Experts fear Thanksgiving gatherings could hasten a ‘triple disease’

In each of the last two years, Thanksgiving has helped usher in some very unwelcome guests: devastating waves of COVID-19.

No one believes this year will be anything like the last two dark pandemic winters, at least when it comes to COVID-19. But the country is now dealing with a different kind of threat – an unpredictable confluence of old and new respiratory pathogens.

“We are facing an onslaught of three viruses – COVID, RSV and influenza. All at the same time,” says Dr. William Schaffner, an infectious disease specialist at Vanderbilt University. “We call this a triple pandemic.”

Flu and RSV are back, big time

Respiratory syncytial virus (RSV) began growing unusually early this year, infecting babies and young children who had little or no immunity to this virus, which had not circulated as much for the past two years, in part due to COVID- 19 Precautions.

The resurgence of RSV is still swamping pediatric emergency departments and intensive care units across the country. Some parents are forced to wait more than eight hours in emergency rooms for their critically ill children to be treated.

“Every children’s hospital in the United States right now has intensive care units that are busy or overwhelmed,” said Amy Knight, president of the Children’s Hospital Association. “It’s very, very scary for parents.”

At the same time, an unusually early and severe flu season is brewing, dominated by the H3N2 strain, which often hits children and the elderly particularly hard.

“Influenza has hit the southeastern United States. It’s made its way into the Southwest. It’s spreading up the East Coast and into the Midwest with some severity,” Schaffner said.

Coast-to-coast flu hospitalizations for this time of year are at their highest in a decade, according to the Centers for Disease Control and Prevention.

“Flu activity is currently high and increasing,” said Lynnette Brammer, an epidemiologist with the CDC’s influenza division. “The good news is that vaccines are doing well this yearmatched to the viruses currently circulating and there is still time to get vaccinated.”

But now another Thanksgiving is coming.

“These holiday celebrations, with all their travel and close contact, usually act as virus accelerators,” says Schaffner. “We spend a lot of time together. We laugh and take a deep breath. And that is an ideal environment for these respiratory viruses to spread to others.”

What will COVID do this time?

Of course, COVID-19 still sickens tens of thousands and kills hundreds of people every day. And new, even more contagious Omicron subvariants that are particularly adept at infecting humans—even if they’ve been vaccinated or previously infected—are taking over.

“There are a lot of moving parts here,” says Dr. David Rubin, who has been following the pandemic at the Children’s Hospital of Philadelphia’s PolicyLab.

“What will all this mean for COVID? Will we see a COVID resurgence in January/February that will be quite significant? That could still come.”

Many infectious disease specialists say that the immunity people have to vaccination and infection should prevent a new spike in COVID-19 infections from causing a large spike in hospitalizations and deaths.

“I’m confident given where we are with COVID that we’re not expecting anything like last winter. But at the end of the day, Mother Nature has the final say on these things,” said Dr. Ashish Jha, the White House COVID-19 coordinator, told NPR.

“We’re in uncharted territory here” with three viruses all circulating at high levels at the same time, he says.

“I think it’s a really worrying situation looking ahead to the coming weeks,” said Jennifer Nuzzo, an epidemiologist who directs the Pandemic Center at Brown University.

Nuzzo is worried because A weary nation has abandoned many of the precautions people took to protect themselves and others. Influenza vaccination rates have decreased by about 10% to 15% compared to previous years. Only about 11% of those eligible for the new Omicron bivalent boosters were boosted.

“We can’t accept that it’s definitely going to happen,” she says. “We can very well take action to prevent a spike in hospital admissions and deaths.”

Nuzzo and other experts say Americans can be vaccinated and boosted, especially if they’re at high risk because of age or other health issues.

People should consider Zooming for Thanksgiving if they’re sick, test for COVID-19 before gatherings (especially those involving older friends and family and other vulnerable people), and even consider wearing that mask again as often as possible to put on.

“If you’re not eating or drinking, it’s probably a wise idea to protect the immunocompromised, the infants, and the elderly in the household,” says Dr. Tina Tan, an infectious disease specialist at Northwestern University Feinberg School of Medicine.

There is evidence that RSV may already have peaked, and the flu could also peak early before a new COVID-19 surge occurs. That would help to relieve the hospitals at least somewhat.

There’s even a theoretical possibility that the flu and RSV could blunt any new COVID-19 surge in the same way that the coronavirus has supplanted those viruses for the past two years. One possibility is a phenomenon known as “viral interference,” in which the presence of one virus reduces the risk of contracting another.

“COVID could be surpassed, which is potentially good news,” says Rubin.

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