell slightly across all age groups last year compared to the previous year, according to CDC analysis. The vaccination rate for children aged 6 months to 4 years, who are at high risk, showed the biggest drop - to 67% from 75% before the arrival of the coronavirus.

The lower figure could be because distrust of COVID-19 vaccines has extended to flu vaccines, or simply because parents have forgotten the danger the flu poses to young children. It is too early to say whether the numbers will improve this year.

Elderly and immunocompromised people should get both COVID-19 and flu shots, according to public health experts. Healthy young people may also want to opt for both vaccines if they don't want to get sick or can't afford to miss work or protect others who are at higher risk.

Some groups of people are at increased risk of severe illness and hospitalization due to the flu. During flu seasons from 2009 to 2022, hospitalization rates were 80% higher among Black adults, 30% higher among American Indian/Alaska Native adults, and 20% higher among Hispanic adults, according to a CDC report released last week. compared to white adults.

However, influenza vaccination rates were much lower in these groups. Vaccination coverage also fell by about 9 percentage points from the previous year among pregnant women of all racial and ethnic groups.

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In February 2020, Gordon was preparing to talk to his 7-year-old daughter's class about the coronavirus when a boy in the class died from an infection with the influenza B virus.

“Most of the time you don’t get very sick, but sometimes you can,” Gordon said of the flu. “We have an effective flu vaccine, so I encourage people to get vaccinated.”

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