Three Things Thursday

Looking toward the winter months with our eyes on viruses & vaccines

Given that we are living through THREE global health emergencies (COVID, polio, and monkeypox), new vaccines are being approved, new outbreaks are occurring, and the reality that being healthy is indeed a radical selfless act of loving others (read: we need to redefine what it means to be healthy), “Three Things Thursday” highlights three things I am paying attention to as an epidemiologist each week.

Hoping these posts help to educate and empower you
to be healthy and create healthy communities.

Here we go… Three Things Thursday for October 27, 2022.

The Tripledemic

The public health community is anticipating a tripledemic this winter — in other words, three epidemics (aka outbreaks) occurring at the same time. This includes increasing cases of influenza, COVID-19, and RSV. Early public health surveillance data shows an earlier-than-expected increase in the number of influenza and RSV cases (more on RSV below) right now. And if the past two COVID winters have taught us anything, it is that COVID cases will surge as we head indoors during the winter months and new variants are likely to show up during those winter outbreaks.

We should all be preparing for the spread of all THREE of these diseases throughout the coming months. Preparations should include —

1. Get vaccinated.
   We all need to receive our COVID-19 booster (3-4 months after your last shot or most recent infection) and our annual flu vaccine. The new COVID booster is proving to be highly effective against severe illness and death. And the flu shot reduces the risk of being admitted to the ICU by 82%.

2. Stay home when you are sick.

   As we are facing a tripledemic, there is no such thing as just a sore throat or just a little cough. A cough, sore throat, headache, fever, and runny nose are all symptoms of the three diseases behind this tripledemic. Regardless of what virus is causing your symptoms, it is best to stay home until you have been symptom-free (without medication) for at least 48 hours. And when you return to work/school be sure to wear a mask for a couple of days to prevent others from getting ill.

3. Wear a mask.

   Masks can be worn as a form of protection or prevention. If you want to avoid exposure to a respiratory virus, a well-fitting n95 or kn95 mask will reduce your exposure to virtual particles and decrease the likelihood of you becoming sick. If you have to be in a crowded indoor environment with poor air circulation, a mask will provide you with protection. Additionally, an individual can wear a mask to prevent others from contracting their illness. I highly recommend wearing a mask for ~5 days after you’ve been sick to ensure you are not sharing your illness with others. And if you are unable to stay home while you are symptomatic (maybe you don’t have paid sick leave), please wear a well-fitting mask at all times and do not take it off while you are around others.

4. Practice proper hygiene.

   Both influenza and RSV are spread via respiratory droplets. And those droplets can live on surfaces for several hours. To prevent the spread of these diseases, we all need to practice sneezing and coughing into our elbows (to prevent droplets from landing on surfaces). We also need to properly wash our hands and avoid putting our hands near our eyes, nose, and mouth.

Surge In RSV Cases

Respiratory Syncytial Virus, better known as RSV, is usually a mild illness that produces cold-like symptoms in adults but can cause pneumonia and bronchitis in young children. Each year there are approximately 58,000 RSV hospitalizations and 100-500 RSV deaths among children younger than 5 years old. There is no vaccine or approved treatment for RSV.

Usually, RSV cases begin to increase in December each year, but this year (2022) the number of cases began to surge over the summer. Currently, the case positivity of all RSV tests in the United States is between 10-15% (meaning that 10-15 young children being tested for RSV have RSV). And when case positivity rises above 5%, the public health community begins to worry about an outbreak of disease.

Adding to the RSV concern, approximately 75% of the 40,000 pediatric hospital beds in the United States are currently full because of the current surge in RSV cases. In my small town, our community hospital already has two RSV patients admitted for inpatient care.

There is cause for alarm heading into the winter months — a perfect storm is building. The disease is spreading and the healthcare system is already stretched.

"Last year, more people were wearing face masks and children were more likely to stay home while sick. This year, parents are sending their children to daycare and school for the first time following two years of the pandemic. ... Children who haven't been previously exposed to respiratory viruses are getting sick"
~Dr. Laura Romano

If you are the parent, grandparent, or caretaker of a young child, be sure you know the symptoms of RSV and the signs that medical care should be sought immediately.

COVID Vaccine Added to Vaccine Schedules

Last Thursday, the ACIP (the CDC Advisory Committee on Immunization Practice) voted 15-0 to approve adding the COVID vaccine (and booster) to the childhood, adolescent, and adult immunization schedules. Despite what some ill-informed and loud news broadcasters have said, this vote does NOT mean that the COVID vaccine is now required for school-aged children. According to federal law, the CDC can only make recommendations for the use of vaccines. School-entry vaccination requirements are determined by the state (or local jurisdiction).

Adding the COVID vaccine to the immunization schedule is a step forward in our pandemic recovery. The vote streamlines clinical guidance; putting all recommendations about all vaccines into a single document.

ACIP member Matthew Daley, a senior investigator at the Institute for Health Research at Kaiser Permanente Colorado, noted —

“There is symbolism in adding COVID-19 to the childhood immunization schedule, and that symbolism is that we view this as routine and that we view this as COVID is here to stay.”

As of this morning, only Washington DC and California require COVID vaccine shots as part of their school-entry vaccination programs. Twenty-one other states have already passed laws prohibiting COVID vaccine mandates for students.

The ACIP recommendation also allows all of us, including low-income individuals and families, to access the free-of-charge vaccine once the pandemic response funds dry up. Currently, COVID vaccines and boosters are available to everyone at no cost. We are expecting that at some point during 2023 that the COVID vaccine will no longer be free to everyone (there will be no more money in the pandemic funds to cover the costs of the vaccines). Under the Affordable Care Act, vaccines on the immunization schedule will require most healthcare plans to cover the cost of the vaccines with no cost-sharing to patients. Adding the COVID vaccines to the immunization schedule also allows the shots to be given for free to children whose families cannot afford them.

Do you have questions?

Be sure to share this update with your friends & family —