Three years after “pandemic” entered our everyday lexicon, there’s a new, unwelcome vocab term to learn: “tripledemic.” As the weather gets cooler, and friends and families gather indoors for holidays, emergency departments around the country must now balance an influx of Covid, flu and Respiratory Syncytial Virus (RSV) cases.
It measures copies of the viruses per gram of solid waste, which indicates levels of infection in a community.
“It’s, I think, a perfect way to monitor the health of the community,” Dr. David Ghilarducci, Santa Cruz County Deputy Health Officer, says. “One of the problems with testing is you’ve got to go to a testing center, you’ve got to get the test, you’ve got to wait for the results. There are lots of barriers to that.”
The wastewater numbers show community trends more accurately, but they don’t necessarily reflect the situation in local hospitals.
Emergency departments are now nearly full with the combined force of the three viruses. In a recent press release, county health officials urged people with mild to moderate symptoms to refrain from trips to the ER and instead recover at home or turn to primary care providers.
Ghilarducci reports that Dominican Hospital is nearly full. Alongside limited resources, staffing poses one of the biggest challenges, he says.
“A lot of people have burned out after Covid,” he says. “They have left the medical profession, have maybe been unwilling to work extra hours like they used to because they’re just tired.”
Covid and flu tend to hospitalize older adults, but RSV primarily affects young children, creating another strain.
“We started off with very little inpatient pediatric capacity in our county—really, statewide,” says Ghilarducci. “And so that is particularly scary because we might rely on sending kids to children’s hospitals over in Santa Clara County. Those hospitals are now full, and we’ll have kids that we’re going to have to take care of here in this county because there’s simply no place to send them. Capacity’s constrained everywhere.”
Before Covid, most kids were exposed to RSV before their second birthday. But Covid precautions largely kept both flu and RSV away. Now, four and five year olds are catching the virus alongside infants.
“So now we have this susceptible population that is catching up for the first time,” says Ghilarducci. “The same is true for flu; we largely skipped flu the last couple of years because of Covid precautions.”
Now, with restrictions lifted and life returning to normal in many spheres, people are catching viruses they haven’t been exposed to in a few years.
“I’m actually least worried about Covid right now,” says Ghilarducci, citing a recent study that only about 5% of the U.S. population has never been exposed, either through infection or vaccination.
“That’s a far different situation than what we looked at last winter, and even better than what we saw the winter of 2021,” he says.
That’s not to say the situation couldn’t change.
“Covid continues to produce variants,” says Ghilarducci. And immunity wanes over time. “So we fully expect to see more hospitalizations and deaths from Covid.”
UCSC infectious disease ecologist A. Marm Kilpatrick makes similar points. The increase in transmissions over winter comes as no surprise, he says.
“We spend more time indoors, and environmental conditions allow viruses to persist longer in the environment—cooler, drier,” he says. “But the severity of the disease will likely remain low and decrease further unless a new variant arises with higher severity—or that is so different that it can evade multiple aspects of our immunity.”
Researchers have no way of anticipating a variant like that.
“We all hope it won’t happen, but no one can predict whether it will or won’t,” says Kilpatrick. “Anyone that says they can is spreading BS.”
Fortunately, familiar precautions work against all three viruses.
In another press release, Santa Cruz County listed several recommendations: Get vaccinated and boosted—and treated if needed. Stay home when sick to avoid spreading the viruses. Avoid going to the ER for anything beyond severe symptoms. Test before gathering with large groups of people. Wear a mask. Wash your hands, and cover your coughs and sneezes.
“If you’ve been boosted before, that’s great,” says Ghilarducci. “But if you don’t have the new booster, you don’t have full protection like you used to.”
He recommends the flu vaccine as well. There aren’t any vaccines for RSV yet.
And to the notion that the Covid pandemic is “over,” Ghilarducci responds that it hasn’t ended, just changed.
“I wouldn’t let your guard down. It’s okay to relax a little bit. But also think about all the principles that helped keep you safe and alive over the last couple of years,” he says. “Those, I think, will continue to be important.”