As if the COVID-19 pandemic wasn’t bad enough, experts say winter 2023 finds us in the midst of a “tripledemic.”

What is a tripledemic? While there’s no evidence-based definition, the current use of this term refers to the simultaneous occurrence of respiratory syncytial virus (RSV), flu, and COVID-19.

Clinicians can help patients face this trio of conditions by encouraging them to mask up, get vaccinated, and take other steps to reduce the risk of infection.

 

Statistical status quo

The emerging tripledemic is reportedly flooding EDs nationwide, with little hope of a reprieve. And while peer-reviewed studies have yet to emerge, some institutions are doing their own research.

Yale Medicine has been documenting this situation in its medical centers.

Macmillan C. ‘Tripledemic:’ What happens when flu, RSV, and COVID-19 cases collide? Yale Medicine. January 12, 2023.

In early December 2022, researchers there found that RSV cases were starting to drop, while flu and COVID-19 cases spiked up. The flu increase was attributed to a lack of immunity to the virus due to the limited exposure that came with COVID-19 precautions.

 

In an interview with MDLinx, Scott Roberts, MD, an infectious diseases specialist at Yale Medicine, summed up the trend.

“RSV has had a great impact on our pediatric population,” he said. “We have seen this plateau in our region. Flu is at record levels and rising, which is quite concerning. COVID is still quite prevalent in the community, but this varies region to region.”

In our hospital, flu admissions have eclipsed COVID cases for the first time. We are seeing record levels of flu and RSV cases at the moment. COVID is still circulating, although at levels much less than last winter.

 

Predates expected surge

Not only is this surge of RSV, COVID-19, and flu occurring at faster rates, but it’s also hitting the nation before the usual seasonal spike, according to an article published by the Boston University (BU) School of Public Health.

McKoy J. RSV, flu, and COVID: Understanding today’s ‘tripledemic.’ Boston University School of Public Health. December 9, 2022.

 

RSV cases are as much as 60% higher than their 2021 peak, and inpatient hospitalizations for flu are at the highest levels they’ve been in the past 10 years.

The silver lining may be that RSV cases could be peaking in some parts of the US, including the South, according to the CDC as reported by The Washington Post.

Nirappil F. Flu hospitalizations soar as triple viral threat looms ahead of holidays. The Washington Post. December 5, 2022.

RSV, however, is expected to remain a major threat, because there is no vaccine for this virus.

 

For the week of December 12, 2022, the CDC posted that although the number of COVID-19 cases was higher than it was in October, it had decreased slightly since then.

 

Focusing on fallout

This situation presents a novel challenge to healthcare systems. Hospitals are designed to reflect “typical need” plus the potential for surges. With an excess surge such as that caused by the tripledemic, there isn’t enough capacity; both EDs and ICUs are quickly filling.

In addition, there’s been a run on antibiotics, which has depleted supplies. Although some of this increased demand can be attributed to legitimate indications for the drug, cases of overprescription may exist.

There are also shortages of ibuprofen and acetaminophen, which bodes poorly for children with aches and fevers. Canada is experiencing similar issues, according to the BU article.

The greatest danger is straining the healthcare system to the point where limited resources will lead to lesser care for all of us, including those with and without respiratory viruses.

“If beds are full due to flu or RSV patients, there are no beds for heart failure, surgeries, and other conditions that require care,” Dr. Roberts said.

 

Carefully counsel patients

Physicians need to be especially vigilant in counseling patients.

Physicians should encourage patients to take precautions, especially over the next few weeks to months while the diseases are circulating at high levels.

“They should get tested if they have symptoms and seek out treatment if they qualify (for flu and COVID-19),” Dr. Roberts advised.

He also suggested “maximizing protection against RSV, COVID, and flu as best as possible. This includes masking for all of them, being up to date on vaccinations for COVID/flu, rapid testing for COVID before gatherings, and handwashing and disinfecting contaminated surfaces for RSV.”

The CDC has recommended masking once again, as 13.7% of communities are exhibiting “high levels” of the COVID-19 virus, according to a report published by The Hill.

Caprariello A, Delandro T, Nexstar Media Wire. CDC urges masking return as tripledemic surges. December 12, 2022.

 

 

Time to mask up again?

A public health threat like this can surely put a crimp on social gatherings. Nevertheless, Dr. Roberts stated that such activities can still be done—carefully.

He stated that get-togethers “can be done safely, but everyone needs to evaluate their risk tolerance. For example, will vulnerable immunocompromised people be at the gathering? Will it only be young healthy college students?”