Ask the Doctor: The “Tripledemic” Collision of Flu, RSV, and Covid
The potential for a so-called “tripledemic” this fall and winter has made headlines in recent weeks, especially up north where some hospitals are filled to capacity with pediatric patients suffering from respiratory illnesses including RSV.
The “tripledemic” viruses that has some medical professionals concerned are RSV, flu, and COVID.
While we haven’t seen a similar surge of hospitalizations here in Florida, pediatric cases are rising…in fact, when it comes to RSV, cases haven’t tapered off after an unusual summer surge.
We recently sat down with two local doctors to get expert advice on how parents can better protect our children as we head into the holiday season. (Just a heads up: you might find yourself stocking up on hand sanitizer again.)
Meet the Experts:
- Dr. Juan Dumois is a Pediatric Infectious Diseases physician at Johns Hopkins All Children’s Hospital.
- Dr. John Prpich, pediatric pulmonologist from St. Joseph’s Children’s Hospital.
More Expert Advice:
Have you seen a similar increase in pediatric patient hospital admissions due to RSV, COVID and/or flu like up north?
Dr. Juan Dumois: Not quite yet. We have seen an increase in some respiratory illnesses throughout the summer that were usually high for the summer. But it didn’t just go up in the last week or two, it’s been like that for the last 2-3 months.
Especially with RSV.
Regarding influenza, that is just starting to creep up in the last 2-3 weeks, but not to the extent they’ve been reporting up north.
Dr. John Prpich: I would say that that from an RSV standpoint, historically, our season was around September, October or so, through March.
But this year, we had RSV in our community all summer long. So even though we are warm and it’s nice, we don’t really understand why, but we had a small amount of RSV in our community all summer long and then around September and into October, we saw it go up very precipitously. It’s pretty prevalent in our in our community right now.
But along with the other respiratory viruses, our children’s hospital is full of kids.
And then you hear a lot of stories of other hospitals and places that are almost at capacity or at max capacity with all the kids being admitted with all kinds of generic bronchiolitis– which is sort of the catchall term for when these kids get one of these viruses and it goes to their lower respiratory tract.
Is what’s happening up north an indication of what we’ll see here in Florida in the coming months?
Dr. Juan Dumois: Yes. I think this could be very predictive of what we’re going to be seeing in the next few months and so we have to be prepared for that. It does give us an opportunity to prepare in a way that may help prevent some of the extent of the disease-the number of kids being hospitalized especially.
Some of the children’s hospitals up north seem to be overwhelmed – even having trouble finding beds for children who need to be admitted to the hospital. And because a lot of that is generated by the flu, getting flu shots would significantly decrease their chance of being hospitalized.
How has the COVID pandemic impacted the normal viral season?
Dr. Juan Dumois: It has altered many virus seasons.
With RSV—rising and maintaining a steady presence this year when normally RSV is a winter virus that starts rising in October, peaks around December and then starts waning by March or April. We saw the opposite this year.
It hasn’t come down much in the Tampa Bay area, so it is possible instead of continuing to taper and disappear that—the way we do things differently in the wintertime, it may start rising again.
COVID 19 did change how RSV cycles and it also changed our immunity to RSV.
RSV immunity probably needs boosting on a regular basis, sort of like the flu so that may be part of the reason that we’ve seen so much RSV this summer because kids didn’t catch it for a few years.
We can’t do much about RSV-there is no vaccine for that.
We have the vaccines for COVID, there are some age restrictions, but there is definitely the flu vaccine too.
Dr. Prpich: Yeah, I mean it’s a very interesting question. I think, yeah, there is a likely connection. I don’t think we understand in what way.
I think it’s like all things, it’s probably going to be multifactorial. You know, we went almost a solid two years, certainly a year and a half, where really our kids were not sick in terms of regular respiratory viruses.
And a big chunk of 2021 was much calmer than we’ve seen in the past as well, so there’s times when I’m having conversations with the parents where I almost wonder if we forgot what it was like to be sick.
Certainly our perspective has changed a little bit and our awareness of respiratory illnesses has changed. And I think it’s worthwhile at least acknowledging that.
Since there is no vaccine for RSV, what do parents need to know about this virus and how to protect our kids from it?
Dr. Prpich: It is very contagious. Back when everyone was doing everything we were doing for COVID -when we thought it was droplet spread on surfaces, what we all learned ended up not being true for COVID is true for RSV and rhinovirus, and these other respiratory viruses.
And that was why we first thought so much about that contact transmission because that’s what we routinely see with all of the other respiratory viruses. So, it’s (RSV) very contagious.
But it’s more of the typical sort of snotty nose or increase respiratory secretions. The virus is in those particles will land on a solid surface and it can live on that solid surface for a prolonged period. Hours at times.
And then another child comes along and touches that surface or touches that toy or puts that thing in in their mouth. Hand washing, wiping down solid surfaces really are much more applicable to these respiratory viruses.
