Earlier this month, Tyson Bell entered UVA Health’s intensive care unit and discovered that half of the patients in his care were no longer able to breathe on their own. All were on ventilators or high-flow oxygen. “The last time I saw it was in early 2022,” Bell, an infectious disease and critical care physician at the hospital, told me. Records from around the same time that a variant of the original Omicron was hitting the region and crushing the coronavirus infection. But this time, the coronavirus, influenza and RSV came together to fill UVA’s wards — “all at the same time,” Bell said.
Since the arrival of the coronavirus, experts have fearfully predicted the worst of this winter: three respiratory virus outbreaks hitting the United States at once. Sam Scarpino, an infectious disease modeler at Northeastern University, said last year that those fears didn’t materialize. But this year, “we’re poised for that to happen” as respiratory syncytial virus, influenza and COVID-19 threaten to peak at about the same time.how’s it going grim expression The CDC canceled the emergency call Last Thursday, additional vaccinations against all three pathogens were called for, marking the first time since the pandemic began that seasonal vaccinations have received such attention.
Nationally, the medical system is not yet in a crisis situation. Barring some unforeseen development in virus evolution, a repeat of the first terrifying Omicron winter seems highly unlikely. Nor is the U.S. necessarily doomed to suffer an encore of last year’s horrors. At the time, the early waves of respiratory syncytial virus and then influenza were hitting the country, pushing pediatric emergency departments and ICUs beyond capacity, and some hospitals began setting up temporary tents outside. To accommodate overflow. On the contrary, more than any other year since SARS-CoV-2 emerged, our common respiratory viruses “seem to be reverting to old patterns” in terms of timing and magnitude, Kathryn Edwards said. , vaccines and transmissibility, a Vanderbilt University disease expert told me.
However, even if the seasons of RSV, influenza, and SARS-CoV-2 are common, they could cause a catastrophe if they overlap. “It doesn’t take long for any of these three viruses to scale significantly and overwhelm our hospitals,” Debra Hawley, the CDC’s chief medical officer, told me. Ta. And in theory, it shouldn’t take much to avert a potential medical crisis down the road. For the first time in history, the United States is infected with influenza, the new coronavirus, and RSV: “There are three opportunities to prevent three different viral infections,” Grace Lee, a pediatrician at Stanford University, told me. Yet Americans largely ignore the gunfire aimed at them.
So far, influenza vaccination rates are lower than last year. According to a recent opinion poll, even half Americans surveyed probably or absolutely I have no plans to receive the COVID-19 vaccine this year. The respiratory syncytial virus vaccine was approved for older adults in May and for pregnant women in August, but has struggled to gain a foothold. The three doses, which will be distributed to all eligible people, could keep hundreds of thousands of Americans out of emergency departments and intensive care units this year. . But that won’t happen if people continue to avoid protection. The particular tragedy of the coming winter may be that any suffering would have been far more avoidable.
Much of the suffering of last year’s respiratory season can be attributed to a frightening combination of timing and intensity. A wave of RSV hit the country early and hard, peaks in November And hospitals ran out of time to recover before the flu hit (again, ahead of schedule). Maximum value in December. Children have borne the brunt of this onslaught after years of being protected from respiratory infections by pandemic mitigation measures. “As masks went down, infections went up,” Lee told me. Infants and young children were becoming seriously ill with their first respiratory illness, but so were older children who did not have typical infections in infancy. With medical workers still exhausted and severely reduced by the pandemic-induced population exodus, hospitals were eventually overwhelmed. “We didn’t have enough capacity to take care of the children we wanted to take care of,” Lee said. Providers prioritized cases over the phone.parents time spent Comforting sick children in a crowded waiting room.
Still, one of the biggest concerns about last season was that the RSV, influenza, and coronavirus waves didn’t all culminate all at once. The winter peak of the coronavirus did not arrive until January, after RSV and influenza had largely subsided.But now, RSV It remains close to the highs that have been maintained for the past few weeks.Hospitalizations due to the new coronavirus are on the rise. slowly but steadily rising, and influenzaAfter simmering in almost complete silence, I think that the “It’s going really well,” Scarpino told me. All three viruses have yet to reach last season’s highs. However, when all of them combine, the amount exceeds what many hospitals can handle. Across the country, many emergency departments and ICUs are nearing or full. “Right now, we’re okay with treadmilling,” Sally Palmer, chief pediatrician at Weill Cornell Medical Center and NewYork-Presbyterian Hospital, told me. “If you add a lot more things to the mix, you’re going to end up in a similar situation to last year.”
