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Doctors Urge Caution in a Season of Flu, RSV, and COVID

By Joseph Bednar January 5, 2023

Riding Out a ‘Tripledemic’

Two years ago, flu took a vacation.

Dr. Mark Kenton remembers those days — but they were no vacation for emergency doctors, who had dealt with almost a year of COVID-19 and the hospitalizations and deaths that it caused, with vaccines just beginning to emerge.

But influenza, and respiratory syncytial virus, also known as RSV? There was almost none to be found, mainly because masking and isolating had become the norm, cutting off the potential for spreading these common viruses.

“With COVID, we had people masking, home from school, and we had no flu; there was no RSV,” said Kenton, chief of Emergency Medicine at Mercy Medical Center in Springfield. “In fact, Mercy didn’t have one ICU case of flu. Then, when we started to normalize, these viruses made their way back.”

So much that the prevalence of flu and RSV this year, combined with a still-lingering COVID threat — albeit one that has been muted by vaccinations — has combined for what has been called a ‘tripledemic’ this winter.

“It seems like the RSV population this year is much larger than in the past, which complicates things,” Kenton said. “We’re definitely seeing a lot of influenza, even in patients who have been vaccinated, and we’ve actually been seeing a lot of pneumonia. There are a lot of respiratory complaints this time of year, because it spreads through schools with kids at the end of the term, and parents may not want to keep the kids home.”

Because COVID still has a presence, he explained, when somebody comes in with a respiratory complaint, they’re tested for that as well as for influenza and RSV, a common respiratory virus that usually causes mild, cold-like symptoms, but can be more severe in certain patients.

“With COVID, we had people masking, home from school, and we had no flu; there was no RSV. Then, when we started to normalize, these viruses made their way back.”

Dr. Mark Kenton

“We were seeing a lot of RSV a few weeks ago, but it seems that may be tapering off now,” Kenton added, noting that Mercy has seen both children and adults with RSV, a condition that can be especially precarious for infants. “We worry about them getting RSV; a lot of local hospitals have been inundated with pediatric RSV.”

Indeed, RSV is the most common cause of bronchiolitis and viral pneumonia in children under age 1. The Centers for Disease Control and Prevention (CDC) reports that approximately 58,000 children under age 5 are hospitalized each year with the infection. Most infants are infected before age 1, and virtually all children have had an RSV infection by age 2. RSV can also affect older children, teenagers and adults.

Spiros Hatiras says he’s not sure who came up with that phrase ‘tripledemic.’ He’s quite sure, though, it wasn’t someone in healthcare.

“It had to be someone in the media — they’re the ones who like to attach names to things like this,” said Hatiras, president and CEO of Holyoke Medical Center.

But it’s as good a term as any to describe a convergence of COVID, flu, and RSV. In some parts of the country, this convergence is filling hospitals and putting additional strain on staffs already taxed by shortages of nurses and other healthcare professionals. But Hatiras told BusinessWest he hasn’t really seen much of any of the above at his hospital — from the individual ailments to the additional strain on people and resources.

Indeed, he reported very few, if any, COVID cases, noting that there isn’t anyone in his hospital solely because of COVID, though some are there for another reason and test positive for COVID. Meanwhile, he reports few cases of RSV, and flu numbers that are similar to previous years and nothing out of the ordinary.

The Emergency Department is crowded, he acknowledged, but not because of this tripledemic; rather, it’s because fewer staff members — a result of the ongoing workforce crisis, especially in healthcare — are tending to what would be considered a normal amount of patients.

“Because there were so few cases of RSV in the first two years of the pandemic, most infants and toddlers did not get the natural immunity that their body would have produced if they had natural illness. That left a larger number of children more vulnerable to getting RSV illness, which is what we are seeing now in the community.”

Dr. John O’Reilly

Kenton has observed the same phenomenon in the workforce. “So many nurses in this profession are either retired or gone on to something else,” he said. “This is everywhere, across the board. Every hospital is dealing with staffing issues. Even with [patient] volumes overall being down, when you get the tripledemic, it’s become a significant strain on resources within the hospital.”

What Is RSV?

Flu is a common term, and most people are now well-versed in COVID, but not everyone knows what RSV is, and how it deviates from other respiratory ailments.

While RSV results in mild, cold-like symptoms for most — a runny nose, nasal congestion, cough, and fever — for some, especially infants and older adults, it can lead to serious illness, though only a small percentage of young patients develop severe disease and require hospitalization, said Dr. John O’Reilly, chief of General Pediatrics at Baystate Children’s Hospital.

