By Linda Nwoke

The United States is observing a concurrent surge of COVID-19, influenza (flu), and respiratory syncytial virus (RSV), called a “triple demic” or “tri-demic” by medical experts. The situation consists of an escalation of respiratory illnesses that pose a significant threat to an already strained healthcare system, resulting in a potential lapse in care for vulnerable communities.

The Ethnic Media Services gathered medical experts such as Dr. Benjamin Newman from Texas A&M University, Dr. Manisha Oscar from Stanford Children’s Health, and Dr. Jose Perez, Chief Medical Officer at South Central Family Health Center in LA, to discuss the unprecedented rise in infections. They explored various issues, providing valuable insights into the continued use of vaccines and masks.

Dr. Jose Perez, Chief Medical Officer at South Central Family Health Center, shared that over 100 viruses are causing upper respiratory infections, including SARS-CoV-2 (COVID-19). He explained that the recurring nature of RSV results in illness for young children, resulting in symptoms that range from upper respiratory problems to lower respiratory infections, including bronchitis and pneumonia. “All three viruses invade the human body by coming into contact with body fluids from an infected individual,” says Dr. Perez. He explains that the infections are more prevalent in the winter due to increased indoor activities and holiday celebrations.

Generally, the method of transmission involves infected individuals spreading mucus particles through coughing and sneezing, contaminating surfaces like counters and doorknobs. Dr. Perez says the ease of transmission allows the virus to enter through the nose or mouth when uninfected individuals touch infected surfaces and their faces. He notes, “It is tough to tell which virus affects the patient based on symptoms alone.”

Managing the Symptoms 

The experts explained that there are simple ways of managing what is commonly referred to as a cold, which is best treated with “Rest, lots of fluid, some chicken soup, ibuprofen for pain and fever, and sometimes a cough syrup is all that is necessary to get the patient through the symptoms that can last up to 7 to 10 days,” says Dr. Perez.

According to Dr. Perez, respiratory infections have a universal risk: “Everyone is at risk; if you’re human and alive, you can catch it.” He identifies those at higher risk, including individuals with lung diseases like asthma and COPD, obesity, immunosuppression, diabetes, and HIV. Patients undergoing cancer treatment are also considered immunosuppressed.

Additionally, for RSV, infants under 12 months, premature babies, and the elderly 65 years and older are deemed particularly vulnerable. Dr. Perez provided a national overview, noting that in week 51 of 2023, there were about 6,600 COVID tests with a 17% positivity rate. There was a peak in week 50 for RSV, with a subsequent decrease to a 12–13% positivity rate in week 51.

Measures of Prevention

According to Dr. Perez, some of the measures for prevention include: “Watch your distance; staying away from someone who seems to be sick about six feet will help minimize your risk.” He emphasized that wearing masks, handwashing, and staying home if feeling sick are essential ways of managing the situation. Moreover, the expert highlighted the ongoing importance of vaccination, stating, “Vaccines are still essential.” Despite ending the federal government’s funded free vaccine program in May, individuals can access vaccines through health plans or specific programs in their states. On vaccine availability, Dr. Perez stated, “The COVID-19 vaccine is available to all people five years and older.”

Dr. Perez explains the contagious period: “7 to 10 days is what we believe when you’re contagious.” He emphasized that symptoms indicate a week or more of infection, highlighting the gradual process of the virus multiplying and overcoming the immune system before symptoms emerge. Dr. Perez succinctly notes, “You don’t get sick from one day to the next; it takes time for the virus to grow, incubate, and make you sick.”

The New COVID 19 Variant – JN1

Dr. Newman reiterated the importance of getting vaccinated, irrespective of the variant. He stated, “It doesn’t matter which variant you have when you’re lying in a hospital bed or a medically induced coma. Suppose any one of these gets through your defenses. In that case, there is an increased risk of hospitalization and death, and the vaccines mitigate that. They make it less likely, but it is still possible.”

The expert highlighted the significance of the JN1 variant, noting that it accounts for 50% of global cases and spreads rapidly. He explains its unique challenge: “Now, with this new strain, it looks as though the virus has forked or split. There are two very different lineages; one vaccine does not protect against both now. There’s some protection, but it is relatively minor, “says Dr. Newman.

Furthermore, the JN1 variant does not grow faster than the other existing strains; instead, it changes its form. “This new strain is as different from the current vaccine strain as that strain was from the vaccine strain before it,” says Dr. Newman. Discussing the broader impact of COVID, he noted that “COVID has slipped down to number seven on the CDC’s most updated list of causes of death.” However, there is concern that it contributes to other categories of neurological challenges, such as anxiety and sleeplessness, through long COVID. Dr. Newman highlighted the similarities between Jn1 and previous strains, stating, “This virus is very much the same as all the ones that came before, just a little bit better at growing and evading immune defenses.”

Discussion on RSV-Transmission Methods and Preventive Measures 

Dr. Manisha Oscar, a pediatric pulmonologist at Stanford and one of the experts, spoke about RSV. She explained the differences observed in RSV season since the COVID-19 pandemic, highlighting the severity in infants, with symptoms like trouble breathing, wheezing, and decreased oxygen levels. “The leading cause of bronchiolitis in children is RSV,” she stated, with millions of outpatient visits, hospital admissions, and deaths annually. The most vulnerable to this disease are premature infants and immunocompromised individuals.

The expert also noted that it is as common as other respiratory problems, stating, “Nearly all children get infected with RSV before their second birthday.” Furthermore, she explained that transmission occurs through contact and droplets, especially surfaces. Therefore, there is a need for vigilant cleaning to prevent RSV. Dr. Oscar also highlighted that there is no specific antiviral medication for RSV in children. According to her, “Right now, there are no specific antiviral medications available to give to children who have RSV illness.” However, supportive treatment was emphasized, especially managing the fever with Tylenol and addressing infant nasal congestion. In severe cases, she recommended hospitalization and a variation of treatment with intravenous fluids and mechanical ventilation.

Regarding the importance of prevention among infants and older adults, she stated, “Prevention is the best treatment for RSV at this time.” She mentioned Synagis (palivizumab), an antibody given to prevent severe RSV disease in specific high-risk infants. The expert highlighted the recent FDA approval of nirsevimab (B46), another passive antibody recommended for all infants below eight months and older children with high-risk conditions. She noted its effectiveness in preventing RSV-associated lower respiratory tract infections, hospitalization, and ICU admission. However, she acknowledged the implementation challenges for the treatment option, including cost barriers and limited supply.

Development of RSV Vaccines for Adults 

Dr. Oscar also discussed the development of RSV vaccines for adults aged 60 and above, stating that the vaccines, administered as a single dose before the fall-winter season, have proven highly effective and reduced lower respiratory tract infections by almost 82%. Pregnant women in their third trimester are approved to take RSV F, which also protects newborns against severe RSV disease. “It reduced the risk of severe RSV disease by 82% within three months and by 69% by six months after birth, and the risk of hospitalization also significantly decreased.”

Presently, individuals aged 60 and above are being targeted for vaccination; due to their elevated risk, it is essential to expand the intervention into other age groups that have high-risk conditions such as asthma or diabetes in the future.

  COVID, flu, Health, RSV