That prediction is not certain. RSV dance around the top of the nation, may begin to decline rapidly. Influenza may take some time to reach its peak. COVID-19 also remains a wild card. It has not yet settled into a predictable pattern of ebb and flow and will not necessarily maintain or even exceed its current pace. This season may still be milder than last season, and the effects of these diseases may occur similarly or even more widely apart.
But several experts told me they think a significant overlap is likely in the coming weeks. With the holiday season in full swing and people rushing to travel hubs on their way to family gatherings, the situation is ripe for an outbreak. Mask-wearing and testing rates remain low, and many people are ignoring symptoms and returning to work, school, or social events, despite the possibility of infection. Nor does the virus itself seem to be giving us a break. For example, last year’s influenza season was dominated by a single strain, H3N2. this year, multiple influenza strains Different types of viruses appear to be increasing at the same time, making it much more likely that people will be infected with one or more versions of a virus in rapid succession. Healthcare workers are in a better situation in many ways this year. Mr Perma said the staffing shortage was not too severe and that many experts, especially in pediatric medicine, were prepared to deal with multiple viruses at the same time. Children also have more experience with these bugs than they did this time last year. However, mask-wearing in medical settings is not as consistent as it was in early 2023. Additionally, if synchronized syncytial virus, influenza, and COVID-19 spread in a community at the same time, new problems may arise, such as co-infections, which are not yet well understood. Get up. (Other respiratory illnesses are still prevalent.) There’s a lot that experts can never predict. It’s just that we haven’t yet had a year in which three viruses actually hit us at once.
Of course, a vaccine would alleviate some of the problem, Houry said, which is part of the reason the CDC made the clarion call.But Americans He doesn’t seem very interested in taking targeted shots..Influenza vaccination uptake is decreasing overall all age groups Compared to last year, even among older people and pregnant people, who are particularly at risk. Bell also said that while COVID-19 vaccinations are progressing at a similar pace to 2022, coverage remains “abysmal,” especially among children. The RSV vaccine has arrived. only 17 percent Uptake is increasing among pregnant people, another group targeted for vaccination. I’m in trouble This is due to delays and confusion over eligibility. Some of Ms. Pelmer’s pregnant physician colleagues have been turned away from pharmacy appointments or told that the shots may not be covered by insurance, she said. “And some of those same parents end up having their babies hospitalized with RSV,” she says. Infants were also thought to be able to acquire passive immunity from monoclonal antibodies. But national shortages of these drugs are forcing health care providers to limit their use in infants. highest risk— Another way in which actual protection against respiratory disease falls short of potential. “There was great excitement and hope that monoclonal antibodies were the answer and that everyone could have access to them,” Edwards told me. “But then it became very clear that this was not functionally possible.”
Last year, at least some of the misery caused by respiratory viruses was inevitable. After the U.S. ended pandemic mitigation measures, the pathogen was destined to return with a vengeance. The early arrival of respiratory syncytial virus and influenza (particularly on the heels of a brutal summer surge of enteroviruses and rhinoviruses) also left people with little time to prepare. And of course, the RSV vaccine didn’t exist yet. But this year, the timing is kinder, our immunity is stronger, and our arsenal is better equipped. Higher vaccination uptake will undoubtedly reduce the rate of severe disease and limit community spread. It will maintain hospital capacity and make it safer to move between schools, workplaces and travel hubs. Disease waves will peak lower and contract faster. Some may not develop at all.
But for now, we are collectively wasting an opportunity to strengthen our defense. “It’s like we’re going into battle without armor,” Bell said, even though local officials have been pleading with people for months to prepare. Because of that, this year has been terrible in other ways. Whatever happens in the coming weeks and months, it will be an even worse version of what could have been: a season of missed opportunities.
