Flu and other respiratory virus activity continues to ramp up across the US

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Government health officials on Friday warned of an early and severe start to cold and flu season in the United States, saying they were closely monitoring hospital capacity and medical supplies and were ready to send help if needed.

“We suspect that many children are being exposed to some respiratory viruses now for the first time, having avoided these viruses during the height of the pandemic,” said Dr. Jose Romero, director of the US Centers for Disease Control and Prevention’s National Center for Immunization and Respiratory Diseases, said on a call with reporters.

Across the United States, cases of respiratory syncytial virus, or RSV, and influenza are increasing. At the same time, Covid-19 cases, which had been dropping, appear to have plateaued over the last three weeks, Romero said. Cases have flattened as a raft of new variants has been gaining ground against BA.5, the Omicron subvariant that caused a wave of illness over the summer.

The spikes in viral illnesses have already begun to strain hospitals.

Dawn O’Connell, assistant secretary for preparedness and response, said Friday that her agency was staying in close contact with health care systems and states.

“We are monitoring capacity across the country sharing best practices to reduce the strain on systems and standing by to deploy additional personnel and supplies as needed,” she said, noting that so far, no states have requested this help.

“There’s no doubt that we will face some challenges this winter,” O’Connell said.

Flu, RSV hitting early and hard

Seventeen states, Washington, DC, and New York City, are reporting high or very high respiratory illness activity amid a flu season that’s hitting harder and earlier than usual, according to data published Friday by the US Centers for Disease Control and Prevention.

Influenza activity continues to increase in the US the number of flu illnesses, hospitalizations and deaths so far this season nearly doubled in the past week. The CDC now estimates that there have been at least 1.6 million illnesses, 13,000 hospitalizations and 730 deaths from influenza, including two reported deaths among children so far this season. About one in 11 tests for flu were positive last week.

“In fact, we’re seeing the highest influenza hospitalization rates going back a decade,” Romero said.

The last time flu hospitalization rates have been this high at this point in the season was during the H1N1 pandemic. The latest CDC update tracks data through October 29.

There’s no real mystery about why viral illnesses are on the upswing, said Dr. Michael Mina, who is an epidemiologist and chief science officer at eMed, a company offering telehealth test-to-treat services.

“We enjoyed the benefit of not having influenza for the last couple of years, primarily because of SARS-CoV-2. Extra mitigation measures like social distancing, masking, and not going out for roughly a year have only delayed the inevitable. Now that we have released the pressures put in place to keep viruses at bay and move into this first real flu season, we, unfortunately, feel its impact,” he said.

RSV cases are also increasing nationally, although there are regional differences in the circulation of these viruses, Romero said. It’s a common respiratory infection that typically causes mild, cold-like symptoms, but it can cause serious illness, particularly in older adults and infants.

In the South and Mountain West, RSV cases appear to have peaked in October. In those regions, RSV cases are falling, even as influenza is spiking.

Flu activity is highest in the South, followed by the Mid-Atlantic and parts of the West Coast. Data from Walgreens that tracks prescriptions for antiviral treatments – such as Tamiflu – suggest there are hotspots in Mississippi and Alabama, as well as the Gulf Coast area, including Houston and New Orleans.

RSV hospitalizations were also significantly higher than usual, according to another weekly update published by the CDC on Thursday.

Cumulative RSV hospitalization rates have already reached levels that are typically not seen until December in the US. They’re rising among all age groups, but especially among children.

About four out of every 1,000 babies under 6 months old have been hospitalized with RSV so far this season – just about a month in. More than two in every 1,000 babies between 6 months and one year have been hospitalized with RSV so far this season, as have more than one in every 1,000 children between age one and two.

Overall in the US, nearly one in five PCR tests for RSV were positive for the week ending October 29, nearly doubling over the course of the month.

Weekly cases counts are less complete for the most current weeks, but there have been more RSV cases detected by PCR tests each week in October 2022 than any other week in at least the past two years. Weekly case counts for the week ending October 22 were more than double any other week in 2020 or 2021.

There are signs that RSV cases are slowing in the southern region of the US, but test positivity rates and cases continue to rise in other regions, especially the Midwest.

And pediatric hospitals remain more full than average with RSV patients and other conditions. According to data from the US Department of Health and Human Services, more than three-quarters of pediatric hospital beds and pediatric ICU beds are currently in use nationwide, compared with an average of about two-thirds full over the past two years.

As of Friday, seventeen states have less than one in five beds available. Five of them are more than 90% full: Rhode Island, Arizona, Maine, Minnesota and Delaware, along with Washington, DC.

Vaccination is the best protection

Romero stressed that with holiday gatherings just around the corner, vaccination is the best protection against these infections.

“We have vaccines for two of the three viruses we talked about influenza, and COVID 19,” he said, and he urged Americans to take advantage of them, though not enough have.

According to the CDC’s data tracker, just 8.4% of eligible Americans have received a new updated Covid-19 booster.

Vaccinations are lower than usual for influenza, too. Based on data from insurance claims, adult flu vaccinations are down about 5 million compared to where they were last year at the same time, said Lynnette Brammer, who leads surveillance for the CDC’s influenza division.

For children, coverage looks about the same as last year, but those levels represent a 6% drop from what flu vaccinations in kids looked like before the pandemic, Brammer said.

Romero stressed that while most adults only need a single annual influenza vaccine, children who are being vaccinated against the flu for the first time need two shots.

He also advised people not to try to guess what they had based on their symptoms alone since many of these viruses can cause similar symptoms.

Going to the doctor for a test as as soon as you start to feel bad could help you take advantage of early antiviral treatments which are available for influenza and Covid-19.

Romero said the CDC was preparing to send doctors more information about who should qualify for these test-to-treat strategies.

In addition to vaccination, Romero reminded people to cover their coughs and sneezes, avoid other individuals who are sick, wash hands frequently and use alcohol-based hand sanitizers.

“People who also may also choose to wear a well-fitting mask as an added precaution,” Romero said.

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