“It has seemed unrelenting over the past three years,” said Ann Burke, vice president of medical affairs for Holy Cross Health in the Maryland region.
The covid-19 pandemic upended holiday plans in 2020 and 2021. While coronavirus remains a serious concern, this year two other common respiratory viruses, influenza and RSV, are wreaking havoc — particularly in the DMV, which is one of the regions with the highest flu activity in the country.
Ahead of Thanksgiving gatherings, doctors like Burke are urging people to take precautions like masking in crowded public spaces and on airplanes, covering coughs and sneezes, washing hands, and getting a flu shot and covid booster dose.
“Wash your hands and get your vaccine,” Burke said. “Try to help us out.”
Burke also gave a warning for families with newborns, which are particularly vulnerable to devastating consequences from RSV: “I strongly recommend families with a newborn child restrict the number of visitors in their home. I know this is a really unpopular statement.”
As RSV and influenza have skyrocketed, covid has reached a plateau.
The District and Maryland are reporting similar levels of new cases as last year around this time, and Virginia’s weekly new cases are slightly lower than last year. But cases began to rapidly rise around Thanksgiving last fall when omicron emerged and created a record-setting spike in cases. So far, signs point to a much milder wave of covid cases this winter, according to epidemiologists and virologists who are monitoring the covid-19 variants currently circulating.
CDC warns of tough winter as flu, RSV and covid collide
With vaccines now widely available for all age groups and 68.7 percent of Americans through the primary coronavirus vaccine series, public health precautions that were previously required are now mere recommendations. Local officials have dropped mask mandates and testing requirements. Most school districts have ditched strict masking rules and jettisoned complicated testing and quarantine programs.
Vulnerable populations also have access to extremely effective antiviral treatments like Pfizer’s paxlovid that had not yet been authorized by the Food and Drug Administration last fall.
Still, few Americans have received an updated bivalent booster shot and strains on health care infrastructure remain.
“We still have around 400 individuals who are hospitalized with covid,” said JinLene Chan, Deputy Secretary for Public Health Services for the Maryland Department of Health. “It hasn’t gone away.”
Chen said that people can safeguard their holiday plans and protect loved ones by taking precautions ahead of indoor gatherings. Wearing masks in crowded public spaces in the days leading up to a holiday celebration, washing hands, and staying home if you feel sick can prevent all three respiratory infections from spreading to other people.
“Getting the flu and covid shots are important,” she said.
Already, the District, Maryland and Virginia are among the 16 U.S. jurisdictions that the Centers for Disease Control and Prevention says are coping with “very high” rates of influenza-like illness in what may be shaping up to be the most severe and early-onset flu season since the 2009 swine flu epidemic. And a spike in RSV has led to more sick children than can be accommodated in local pediatric intensive care units.
“It’s much too early for us to see a lot of influenza,” said Andy Pekosz, a virologist, professor, and vice-chair of the Department of Molecular Microbiology and Immunology at the Johns Hopkins Bloomberg School of Public Health. The story is the same for RSV, he added. The early and rapid uptick in cases may be a sign that these respiratory viruses will run rampant this fall and winter, prompting a severe and lengthy season for illnesses that can be deadly for some vulnerable populations.
“That’s the worst case scenario — it is coming in strong and will last long,” Pekosz said.
RSV leads to between 6,000 and 10,000 deaths in adults over 65 and 100 to 300 deaths in children under 5 each year, according to the CDC. Influenza killed between 12,000 and 52,000 people annually between 2010 and 2020. But the past two years have seen extremely mild flu and RSV seasons — perhaps because coronavirus mitigation efforts helped tamp down the spread of other viruses as well, Pekosz said.
Children and adults who get RSV typically experience cold-like symptoms including runny nose and sneezing, but severe cases can develop fevers, wheezing and even require ventilation to maintain oxygen levels. The flu usually brings fever, chills, body aches, cough, runny nose, sore throat, headaches and fatigue.
What’s the difference between RSV, the flu and covid-19?
In the week ending Nov. 12, Maryland reported 5,144 positive influenza tests and Virginia reported 2,607. The District had 593 confirmed cases of influenza. The rates of flu-like illness across the DMV are already as high or higher than the typical peaks seen much later in the flu season, around late January through March.
It remains to be seen if cases will continue to rise, but epidemiologists say the very mild flu seasons of 2020 and 2021 may have left large portions of the population with little immunity against the virus.
Travelers who may be leaving the DMV and returning after Thanksgiving should check on the levels of respiratory viruses at their holiday destinations, said Montgomery County Acting Health Officer James Bridgers.
“Check the local health department if you’re travelling outside of the DMV and be mindful of any respiratory illnesses that you may be going into,” he said. That is especially true for people headed to the south or states like California, Colorado and Texas, where influenza and RSV have spread rapidly and far earlier than anticipated by doctors and epidemiologists this year.
In Virginia, hospital and urgent care visits for RSV and flu-like illness have nearly quadrupled in recent weeks, said deputy state epidemiologist Laurie Forlano. Those numbers may keep climbing as people increasingly gather indoors as temperatures cool and holidays approach. Coronavirus, which is only slightly up in Virginia over the last week, may also spread more.
“It’s a little too soon to tell, I think, where that’s going to go as the weather gets colder,” Forlano said. “We tend to be inside or around other people more and that can help these viruses transmitted from one person to another.”
Even as winter approaches, some jurisdictions, like Arlington County, have implemented plans to scale back coronavirus testing and county-sponsored vaccination clinics as demand has tapered off in recent months. Arlington announced that its testing kiosks will close by the end of November, and its county-run vaccine clinic will permanently shutter on Dec. 17. Virginians can search for vaccine clinics and test sites within 100 miles of their zip code on the Virginia Department of Health website.
Forlano said closing these public resources is part of a transition toward treating coronavirus like other illnesses — including influenza — that are routinely treated through doctor’s offices and pharmacies. People will still be able to access vaccines, boosters and rapid tests at pharmacies and get PCR tests from health care providers, she said.
“The good news is that we’re in a much different place today than we were … two years ago with covid-19,” she said. “We have plans in place should more testing become necessary, but I’m glad that we have a much different and more robust landscape for both testing and vaccines at this point in time.”
Montgomery County, Md., has not yet begun to wind down coronavirus testing and vaccination centers — but the county may consider doing so in January after the holiday season comes to a close, said Bridgers. Maryland’s most populous county expects to see consistent demand for testing, vaccines and boosters through the end of the year, he added. In the week ending on Nov. 13, more than 900 people got covid vaccines in Montgomery, including more than 200 administered at county-run sites, and the county performed more than 900 covid tests, Bridgers said.
How to use at-home covid tests and where to find them
“We’re urging people as we go into the holiday season to make sure they’re up to date on their vaccinations,” and get tested for covid-19 before gathering with family and friends, Bridgers said.
Pekosz agrees that coronavirus tests are a smart idea before gathering for Thanksgiving dinner, but warned that a single rapid test does not guarantee safety. Taking at least two tests over several days — called serial testing — will give a more reliable result. But no rapid test is perfect, Pekosz said, and anyone who feels even a little bit unwell should stay home.
“People want to see their families,” he said. “Maybe they’ll ignore that scratchy throat or sniffle or fever that they have. But you can transmit [these viruses] before you actually show symptoms. Even with the slightest sign of symptoms, people should be more weary.”