The past few years of the pandemic have served as a sort of crash course for how to limit the spread of a respiratory virus. This continues to be important as Oregon enters another respiratory season, which experts predict has the potential to become a “tripledemic”: not only COVID, but also influenza and respiratory syncytial virus, or RSV.
It’s not uncommon for respiratory illnesses to become more prevalent in the winter months as people gather indoors, but hospitals across the U.S. are seeing an unusually early rise in RSV infections in children. Cases of RSV in Oregon remain low, but are expected to pick up, according to Oregon Health & Science University’s latest statewide biweekly forecast. As of October 29, Oregon Health Authority reported that Oregon met the criteria for the onset of RSV season, and is keeping a close eye on RSV activity.
RSV cases tend to be mild, causing cold-like symptoms that resolve in a week or two, but it can cause severe illness that may require hospitalization. Older adults, immunocompromised people, and infants under six months of age are at greater risk of severe illness.
"RSV is almost like a rite of passage for young kids,” says Dr. Dawn Nolt, a professor of pediatrics at OHSU with a focus on infectious diseases. Most children will get it by the time they’re 2. Due to social distancing, virtual learning, and other COVID mitigation measures—which have largely been relaxed in Oregon since last winter—many kids who were not exposed to RSV in the past two years are now experiencing their first infections.
Dr. Melissa Sutton, OHA’s medical director of respiratory viral pathogens, says hospitals are concerned that RSV and flu on top of COVID will create a significant burden on health care systems that are still recovering from the strains of the pandemic.
While the number of COVID cases in Oregon have “declined a little” since September, infections and hospitalizations are projected to peak around December, according to OHSU’s forecast.
“COVID can be a bit difficult to predict because of emerging variants and how they shape transmission, but we do think we will see ongoing, significant COVID transmission in our communities,” says Sutton.
Sutton notes that there are several new subvariants that contain "mutations of concern” that allow immune escape. “But they are changing at a much slower rate than they have in the past,” she says. “I honestly can't say [what variant] is going to win in the end, but I do think we're in a period of relative variant stability.”
European countries have seen an uptick in antibody-evasive subvariants like BQ.1, and XBB has been spreading in Southeast Asia. BA.5, which drove a surge in infections over the summer, is still the dominant strain in the US, but the country is seeing an increase in BQ.1 and BQ.1.1, according to data from the CDC. As of November 5, the two variants make up about 35 percent of cases in the country. But experts don't expect the coming wave to be like the omicron surge last winter, which Sutton describes as “truly unprecedented.”
“Omicron was a big shift. It’s like way out there on its own antigenic cluster,” Nolt says. “I don’t expect a big surge unless the virus really shifts.”
There has also been an increase in parts of the US for influenza, which OHSU forecasts to “outpace” COVID-related hospitalizations in Oregon in the fall and winter. “Every respiratory season, we get a little boost because your immune system sees influenza,” says Nolt. “But we haven’t seen much flu in the past three years.”
COVID restrictions have been eased back, and many Americans have returned to pre-pandemic behaviors. But, Nolt says, “We shouldn’t resign ourselves to having respiratory infection.” Many of the measures that were implemented in the pandemic are still effective in reducing the transmission of other viruses, too.
With winter around the corner, not to mention the holiday season and its many gatherings, Sutton recommends that people make sure they are up to date with their COVID-19 vaccinations. In Oregon, only 7.4 percent of the adult population has received the bivalent booster—which includes both the original strain and the omicron variants BA.4 and BA.5—in addition to completing the primary series. This follows a similar pattern for the rest of the country; only about half of Americans have reported hearing about the updated shot.
Although there is not a vaccine available for RSV, Sutton notes how effective masks have been in limiting the spread of respiratory viruses. Nolt also recommends many of precautions that we’ve already learned during the pandemic, such as handwashing, social distancing, and staying home when you’re sick.
“It’s also important that everyone makes a plan for how they will be cared for and how they will care for others if they get sick. So, people who are at increased risk for severe disease, or who experience moderate or severe illness, should reach out to their health care provider early to ask about antiviral therapies and testing,” says Sutton. “We do have many tools that we can use to help keep people from getting severely ill, but we need to be prepared to use them.”