COVID, Flu, and RSV Challenge Public Healthcare

Pediatrician Capt. Michael Zimmerman with the help of Kaylin Bowers, a registered nurse assesses Santiago Flores, five months old, during a health check up to ensure he hasn’t contracted RSV.  (Photo credit: Courtesy Photo by Spc. Kelly Acevedo, USAG, Fort Polk Public Affairs)
By Ian Neligh

Across the United States, hospitals have experienced a high burden of infections and hospitalizations due to respiratory syncytial virus (RSV), influenza, and COVID-19. 

The unusual trifecta of viruses poses a formidable challenge to public healthcare. This was especially evident during the holiday season, which saw a spike in hospitalizations.

As a result, hospitals have been unable to accommodate everyone requiring medical care. Part of the rise in RSV and influenza can be attributed to an increase in the public wearing masks and socially distancing due to COVID.

A military doctor holds a syringe.
Hospitals have experienced a high burden of infections and
hospitalizations due to respiratory syncytial virus (RSV), influenza and
COVID-19 in recent months. (Photo credit: Janet Aker, Defense Health
“This past summer into fall as people stopped wearing masks and began to meet in person again respiratory viral infections began to increase,” says Uniformed Services University (USU) associate professor and pediatric infectious disease specialist Dr. Allison Malloy. “We saw a surprising rise of RSV in the summer months that reached a pinnacle in December with more hospitalization than had been seen in the prior 10 years.”

Hospitalizations caused by influenza peaked in December adding to the challenges faced by hospitals and healthcare providers. 

 “Compared to the peak in hospitalizations in December the number of people who experience severe respiratory disease is lower now, but still prevalent,” says Malloy. “Many people across the U.S. are experiencing respiratory infections and the numbers reported by the CDC suggest they are increasingly managing them at home.”

According to Malloy, RSV cases began to rise in July and peaked in December, which usually occurs in January for much of the country. Influenza, which has its historic peak in January and February, also peaked in December. 

RSV often hospitalizes the youngest infants, Malloy says, but recently it began to affect early school-age children who also required hospitalization.

“Currently, there are no vaccines for RSV and this left many young infants and those over the age of 65 years susceptible to significant disease,” explains Malloy. “The disease burden in the elderly is often overlooked, as RSV is considered a disease of infants, but can contribute to hospitalizations and deaths at similar rates to influenza.”

Malloy says it is difficult to tell exactly what COVID is doing right now in the population because many people are testing at home and these numbers are not reported. However, hospitalization rates are down. Malloy adds that this time last year the CDC reported 20,000 patients a week due to COVID and that number is now down to 5,000 hospitalizations per week and most of those rates are driven by folks who are over 65.

Symptoms and Prevention

While these three respiratory diseases are caused by different viruses, the process of becoming infected is similar, said USU associate professor of family medicine Dr. Alan Williams.

“Most often a person gets infected with influenza, RSV, or (COVID) by getting enough viral particles on their mucous membranes,” says Williams. “This could happen by breathing in particles that contain viruses or wiping viral particles from your hands onto your eyes, nose, or mouth.”

Williams says the three have similar common symptoms such as fever, chills, headache, cough, runny nose, body aches, and fatigue and testing is usually the best approach to determine which it is.

“(However,) sometimes testing isn’t necessary when there’s clear close contact with a known illness,” Williams says. “If a child gets symptoms and tests positive for influenza and then everyone in the house has a fever and feels lousy in the next couple of days, you can pretty comfortably say they all have flu.”

These viruses have demonstrated different disease severity based on age. “RSV makes younger kids much more ill than COVID does,” Malloy adds. “And we’ve seen this over the course of the pandemic, where adults are getting sicker than young children are. If a five-year-old has a runny nose and starts to get a bit wheezy, it’s more likely to be RSV than it is to be COVID.  

“Many people across the U.S. are experiencing respiratory infections and the numbers reported by the CDC suggest they are increasingly managing them at home.” - Dr. Allison Malloy

She says if a child doesn’t seem too sick but has a mild sore throat, and they’re vaccinated, it is likely COVID. 

“As we see new variants of (COVID) circulate the symptoms can change, with the current strain of the Omicron variant, we’re seeing sore throats, headache, a little bit of runny nose,” Malloy says, adding the early distinguishing factor of the early COVID variants, such as the loss of smell, doesn’t seem to be happening with this strain.

Williams says for RSV and Flu people should wait until the symptoms are significantly improved and have had no fever for 24 hours without taking fever-reducing medications before ending isolation.

“Continue to wear a mask around others until your symptoms are resolved,” Williams says. “For COVID, we add in a minimum of 5 days of isolation and 10 days in a mask in addition to the same previous criteria. The first day of symptoms or a positive test, if there are no symptoms, is counted as day zero.”

Williams adds any action taken that decreases the chances of coming into contact with a virus should decrease a person’s chance of getting infected.

“Wearing a mask decreases the number and size of particles you inhale,” Williams says. “Having fewer close contacts means fewer opportunities to contact the virus. Washing your hands decreases any hand contamination if it is present.”
If someone develops symptoms, they should wear a mask to decrease the size and volume of virus particles they are putting in the air and isolate from others and wash their hands to help others avoid coming into contact with the virus, according to Williams. 

“Both influenza and (COVID) have available vaccines that help prevent serious illness,” Williams says. “There’s some evidence that those vaccines may not prevent infection as much as we’d like, but the vaccines do decrease the likelihood of hospitalization or emergency room visits.”