[Two Epidemiologists Explain What the ‘Triple Threat’ Means
for Children]
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RSV AND THE FLU ARE STRAINING HEALTH CARE SYSTEMS  
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Rebecca S.B. Fischer, Annette Regan
November 18, 2022
The Conversation
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_ Two Epidemiologists Explain What the ‘Triple Threat’ Means for
Children _

Pediatric emergency rooms in some states are at or over capacity due
to the surging number of respiratory infections., GOLFX/iStock via
Getty Images Plus

 

Every fall and winter, viral respiratory illnesses like the common
cold and seasonal flu keep kids out of school and social activities.
But this year, more children than usual are ending up at emergency
departments and hospitals
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In California, the Orange County health department declared a state of
emergency in early November 2022 due to record numbers of pediatric
hospitalizations for respiratory infections
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In Maryland, emergency rooms have run out of beds
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because of the unusually high number
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of severe respiratory syncytial virus
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departments there are having to refer patients across state lines for
care.

In the U.S., the winter respiratory virus season started earlier than
usual this year. Since peak infections usually occur in late December
or January, this uncharacteristic early wave suggests that the
situation could get much worse for people of all ages, particularly
children.

We are epidemiologists with expertise in epidemic analysis
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disease threats [[link removed]],
including respiratory infections. We watch patterns in these
infections closely, and we pay particular attention when the patterns
are unusual. We’ve grown increasingly concerned about the amount of
pediatric hospitalizations over the last few months and the pattern
that is emerging.

The ‘triple threat’

In early November, the Centers for Disease Control and Prevention
issued a health advisory
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activity in respiratory infections – especially among children. The
CDC and other health experts are warning of the so-called “triple
threat” of respiratory illness from RSV
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– and COVID-19
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The underlying reasons for the convergence of these viruses and the
increase in infections so early in the season are not yet clear. But
health experts have some clues about contributing factors and what it
could mean for the coming months.

As of mid-November 2022, a children’s hospital in Buffalo, N.Y., had
already admitted more than double the number of respiratory syncytial
virus patients than in the entire 2019-2020 respiratory season.

When it comes to COVID-19, 2022 is expected to usher in another winter
wave of infections [[link removed]],
similar to patterns seen in 2020 and 2021
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Previous winter surges stemmed from a combination of factors,
including the emergence and spread of new viral variants, more people
gathering indoors rather than distanced outside, and people coming
together for the holidays.

But unlike previous pandemic winters, most COVID-19 precautions –
such as using masks in public areas or avoiding group activities –
are more relaxed than ever. Together with the looming threat of new
variants
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it is difficult to predict how big the next COVID-19 wave could be.

And while the seasonal flu has proved somewhat unpredictable during
the COVID-19 pandemic, it nearly always hits during late October. Flu
season also arrived about a month early and in greater numbers than in
recent history. By our read of the data
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hospitalizations are nearing 10 times what has been seen for this time
of year for more than a decade.

RSV infections tend to follow a similar seasonal pattern as the flu,
peaking in winter months. But this year, there was an unexpected
summer wave
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before the start of the typical fall respiratory virus season.

In typical years, RSV garners little media attention. It’s
incredibly common and usually causes only mild illness. In fact, most
children encounter the virus before age 2
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But RSV can be a formidable respiratory infection with serious
consequences for children
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infants. It is the most common cause of lower respiratory infections
[[link removed](22)00478-0] in young children, and
more severe illnesses can lead to pneumonia and other complications,
often requiring hospitalization.

Why children are particularly at risk

Children [[link removed]], especially
young children, tend to get sicker from flu
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But infants younger than 6 months old stand to suffer the most
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of RSV-related death [[link removed](22)00478-0]
compared to other children younger than 5. COVID-19 hospitalization
rates are also four to five times higher for infants
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than older children.

One reason the youngest children are at greater risk is that their
immune systems are not yet fully developed and don’t produce the
robust immune response seen in most adults. What’s more, infants
younger than 6 months – who are most at risk of severe disease –
are still too young to be vaccinated against influenza or COVID-19.

These viruses present challenges on their own, but their
co-circulation and coinciding surges in infections create a perfect
storm for multiple viruses to infect the same person at once. Viruses
might even act together [[link removed]]
to evade immunity and cause damage to the respiratory tract.

Such co-infections are typically uncommon
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of co-infection is substantially higher for children
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Co-infections can be difficult to diagnose and treat, and can
ultimately lead to greater disease severity
[[link removed](22)00383-X], complications,
hospitalization and death.

Factors behind the triple threat

There are a few reasons why the U.S. may be seeing a surge in
pediatric respiratory infections. First, COVID-19 protection
strategies actually help prevent the transmission of other respiratory
pathogens [[link removed]]. School and
daycare closures likely also minimized exposures children normally
have to various respiratory viruses.

These and other efforts to prevent the spread of COVID-19 seem to have
suppressed the broad circulation of other viruses, including influenza
and RSV. As a result, the U.S. saw an overall drop in non-COVID
respiratory infections
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almost nonexistent flu season
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2020.

[A young boy sits on an exam table with his mother soothing him while
a doctor puts a Band Aid on his arm after giving him a shot.]
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The early surge of respiratory infections underscores the need to get
children up to date on flu and COVID-19 vaccinations. Geber86/E+ via
Getty Images
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The decreased viral activity means that children missed out on some
exposures to viruses and other pathogens that typically help build
immunity, particularly during the first few years of life. The
resulting so-called “immunity debt”
[[link removed](22)00544-8] may contribute to an
excess of pediatric respiratory infections as we continue into this
season.

To further complicate the picture, the changing nature of viruses,
including theemergence of new COVID-19 variants
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and the natural evolution of seasonal influenza viruses, means that we
could be seeing a unique combination of particularly transmissible
strains or strains that cause more severe illness.

Proactive steps people can take

The early surge in respiratory infections with high rates of
hospitalization highlights the importance of prevention. The best tool
we have for prevention is vaccination. Vaccines that protect against
COVID-19 and influenza
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are available and recommended for everyone over 6 months of age
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shown to be safe and effective, and they can and do save lives.

In particular, most recent data on the newly updated bivalent COVID-19
booster vaccine
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suggests that it produces a more rigorous antibody response
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circulating omicron variants than the original COVID-19 vaccines
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The best way to protect infants younger than 6 months old against flu
and COVID-19 is by vaccination during pregnancy
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mother is vaccinated, maternal antibodies
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reducing the risk of COVID-19 hospitalization
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in young infants by 61%. Vaccination of other caregivers, family and
friends can also help protect infants.

Other preventive measures, like hand-washing, covering sneezes and
coughs, staying at home and isolating when sick, can help to protect
the community from these viruses and others. Paying attention to local
public health advisers can also help people to have the most
up-to-date information and make informed decisions to keep themselves
and others – of all ages – safe.[The Conversation]

Rebecca S.B. Fischer
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Assistant Professor of Epidemiology, _Texas A&M University
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and Annette Regan
[[link removed]], Assistant
Professor of Epidemiology, _University of San Francisco
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This article is republished from The Conversation
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the original article
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* RSV
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* flu
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* viruses
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* Health Care
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* children
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* immune system
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