As temperatures go down and more time is spent indoors for the holidays we are also seeing a co-emergence of illnesses like, Respiratory Syncytial Virus Infection (RSV), Human Parainfluenza Viruses (HPIVs), Influenza (flu), and COVID-19 for the first time since the pandemic. Prevention of illness is key as we continue to balance the long-term impacts of the pandemic with other viruses that are resurfacing after some “dormancy” when COVID-19 predominated and mitigation factors like masking, social distancing, and stay-at-home orders were in place.

Currently, our hospitals and urgent care centers are inundated with RSV which is infecting those ages 0 – 4 years at very high rates, as well as our 5 – 17-year-olds. Most of us will get infected with RSV by age 2, as well as multiple times throughout our lifetime. RSV infections are mild in the majority of cases consisting of runny nose, sneezing, coughing, perhaps a fever. Treatment is supportive—stay hydrated, use ibuprofen or acetaminophen for a fever and rest. Considering that anyone can get RSV, it is also important to note that there were an estimated 177,000 RSV infections and 14,000 deaths in our elderly population last year. However, our very young are experiencing an exponential wave of the illness, and as we see staffing shortages and capacity constraints in our hospitals, we must ensure adequate care for those that are at highest risk for severe illness – our very young, immune compromised or elderly. In babies, telltale signs of severe illness include dehydration, labored breathing like abdominal breathing, retractions where the ribs can be seen or decreased activity. In the elderly, cough, congestion, any changes in activity, difficulty breathing, dehydration or changes in baseline behavior are reasons for concern. Treatment is available in very special circumstances for immune compromised babies, otherwise severe cases may require oxygen, fluids or breathing support. As we learned from COVID-19, proper hand hygiene, masking and cleaning surfaces are effective ways to prevent transmission of illness, and we encourage that as we experience this surge of RSV.

Shifting to influenza. Cases are also increasing earlier than previous years with a heavy burden seen in the south. The majority of Influenza A cases are variant H3N2, and we have unfortunately had five pediatric deaths in the United States. It was found that H3N2 currently circulating in the U.S. is genetically similar to the H3N2 component in our flu vaccine, and one study showed that the vaccine was 49% effective at preventing hospitalization outside the U.S. Like most illnesses, our very young, elderly and immune compromised are at highest risk of illness and death. We also have four FDA-approved anti-virals that have reduced the length of illness. As we encounter this mix of respiratory illnesses, please consider getting vaccinated at your local health department, pharmacy or healthcare provider.

We all have COVID-19 fatigue, but we are also doing a great job at recognizing when we are sick and how to prevent transmission as much as possible. Testing, vaccination and treatment are proven to be effective. Our cases are low at the moment, and we hope to stay there through the winter. It is hard to know what to expect in the coming months, but there is hope that we are reaching some level of immunity with natural and vaccine-induced immunity, while therapeutics, testing and our personal mitigation strategies are ingrained in us. However, COVID-19 is still here where those <6 months and >65 are still getting hospitalized, and variants are constantly emerging. Vaccine is readily available for anyone 6 months and above, as well as the bivalent booster for 5+ years. These can be co-administered with the flu vaccine. If you become infected with COVID-19, anti-virals and antibody therapy are also available for patients that meet criteria. Locations for testing kits and treatment can be seen below:

With the holiday season around the corner, please utilize these resources to keep you and your loved ones safe.

Wishing you Happy Holidays ahead — stay warm, healthy and safe!

— Najibah Rehman, MD, MPH
Medical Director
St. Clair County Health Department