“Those hospitalized often have severe breathing problems or are seriously dehydrated and need IV fluids. In most cases, hospitalization only lasts a few days, and complete recovery usually occurs in about one to two weeks,” he explained.

Those who have a higher risk for severe illness caused by RSV include premature babies, very young infants, children younger than age 2 with chronic lung disease or congenital heart disease, children with weakened immune systems, and children who have neuromuscular disorders. Other at-risk groups include adults age 65 and older, 177,000 of whom are hospitalized and 14,000 of whom die from RSV each year in the U.S.; people with chronic lung disease or certain heart problems; and people with weakened immune systems, such as from HIV infection, organ transplants, or certain medical treatments, like chemotherapy.

The COVID pandemic has had a big impact on the normal pediatric respiratory illness cycles, O’Reilly noted. “Early in the pandemic, masking and social distancing helped to limit the spread of respiratory viruses such as RSV. Because there were so few cases of RSV in the first two years of the pandemic, most infants and toddlers did not get the natural immunity that their body would have produced if they had natural illness. That left a larger number of children more vulnerable to getting RSV illness, which is what we are seeing now in the community.”

There is no vaccine yet to prevent RSV infection, but there is a medication, called palivzumab, that can help protect some babies at high risk for severe RSV disease, O’Reilly noted. Healthcare providers usually administer it to premature infants and young children with certain heart and lung conditions as a series of monthly shots during RSV season.

“Don’t go out or attend gatherings if you are sick. Take COVID-19 tests if you think you have COVID-19 symptoms. Frequent hand washing can also help prevent the spread of respiratory infections. Wash your hands often with soap and water for at least 15 seconds and consider carrying a hand sanitizer with you at all times. Open windows for ventilation. Practice proper cough etiquette. And, because there is more sickness at this time of year, refrain from sharing utensils or drinking cups.”

The severity of symptoms can vary depending on the age of the child and whether he or she has any chronic medical problems, such as asthma or premature birth. Bacterial infections such as ear infections and pneumonia may develop in children with RSV infection.

At first, it’s all about symptom management for young children with RSV, O’Reilly said, including keeping the child hydrated and the fever under control. “If a child is having high fevers without relief for multiple days, or increased difficulty with breathing, such as wheezing, grunting, or ongoing flaring of the nostrils is observed along with a child’s runny nose and cough, then a call to your pediatrician is warranted.”

Part of the reason why RSV is a common virus in children is the fact that it can be easily transmitted. It can spread directly from person to person — when an infected person coughs or sneezes, sending virus-containing droplets into the air, where they can infect a person who inhales them, as well as by hand-to-nose, hand-to-mouth, and hand-to-eye contact. The virus can be spread indirectly when someone touches any object infected with the virus, such as toys, countertops, doorknobs, or pens, and can live on environmental surfaces for several hours.

The CDC’s advice on limiting the spread is the same as any virus-prevention measure: covering coughs and sneezes with a tissue or sleeve, washing hands often with soap and water, avoiding touching one’s face, disinfecting surfaces, staying home when sick, and avoiding close contact with sick people, as well as kissing, shaking hands, and sharing cups and utensils with others.

“The good news,” O’Reilly said, “is that most infants and children overcome RSV infections without any long-term complications, as RSV infections can often be relatively asymptomatic and even go unnoticed.”

Safety First

After almost three years of COVID, it’s easy to push those common-sense cautions aside, but that would be a mistake, said Dr. Vincent Meoli, Massachusetts regional medical director at American Family Care, which operates urgent-care clinics in Springfield and West Springfield.

“We know there is a significant amount of COVID fatigue as we enter our third year of the pandemic, but vigilance is still important, both to protect those most at risk of developing complications and to minimize the impact on our healthcare system,” he said, noting that area hospitals saw high rates of RSV admissions early in the season.

“We saw a tremendous reduction in flu cases during the height of the pandemic because people were wearing masks and isolating,” Meoli said. “Now that society has opened up again and masks are no longer required in most places, we anticipate the number of flu cases to increase.”

Kenton emphasized that, while flu and RSV might be more prevalent now, COVID hasn’t gone away. According to the CDC, about 350 people in the U.S. still die every day from COVID, and about six out of every seven of those are unvaccinated.

“I always say, vaccinate, vaccinate, vaccinate. It’s been proven that, with vaccination from COVID, you’re still able to get COVID, but you’re less likely to die,” he told BusinessWest. “Are you going to feel sick? Yes, absolutely. But you’re less likely to be hospitalized and die from it. It’s still present, unfortunately. I think it’s always going to remain present for us in combination with the flu and RSV. So definitely get the flu vaccine every year, too.”