Dr. Dumois: Two things: one, don’t touch your hands to your mouth or nose and if you have a habit of doing that be conscious of it and stop doing it and I’ll ask the parent to remind their child to stop doing it.
Second: make sure they clean their hands before they have to touch their lips or nose and that can be done with soap and water or hand sanitizer.
And then under that category, I would teach them the most common mistake people make when using hand sanitizer.
You need to use a squirt and a half or two squirts of hand sanitizer so that it takes at least 15 seconds for your hands to dry.
If a school able to intervene to get all kids use hand sanitizer 4 times during the school day, decreases illness related absences by 24-40 percent. (Click here for the study.)
Is there still a hesitancy to vaccinate children against the flu?
Dr. Juan Dumois: Some families say they don’t want vaccinate their kid because they don’t work because someone got the flu vaccine and then they got the flu.
I think it’s a good idea for children who are at least six months of age be vaccinated and there are several reasons for that.
We know that children who are 2 years of age or younger who catch the flu are as likely to end up in the hospital as an older person 65 years of age or older who catches the flu.
It drops off significantly after they are 2 years old, but it’s really important, I think to offer those children protection.
What kind of protection can we expect to get from a flu vaccine?
Dr. Juan Dumois: It does not create a force field barrier that prevents the virus from entering your nose or mouth, so you can still get infected with the flu virus. So what the vaccine does, is that helps prime your immune system so it detects it more quickly and efficiently in a way that minimizes your symptoms.
The flu vaccine also significantly reduces the rate of deaths from the flu.
There are up to 200 kids a year who die in the US during a typical flu season–very often a preventative death.
What about babies under six months of age who are not eligible to get a flu vaccine?
Dr. Juan Dumois: What you do is provide a protective cocoon of immunization by immunizing everybody around that child, so everybody who lives in the home.
And also if there are any other persons who are going to be in contact with this child in their first 6 months of life, they need to be immunized too.
That cocoon of protection is the next best thing you can do to protect kids under 6 months of age.
The symptoms of Flu, RSV and COVID are pretty similar. When do parents need to be worried?
Dr. Juan Dumois: The symptoms overlap a lot so instead of trying to determine based on symptoms which virus your child has, you need to know what are the symptoms that should lead you to take your child to the doctor regardless of the virus.
Those would be when the child looks visibly sicker than normal. As opposed to the child who is coughing, has a runny nose, they’re sneezing, but they’re still playing and they’re eating and drinking.
If your child is acting so sick that they’re not even responding to you normally-that may be more of an emergency situation instead of calling the pediatrician, go immediately to an emergency center.
If your child is turning blue around the lips and anywhere else—and it could be a sort of grayish-blue color, that’s a sign of low oxygen in the blood and that’s an emergency situation
If your child has started to significantly decrease how much they are eating or drinking or are sleeping a lot more than normal and you’re just concerned, even they aren’t showing any emergency signs, that’s a valid reason to call your pediatrician.
Dr. Prpich: If they’re breathing fast or if they’re breathing heavy, we talk about retractions–so that’s if they’re sucking in, in between the rib cage. So those retractions are an indicator of increased work of breathing.
Kids with a cold, don’t care and they’re just running around and it’s not slowing them down.
But if your kid is really working hard to breathe– you can tell because they’re just lying there. They may not really want to do much or they’re tired. They’ve been working so hard.
RSV Symptoms according to the CDC:
- Runny nose
- Decrease in appetite
If our child has a fever and they are otherwise comfortable, should we still treat it?
Dr. Dumois: A fever is caused by the body’s attempt to fight off the virus.
Fever causes a lot of fear in parents and a lot of that is unfortunately perpetuated by nurses and doctors who don’t know a whole lot about fever and share the concerns about high fever, but fortunately, even high fevers usually cause no permanent damage, including brain damage to a child. That’s been an old wives tale that’s been perpetuated for hundreds of years.
High fevers, even if it’s 104-105 and the child is delirious sand they’re seeing things on the wall, when the temperature comes down the brain gets back to normal.
Some children do develop febrile seizures, a seizure that is caused by a fever. Most febrile fevers have no long-term effects on the brain.
The main goal of helping a child with fever is not to bring the temperature down, it’s to make them more comfortable.
Some examples of that—the child has a fever, they are lying around, they don’t want anything to drink or eat because they just don’t feel well and treating their fever makes them feel well enough to start eating and drinking. In that manner, treating the fever can avoid them getting dehydrated and avoid going to the emergency room for IV fluids.
If your child is sleeping comfortably, you touch them and they are really hot, you take their temperature and its 103, that child is comfortable and therefore you do not wake them up to give them fever medication. Let them sleep through it and the fever may break on its own.
But on the other hand, if your child has a fever, they’re asleep but then they wake up and they’re crying and they’re miserable, then treat the fever.
So comfort is the main factor in determining whether to treat a fever.