They say the third time’s the charm, but the third winter with COVID may not be so easy, as other diseases that have taken a backseat during the pandemic appear to be on a collision course with a potential winter wave of coronavirus. It should come as no surprise that flu season remains a concern, but the prevalence of respiratory syncytial virus (RSV) is still a concern among health experts. This is on top of fears of another wave of COVID. “We’re anticipating a potentially harsh winter,” said Santa Cruz County Deputy Health Officer Cal Gordon. “There is a possibility that we really have a triple perfect storm.” RSV is a common respiratory illness that can affect people of any age and occurs mostly as a common cold. But like many other viruses, it is often more dangerous for the very young, the very old and the immunocompromised. RSV is the leading cause of lower respiratory tract illness leading to hospitalization for children. On Monday, the California Department of Public Health reported the season first death of a child under 5 from influenza and RSV. According to the Centers for Disease Control and Prevention (CDC), between 58,000 and 80,000 children age 5 and younger are hospitalized for RSV each year. The disease’s main weapon is its tendency to inflame the small airways of the chest, resulting in excessive mucus production and possible viral pneumonia – a difficult condition for young bodies. Gordon, who has worked as a pediatrician for more than 30 years, said Santa Cruz County’s RSV trends are different this year. “It’s showing up earlier and in higher numbers than we’ve traditionally seen,” he said, adding that a major spike hit in early October, when it usually doesn’t happen until winter. “We’re seeing a much higher rate of positivity early on, as well as a higher rate of hospitalization.” This could prove to be a big problem, given the region’s rather limited hospital capacity. “The seasonality of both pediatric inpatient and outpatient cases is where the pediatric population is much more dramatically affected than the adult population,” he said. “This will affect the delivery system.” If RSV trends look alarming, where are we with COVID? In recent months, cases have remained fairly mild locally. Santa Cruz County Health Services reported only 564 active cases Monday, just 63 more than the previous week. However, Gordon doesn’t want to talk too soon. “We really got into our groove right after Thanksgiving last year, and there’s no reason why that won’t happen again,” he said. He added that fewer people choosing to take optional precautions — such as covering up and social distancing — further complicates matters, as it could also allow for increased transmission of flu and RSV. Additionally, Gordon says local uptake of bivalent boosters has remained low, with only about 16% of eligible people opting for the jab. It’s not all bad, though. Gordon estimates that about a third of those 65 and older have received the bivalent vaccine, though he adds that number is “not quite where we want to be.” According to Gordon, flu vaccine uptake, anecdotally, has remained consistent with previous years. Not only that, but it seems to be doing a pretty good job so far. Annual flu vaccines are usually developed several months before flu season, and early trends are used to predict which strain will circulate the most. Gordon said it looks like the builders got it right this year. “Often, we miss it, but this year it looks like the flu shot is ready,” Gordon said. Furthermore, a The RSV vaccine produced by Pfizer is in the worksand the company could seek permission from the Food and Drug Administration (FDA) to introduce the product into interstate commerce by the end of the year. “As a pediatrician, this is extremely exciting,” Gordon said. “It holds the potential promise of protecting not just those most at risk, but potentially an entire generation of newborns.” That said, an RSV vaccine is still a long way from being approved, and vaccines are not foolproof. With the three viruses circulating, the concern remains. How should people prepare? Largely with familiar practices, Gordon said. “Get your shots, wear a mask if you’re sick, wash your hands and remember that even if you have symptoms and test negative for COVID, you could very well have something like RSV,” he said. “It’s things like this that may allow us to help reduce the increase and the number of infections that we expect.”