Dr. Armando Paez, chief of the Infectious Disease Division at Baystate Health, said vaccination is a must, but it’s important to maintain other precautions as well during the tripledemic.

“Don’t go out or attend gatherings if you are sick. Take COVID-19 tests if you think you have COVID-19 symptoms,” Paez said, adding that, during the holiday season and after, people are traveling and potentially spreading viruses. “Frequent hand washing can also help prevent the spread of respiratory infections. Wash your hands often with soap and water for at least 15 seconds and consider carrying a hand sanitizer with you at all times. Open windows for ventilation. Practice proper cough etiquette. And, because there is more sickness at this time of year, refrain from sharing utensils or drinking cups.”

Kenton said there’s nothing wrong with turning down an invitation to a gathering where people are sick — or if there’s a possibility of introducing sickness into that house. “If someone in your house is sick, don’t go to someone else’s house, especially if they have co-morbidity conditions; getting RSV on top of that can cause them to end up hospitalized or potentially die.”

He also reminds people that COVID has an asymptomatic period between infection and symptoms, so if someone in a household tests positive, not only should the infected individual isolate, but it’s a good idea for others in the house to avoid gatherings for a few days until they know they’re negative, to avoid spreading the virus to someone else.

Meoli noted that, for those who do plan to attend gatherings — especially with people at high risk for COVID, like the elderly, children, or people who are immunocompromised — testing for COVID the day before or the day of the gathering can provide some extra reassurance.

“Talk to a healthcare provider if you have any concerns about vaccines, symptoms, or testing,” he added. “COVID-19, flu, and RSV all have the potential for complications, hospitalization, or death.”

It’s certainly a triple threat, area doctors say, but taking simple precautions can help keep families safe and patients out of the hospital — or worse.

Colleges Welcome Students Back with an Abundance of Caution

By Joseph Bednar September 29, 2021

Education Special Coverage

Continuing Education

Matthew Scott says the double protection of vaccines and masks are a good start to keeping AIC’s campus safe.

After a year when colleges offered a wide variety of learning options during the pandemic, from in-person to remote to a blend of both, the vast majority have opened their classrooms, residence halls, and athletic fields for a true on-campus experience this fall. But they’re doing so with caution, both internally — in the form of vaccine requirements — and backed by municipalities that are issuing broad mask mandates. The bottom line through all the changes? The idea that young people need the full college experience, and no one wants to risk a disheartening retreat to Zoom.

Everyone is tired of pivoting, Matthew Scott said. But, by now, they’re good at it, too.

“We’ve learned that our students are adaptable. They don’t always want to be, but they’ll go with the flow and make it happen. And our staff members have just rolled up their sleeves and said, ‘what needs to be done?’”

As vice president for Student Affairs and dean of students at American International College (AIC) in Springfield, Scott is just one of countless higher-education administrators who have spent the past 18 months adapting to one unexpected development after another when it came to COVID-19 and how students could best learn and interact during the pandemic.

“You want to plan in times when you aren’t in the middle of a crisis, so that you’re ready to use that plan when a crisis occurs,” he said. “But when you’re thinking through your crisis-planning process, you’re thinking of things like a fire or a hurricane coming through. Nobody planned for a pandemic. We had protocols for a specific outbreak, but not something like this.”

The lesson? “We learned that we need to be agile. You might spend weeks planning something, and then one order comes through from the local or state government, and you need to pivot.”

The latest pivot for AIC, one similar to what most colleges and universities are doing, involves students living and learning on campus, with residence halls open and clubs and sports in full swing. But a facemask requirement is back, too, at least indoors. And AIC is also requiring students and employees to be vaccinated against COVID.

“We learned that we need to be agile. You might spend weeks planning something, and then one order comes through from the local or state government, and you need to pivot.”

“At last count, we were at 98%, which is a phenomenal number to get to,” Scott said, noting that religious and medical exemptions are being given, but those people are required to be tested weekly, and their quarantine and isolation protocols in the case of infection differ from those of a vaccinated individual. “So far, the vaccination rate has been helping us quite a bit.”

Elms College in Chicopee has also mandated both masks indoors and vaccination for everyone (students, faculty, and staff) without a legitimate exemption.

