COVID-19, Influenza & RSV Testing in Chicago

The Winter of 2022-2022 is showing a rapid increase in Influenza, COVID, and now, RSV infections – the 3 infections being called the “tripledemic”

The CDC is reporting a rapid rise in cases of all 3 types of respiratory viruses – COVID, influenza, and now a mix of a third pathogen – respiratory syncytial virus (RSV) causing a “tripledemic.” So individuals are at risk of getting 1,2, or even 3 infectrions at the same time that results in much more severe illness, risk of hospitalization and death.

We already had COVID and the flu, but RSV also entered the picture this fall. RSV usually affects children but this winter, it is also affecting adults and the RSV hospitalization rate for seniors is 10 times higher than usual for this point in the season

We already had COVID and the flu, but RSV has entered the picture this fall. According to the CDC, 58 000 to 80 000 children, or 1-2% of children under the age of six months who have RSV infection, are at risk for hospitalization. When we think about RSV, we can vividly recall many assumptions that only children can get them. So, should adults be worried about RSV as well? RSV has symptoms similar to the flu or a cold and is sometimes underestimated by many adults of how severe it could be and its fatality. In the United States, CDC’s statistics demonstrate that 60,000–120,000 older adults are hospitalized yearly, and 6,000–10,000 pass away from RSV infections. Not only that, but RSV can also exacerbate pre-existing chronic conditions such as asthma and congestive heart failure or, if not, lead to severe conditions, including pneumonia and bronchiolitis.

According to the New York Times article, there is currently no vaccination for RSV. Still, at least two candidates are in late-stage clinical trials and seem highly effective in older adults. Additionally, Pfizer is developing an antiviral medication.

According to Helix, a lab that assists the CDC with viral surveillance, almost 98 percent of COVID-19 reinfections occur in people who had already been exposed to the virus more than 90 days ago, suggesting that declining immunity — rather than more transmissible variations — is driving the surge.

Until recently, the BA.5 strain was the most adept at evading immunity, but others quickly replaced it. The New York Times COVID-19 surveillance accentuates that the most likely contender for starting a winter wave is one of them, known as BQ.1.1, which has already caused cases to a spike in Europe. The number of cases in some states has increased by as much as 50% over the past two weeks. Additionally rising are COVID-19-related hospital admissions. According to the CDC COVID-19 surveillance, two new variants—BQ.1.1 and BQ.1—are leading as the second and third highest variants, adding to the rising COVID instances. Until recently, the BA.5 variant was the most prevalent.

Contradictory to President Joe Biden’s statement, “The pandemic is over,” the United States is experiencing a unique respiratory virus transmission season. The flu cases are increasing earlier than usual, and RSV incidence rates are exceptionally high in children and adults, even after an unprecedented early increase this summer.

• People are getting co-infections that can be more severe

It is challenging to distinguish between the COVID-19, RSV, or the flu since they have similar symptoms; getting tested is the best approach to determine which infection you have.

You may have either one of the viruses -COVID, Flu, or RSV – or you may have a combination of them. Having more than 1 virus causes more severe illness and takes you out for a much longer period. In addition, in COVID and Influenza infections, it is very important to start treatment with Paxlovid, or Tamiflu respectively. These reduce severity and duration of illness.  Further Paxlovid has also been demonstrated to decrease the incidence of post-COVID syndrome

• Adults are also being admitted for RSV

Infections with both the COVID and Influenza viruses are much more potent than with one alone. In previous years, people got either the Flu or COVID, but in the Winter of 2022-2023, the risk is higher of getting both at the same time.

Compared to people who are just infected with one virus, people who contract both COVID and the Flu at the same time, fare significantly worse.

Being infected with both the COVID and Influenza viruses has been shown to increase the risk of serious hospitalization and death. Patients with both Influenza and COVID-19 infections have a higher incidence of requiring mechanical ventilation and death, when compared to infection with either one alone. Furthermore, individuals that are co-infected with both Influenza and COVID viruses are much more infective than with one alone.

Although seasonal flu viruses are found all year round in the United States, the “flu season” is when these viruses most frequently spread, according to the CDC. The actual start and end dates of flu seasons might vary, although October is when activity often peaks. Flu activity usually peaks between December and February, though it can persist into May. However, as mentioned earlier, the timing and duration of flu activity have become less predictable since the COVID epidemic began.

According to CDC:

-High sensitivity and very high specificity compared to antigen testing

-Can differentiate COVID-19. influenza A/B and RSV

-Highly recommended for older children and adults due to the lower viral load in their respiratory specimens, making antigen testing less sensitive for this age group

Rapid RT-PCR assay performed by nurses at triage to detect influenza A/B is feasible and highly accurate. This claim is supported by this study conducted in which a total of 92 (49%) assays were performed. Result shows the median time from patient entry to rapid RT-PCR assay results was 46 [interquartile range 36–55 minutes]. The sensitivity and specificity of these assays was 0.98 (95% confidence interval: 0.91–1.00).