Tripledemic a concern

With COVID-19 still plaguing the country, healthcare professionals are already identifying what could prove to be a tripledemic this flu season.

The influenza and respiratory syncytial viruses have already seen a sharp increase in cases across the country and internationally, and a similar spike is anticipated to hit St. Louis-area hospitals in the coming weeks.

The St. Louis Metropolitan Pandemic Task Force shared an update Tuesday on its Facebook page featuring four St. Louis-area doctors addressing these concerns.

SSM Health Chief Community Health Officer Dr. Alex Garza described the impact that a combination of COVID, RSV and the flu could have on the availability of area hospital beds – particularly in pediatric hospitals.

“Those viruses combined with COVID could create the triple threat, especially for people who have less robust immune systems, including young children, older adults and those with certain pre-existing medical conditions,” Garza said.

Also in the briefing, BJC HealthCare Chief Clinical Officer Dr. Clay Dunagan expressed that a recent surge in COVID cases in Europe is expected to precede a surge in cases in the U.S., as has previously occurred.

Dunagan said the expected COVID surge could be less serious than last winter’s surge thanks to vaccines, boosters and the generally manageable phase the region is currently in when it comes to cases and hospitalizations holding steady.

In regard to the flu, Dr. Rachel Orscheln, a pediatric infectious diseases physician at St. Louis Children’s Hospital, said an especially hard-hitting flu season is similarly expected due to international trends.

“We’ve seen a preview of what we’re likely to see here as cold weather hits by what happened in the Southern Hemisphere during their cold and flu season,” Orscheln said. “This year, countries in the Southern Hemisphere had an early and difficult flu season, and children were particularly hard hit. We would expect that to be the case here in St. Louis this fall and winter.”

RSV is also expected to severely impact the region as cases have surged around the country.

Dr. Marya Strand, chief medical officer at SSM Health Cardinal Glennon Children’s Hospital, explained that RSV’s prominence this year is due largely to how subdued it’s been the last two years.

With masking, social distancing and quarantining as COVID precautions, very young children weren’t as exposed to the virus as they typically are each year, which Strand says has now made RSV a significantly greater threat.

“We’re seeing children who would normally have had their first case at infancy getting the virus at 2, 3, 4 or even 5 years old now,” Strand said. “Because they’ve never had RSV, they don’t have the immunity and are experiencing more severe symptoms. Many are being hospitalized. Many are also needing increased levels of treatment.”

Symptoms of RSV in infants can include runny nose, congestion, loss of appetite and a cough that might turn into wheezing.

For very young children, symptoms might be runny nose, mild fever, cough or sore throat.

Strand advised to watch out for any symptoms of a respiratory illness in young children.

She added that consulting a primary care pediatrician or getting an appointment via telehealth is a good choice for non-urgent care.

Strand said emergency care might not be the best option for all cases, and the overall goal to address the wave of respiratory viruses is to keep emergency rooms free.

“We’re really hoping to keep the emergency rooms freed up as much as possible for the most acutely sick children during what is already a very busy time,” Strand said.

To further help with that goal, Garza recommended “tried and true” methods to help prevent the spread of respiratory viruses – specifically staying at home if you’re feeling sick and keeping children home if they feel sick and staying up-to-date on COVID vaccines and boosters while also getting this year’s flu shot.

Keeping hands washed and wiping down hard surfaces was also recommended, as was wearing a well-fitting, high-quality mask if you are susceptible to the viruses or expect to be around someone who is susceptible.

“We’ve made tremendous progress, and we know what works, but the next few months could be a new challenge with those three viruses hitting us all at once,” Garza said.

Red Bud Regional Hospital Director of Marketing Meghan Markotay said the hospital currently isn’t experiencing an uptick in RSV cases beyond the usual annual numbers.

Monroe County Health Department Director John Wagner offered similar advice and echoed the doctors’ explanations that, while the current situation isn’t desperate, the combination of the viruses could cause major problems for area hospitals.

“We’re not at a critical point right now with the hospitals, but the anticipation is critical,” Wagner said. “What could be if we end up with a surge in COVID and a surge in flu, that could be a perfect storm and could really put a strain on our hospitals.”

On a related point, the St. Louis Post-Dispatch reported that Pfizer announced that an international study demonstrating the effects of RSV vaccination on those who are pregnant has shown positive results.

This article adds that the findings won’t be useful to the expected wave this year, but could help prevent more severe cases of RSV in babies in the future.

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Andrew Unverferth

HTC web