“Last year, masks were required everywhere. Now, they are not required outdoors if you don’t have anyone within six feet of you,” President Harry Dumay said. “We don’t have distancing in the clasrooms like last year. But we’ll be functioning with a campus that is fully vaccinated.”

While students could choose to take classes in person or remotely last year, Dumay said the college is asking all undergraduates to be in classrooms this year, although remote capabilities are in place in case someone needs to quarantine.

President Harry Dumay says Elms College not only has a plan for this fall, but “a backup to the plan and a backup to the backup.”

“We thought this year would be completely free of all these things, but what we’re seeing in the region and on campus are a lot of breakthrough cases, and Delta is more contagious than the original virus,” Dumay said.

When asked about pushback from students on the vaccine mandate, he said he wouldn’t use that word, exactly. “We certainly had quite a few inquiries from parents, saying, ‘is that necessary?’ Or from staff or employees asking, ‘so what does that mean if I don’t do it?’ I don’t know if anyone resigned on our campus or decided not to come because of the vaccination. There might be one or two cases, but I haven’t heard that.”

Scott said students tend to understand that vaccines not only prevent COVID in many cases, but reduce its severity in others.

At the same time, however, “college-age people are not particularly concerned about hospitalization or death because, for the vast majority of them, they’re able to weather the storm and get through it. But part of the education process is making sure they understand it’s not just about them, it’s about the people around them who might have underlying conditions they might not know about.”

If there has been any pushback, he noted, it has taken the form of questions about why both vaccines and masks are necessary.

“We thought this year would be completely free of all these things, but what we’re seeing in the region and on campus are a lot of breakthrough cases, and Delta is more contagious than the original virus.”

“We’d say, ‘yes, you’re vaccinated, and yes, that probably means there’s a lower likelihood of you contracting COVID, but if you do, you might not know you have it, and you might pass it on to somebody else — maybe a child who can’t get a vaccine, or maybe someone who’s immunocompromised,’” he explained. “For the most part, people get it. More than 1,000 U.S. colleges are requiring vaccines, so we’re among many at this point.”

Taking Their Shot

Holyoke Community College President Christina Royal said HCC balanced the desire among many students to get back to in-person learning with the constantly changing health metrics around the Delta variant. “So we decided to open with about a third of classes in person, face to face; a third online; and another third blended of some sort.”

The original plan earlier this summer called for about 25% of classes in person, she explained, “but as those classes were filling up, we heard students wanted more of them, so we added some additional sections. Then we increased class sizes, which were lowered during the pandemic.”

Now 15 students are allowed in a class, still small enough to allow for social distancing, Royal said.

At the same time, “we were also hearing from other students who were not comfortable coming back in, given the conditions in the world. So that’s where we are this semester — we wanted to have a range of options for students so we can match whatever their comfort level is.”

HCC has had a mask mandate on campus since the start of the pandemic and has never lifted it. The college also modified its ventilation systems. “We have several classrooms that don’t have windows, and we wanted to make sure people felt comfortable in the learning spaces.”

In addition, the campus added protective barriers in many places and signage reminding students about masks, social distancing, and hand washing, as well as the need to get vaccinated.

Holyoke Community College President Christina Royal says the state’s community-college presidents are unified in their support of a vaccine mandate.

That is more than a nudge now, as all 15 community colleges in Massachusetts instituted a vaccine mandate last week for all students, faculty, and staff, which must be fully met by January.

“During the last 18 months, the Massachusetts community colleges have prioritized the health and safety of our communities while also recognizing that many of our students have been disproportionately impacted by the COVID-19 pandemic,” the presidents said in a statement shared with their campuses. “While a significant number of students, faculty, and staff are already vaccinated or are in the process of becoming vaccinated, the 15 colleges are seeking to increase the health and safety of the learning and working environment in light of the ongoing public health concerns and current guidance from the Centers for Disease Control and Prevention.”

In her own message to the HCC community, Royal noted that, “while there is no ironclad defense against coronavirus, extensive public-health research has shown that vaccination greatly reduces the risk of hospitalization and death.”

While the UMass system has not yet instituted a vaccine mandate, UMass Amherst is strongly advising shots for all students and employees. “The science is clear that vaccination is the best way to stop COVID-19 from spreading, and our best way to continue protecting each other’s well-being,” an official statement reads.

In the meantime, individuals who are not vaccinated are required to participate in the university’s asymptomatic testing program.

UMass Amherst is also back to in-person learning, but is following public-health guidelines for wearing masks indoors and distancing where possible.

