Over the past few years, the nation has quarantined, worn masks, and taken precautions to prevent the spread of COVID-19. These precautions also impacted the spread of other respiratory pathogens. As we enter flu season and many of the COVID-19 guidelines are lifted, we see an early increase in the spread of COVID, flu and RSV creating a potential tripledemic this flu season.
RSV infections surged unexpectedly in late spring and early summer 2022, with babies, toddlers and older children being sickened and hospitalized. It settled a bit in the summer and returned with a vengeance in the early fall.1 RSV is affecting not only the younger generations but also adults. Facing a particularly acute crisis, pediatric hospitals have called upon President Joe Biden to declare an emergency to provide more resources to respond to the current surges.2 According to the Centers for Disease Control (CDC), the overall rate of RSV-associated hospitalizations in the 2022-2023 season is expected to be 30.4 per 100,000 people.3 As of December 2nd, the CDC estimated there were 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths from flu, including 14 pediatric flu deaths.4
Influenza-related hospitalizations have risen sharply for children and adults over the past weeks, to rates much higher for this time of year compared to prior flu seasons.1 Other evidence has suggested that masks are effective against influenza as well, with some scientists suggesting that widespread masking during the first two years of the pandemic contributed to the historically low rates of flu and RSV observed in those years.2 Covid, flu, and RSV can be difficult to distinguish since they share many common symptoms. But it’s useful to know which virus you have, since that determines the treatments you should receive and how long you should isolate.5
Some patients may have a co-infection of COVID and another respiratory pathogen. Among the patients who tested positive for SARS-CoV-2, 5.2% also tested positive for RSV. Notably, the mean age of these patients was 52.3 years of age.6 Prepare for the tripledemic by ordering the Pathnostics Respiratory Pathogens Test, which is a highly specific and sensitive multiplex PCR for the nucleic acid detection of SARS-Cov-2, Influenza A, Influenza B, and respiratory syncytial virus (RSV) that uses one nasal swab. This test provides practitioners with the information to diagnose patients and give appropriate therapy options. According to the Infectious Disease Society of America, highly sensitive and specific NAATs (nucleic acid amplification tests) capable of detecting 1 or more viruses have become the diagnostic “gold standard” in clinical virology.7
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1. Shapiro, Nina. “What’s a Tripledemic? RSV, Covid, and Flu.” Forbes, 28 November. 2022, www.forbes.com/sites/ninashapiro/article/whats-a-tripledemic-rsv-covid-andflu/?sh=420f6d1f7579. Accessed 28 November 2022.
2. Shihipar, Abdullah. “It’s not just Covid. Flu and RSV mean masks need to come back.” THINK, 27 November. 2022, www.nbcnews.com/think/opinion/holiday-travel-covid-rsvflu-
means-time-bring-mask-mandates-back-rcna58186. Accessed 28 November 2022.
3. RSV-NET: Respiratory Syncytial Virus Hospitalization Surveillance Network, Centers for Disease Control and Prevention. www.cdc.gov/rsv/research/rsv-net/dashboard.html. Accessed 8 December 2022.
4. CDC – www.cdc.gov/flu/weekly/index.htm (acquired 12.2.22)
5. Bendix, Aria. “Is it Covid, flu or RSV? A few hallmarks can help distinguish among the illnesses.” NBC News Digital, 23 November. 2022, https://www.nbcnews.com/health/health-news/covid-flu-rsv-symptoms-comparisonchart-rcna58523. Accessed 2 December 2022
6. Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens. JAMA. 2020;323(20):2085–2086. doi:10.1001/jama.2020.6266
7. Hanson KE, Azar MM, Banerjee R, Chou A, Colgrove RC, Ginocchio CC, Hayden MK, Holodiny M, Jain S, Koo S, Levy J, Timbrook TT, Caliendo AM. Molecular Testing for Acute Respiratory Tract Infections: Clinical and Diagnostic Recommendations From the IDSA’s Diagnostics Committee. Clin Infect Dis. 2020 Dec 17;71(10):2744-2751. doi: 10.1093/cid/ciaa508. PMID: 32369578; PMCID: PMC7454374.