A ‘potentially rough winter’: RSV, COVID, flu could spell another difficult season

Dr. Susan Wu chats with Kimberli Samuel and her 7-year-old daughter Amelle Samuel
(Irfan Khan / Los Angeles Times)

COVID, the seasonal flu and respiratory syncytial virus, which is particularly dangerous for young children, could cause a big problem in local and national hospitals this winter. What is the situation like in Santa Cruz right now? What can people do to mitigate their risk?

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They say the third time’s the charm, but the third winter with COVID might not be that easy, as other illnesses that have taken a back seat during the pandemic appear to be on a collision course with a possible winter coronavirus wave.

It should be no surprise that flu season remains a concern, but the prevalence of respiratory syncytial virus (RSV) is yet another worry among health care experts. That’s on top of fears about another wave of COVID.

“We are anticipating potentially a rough winter,” said Santa Cruz County Deputy Health Officer Cal Gordon. “There’s the chance of having really a triple perfect storm.”

RSV is a common respiratory illness that can affect people of any age and mostly presents as a standard cold. But like many other viruses, it is often more dangerous for the very young, the very old and the immunocompromised. RSV is a leading cause of lower respiratory illness resulting in hospitalization for children. On Monday, California’s Department of Public health reported the season’s first death of a child under age 5 from flu and RSV.

According to the Centers for Disease Control and Prevention (CDC), between 58,000 and 80,000 children ages 5 and under are hospitalized due to RSV each year. The disease’s major weapon is its proclivity to cause inflammation of the chest’s small airways, resulting in excessive mucus production and possible viral pneumonia — a difficult ailment for young bodies to handle.

Gordon, who worked as a pediatrician for over 30 years, said Santa Cruz County RSV trends are different this year.

“It’s presenting earlier and at higher numbers than we have observed traditionally,” he said, adding that a major uptick hit in early October when it usually doesn’t happen until the winter. “We’re seeing a much higher positivity rate early on as well as a higher hospitalization rate.”

That could prove to be a big problem, given the area’s fairly limited hospital capacity.

“The seasonality of cases both in- and outpatient pediatrics is where the pediatric population is affected much more dramatically than the adult population,” he said. “That’s going to impact our delivery system.”

If RSV trends look concerning, where do we stand with COVID?

The past few months have seen cases remaining fairly tame locally. Santa Cruz County’s Health Services Agency recorded only 564 active cases Monday, just 63 more than the previous week.

Still, Gordon does not want to speak too soon.

“We really went into our surge right after Thanksgiving last year, and there’s no reason why that wouldn’t happen again,” he said.

He added that fewer people electing to take optional precautions — like masking and social distancing — complicates things further, as it could allow for increased flu and RSV transmission as well.

Additionally, Gordon says that local bivalent booster uptake has remained low, with only about 16% of eligible people opting for the jab. It’s not all bad, though. Gordon estimates that around a third of those 65 and older have received the bivalent vaccine, though he adds that number is “not quite where we want to be.”

The flu shot uptake has, anecdotally, remained consistent with past years, according to Gordon. Not only that, but it seems to be doing its job quite well so far.

Annual flu shots are usually developed a number of months ahead of the flu season, and early trends are used to predict which strain will likely circulate the most. Gordon said it appears manufacturers got it right this year.

“Often, we miss it, but this year it looks like the flu vaccine is on point,” said Gordon.

Further, a Pfizer-produced RSV vaccine is in the works, and the company could request permission from the Food and Drug Administration (FDA) to introduce the product into interstate commerce by the end of the year.

“As a pediatrician, this is extremely exciting,” said Gordon. “It puts the potential promise of protecting not only those most at risk, but potentially a whole generation of newborns.”

That said, an RSV vaccine is still a ways away from approval, and vaccines are not foolproof. With all three viruses circulating, the concern is still there.

How should people prepare? Largely with familiar practices, said Gordon.

“Get your vaccines, wear a mask if you’re sick, wash your hands, and remember that even if you have symptoms and test negative for COVID, you could very well have something like RSV,” he said. “It’s those kinds of things that may allow us to help reduce a surge and the number of infections that we’re anticipating.”


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