“If we need to do more education and bring some public-health experts in to reduce misinformation and allow for people to get the facts, then we’ll certainly do that as part of our strategy.”

“The use of indoor masks, required on campus and in the town of Amherst … reduce the spread of infection, said Ann Becker, Public Health director, and Jeffrey Hescock, executive director of Environmental Health and Safety, in the campus’ Public Health Promotion Center, in a statement. But they also laid out the stark facts when it comes to vaccination.

“Our data shows that, among our vaccinated population, only 1.7% have tested positive. Among the approximately 500 individuals who have received religious or medical exemptions from vaccination, 10.05% have tested positive. We urge those not yet vaccinated to consider doing so.”

They noted, however, that positive cases have been predominately among undergraduate off-campus students connected to unmasked social activities. “We have not seen any spread in academic settings. Most cases continue to be of short duration, resulting in mild to moderate illness.”

UMass makes vaccine clinics readily availabe on campus, as do the 15 community colleges. HCC offers free COVID-19 vaccinations for four hours every Tuesday, as well as COVID-19 testing six days a week on campus through the Holyoke Board of Health.

Royal was adamant that a vaccine mandate was the right call.

“I think this is in our collective best interest, for our community colleges and for our region as well,” she told BusinessWest. “At this point, the vaccines have been shown to be effective when we’re talking about preventing disease or reducing hospitalizations and deaths.”

She recognizes that people have many different perspectives that should be respected, but that the college has a duty to combat misinformation.

“If we need to do more education and bring some public-health experts in to reduce misinformation and allow for people to get the facts, then we’ll certainly do that as part of our strategy.”

Life of the Campus

In some ways, it has been a frustrating start to the semester, Dumay said, noting that the general feeling earlier in the summer was that masks would be optional, let alone vaccines, as COVID gradually retreated. While it hasn’t, he noted that it’s important for students to safety enjoy the full Elms experience.

“One of the distinctive features of an Elms College education … is that it offers a vibrant and nurturing environment, and not just with the instruction that happens in the classroom,” he said. “It’s all the interactions and how people behave with one another.”

College leaders believe important personal growth occurs through that interaction, he added.

“You can’t really do that with an online model. You can approximate it, but it’s not ideal. So to the extent we can, we’ll take the steps that are necessary so we’re safe and have an on-campus education, particularly for young people who are at that stage in their life where they’re forming their character.”

Like Scott, Dumay said the key lesson from the pandemic has been that it’s good to have a plan, but one thet can be modified at any given time. “We have a backup to the plan and a backup to the backup. We’re prepared to shift as the environment changes.”

The second lesson is the importance of transparent communication, he noted, because without it, people tend to fill the gaps with misinformation.

“We’re not pretending the pandemic is over by any means,” AIC’s Scott said. “We’re complying with the Springfield mask mandate right now and requiring masks indoors and outdoors when you can’t maintain the six feet. But we still have a tent set up outside; we’re trying to drive people outside as much as possible, just as an extra layer of protection.

“But the 98% vaccination rate, along with masking — I don’t want to give people a false sense of security where you don’t have to be vigilant, but we’re feeling pretty confident that we’re doing what we need to do to keep people safe.”

If a pocket of infection arises, the campus is ready to bring in more testing supplies and trigger quarantine protocols, but Scott feels like the double protection offered by vaccines and masks are the best way to keep that possibility at bay.

“There’s no one to be mad at,” he added. “I’m not mad at the mayor for putting in a mask mandate; he’s doing what needs to be done to keep the people in the community safe. But is it frustrating when you think you have a plan and the pandemic doesn’t cooperate? Of course, but a virus doesn’t cooperate.”

What makes all the planning and inconveniences worthwhile, he said, was seeing the energy of the students as they moved back onto campus a month ago.

“It was kind of a heartwarming moment seeing some of these returners … they left in March of 2020, and they didn’t come back until the beginning of this September. So when they see each other in person for the very first time in a long while, you can see it, you can feel it. They want to be with each other.

“We believe in the on-campus experience,” he added. “They’re coming here for all these things — to participate in athletics, to live in the residence halls, to eat in the dining commons. We’re on an online campus in this moment.”

Dumay saw the same energy at the Elms — and doesn’t want to do anything that might threaten to snuff it out.

“The first week, seeing students back on campus, was fantastic,” he said. “They’re happy to be here. They don’t want to be sent back to Zoom. They’re happy to be with each other. And we’re happy to see them.”

Joseph Bednar can be reached at [email protected]

Doctors Urge Caution in a Season of Flu, RSV, and COVID