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Preparing for a ‘Tripledemic’ Holiday Season

Experts Warn High Levels of RSV, COVID-19 and Flu Could Worsen This Winter

With COVID-19 and flu cases rising, and RSV (respiratory syncytial virus) affecting many young children, experts are bracing for a “tripledemic” of respiratory viruses this holiday season.

“It’s going to be a severe respiratory virus season,” said infectious disease specialist Michael A. Ben-Aderet, MD, associate director of Hospital Epidemiology at Cedars-Sinai. “Getting your flu shot, getting your bivalent COVID-19 vaccine—these things will help prevent infection, reduce transmission and potentially save lives.”Michael A. Ben-Aderet, MD

Masking in crowded places and staying home when sick also are crucial, Ben-Aderet said. Even if someone has symptoms but tests negative for COVID-19, they should still avoid others to limit the spread of viruses and reduce the strain on the healthcare system.

The flu and RSV might cause a mild illness in healthy adults, but they can be life-threatening for young children, older adults and people with weak immune systems, said Nancy L. Sicotte, MD, chair of the Department of Neurology and a clinician who treats immunocompromised patients. She said it’s also vital to avoid overwhelming the healthcare system.

“Even though you may feel that if you got an infection, it may not be so bad, we're trying to keep the pressure off the hospitals,” said Sicotte, the Women’s Guild Distinguished Chair in Neurology. “If emergency rooms receive an influx of patients when the hospitals are quite full, this can impact their ability to take care of you or to take care of other ill patients.”

Protecting the Vulnerable

For immunocompromised patients, navigating the holiday season and its social gatherings can be stressful. “The new subvariants that have emerged over the last few months are causing even more concern,” Sicotte said.

The latest versions of the virus that causes COVID-19 have presented a nasty twist for people with weak immune systems: Omicron subvariants BQ.1 and BQ.1.1 don’t appear to respond to Evusheld, a preventive medication that boosts COVID-19 antibodies in immunocompromised patients whose bodies don’t mount a strong response to the vaccines.

Sicotte still recommends her patients continue their Evusheld infusions for now. “There are several different variants that are out there, Nancy L. Sicotte, MDand we feel it's worth having some of this additional protection, especially as we approach the peak of the respiratory virus season,” she said.

Individuals with weak immune systems should especially be careful to avoid COVID-19 and other viral illnesses while traveling over the holidays. Sicotte said masks are a must in the airport and during flights.

“You know that somebody on that plane has COVID-19 because they've been traveling, and they got exposed,” Sicotte said. “Some people go onto the plane when they're symptomatic these days.”

Despite all the risks, spending time with loved ones over the holidays is valuable, Sicotte said. Just be smart, she advises, and follow the recommended safety measures.

“Once you've followed all the safety measures—you’ve gotten your vaccines, you are being cautious, you're using your mask when you're out in public and indoor places—I think it's also important to recognize that health also includes mental health,” Sicotte said. “Spending time with friends and family is very, very important for mental health.”

Where to Get Care

Those who get sick have options for care. For nonemergencies—such as a low-grade fever, cough, chest congestion or mild fatigueBruce C. Reaves, MD—patients can contact their primary care doctor or schedule a video visit.

Patients who need immediate care for an illness or symptoms that are not life-threatening—including abdominal pain, dehydration, diarrhea, fever or chills, muscle pain, nausea and vomiting, sore throat or cough—can visit an urgent care center. Some providers also offer on-demand virtual care, such as Cedars-Sinai’s Video Visit Now, to treat minor health conditions.

At Cedars-Sinai Urgent Care in Los Feliz, Bruce C. Reaves, MD, said he has seen a big uptick in patients with respiratory virus infections over the past month. “We see a lot of people coming in who don’t want to end up in the hospital,” he said.

For patients with the flu, Reaves said it’s best to see a healthcare provider quickly after being exposed to the influenza virus. “We can prescribe Tamiflu, but it’s best to start this medication within two days of being exposed to someone who’s sick with the flu,” Reaves said.

Urgent Care at Cedars-Sinai Los FelizFor patients with COVID-19, Paxlovid remains one of the most effective therapies, according to Ben-Aderet, who said it's widely available now.

“It's one of the most important tools in our arsenal for people with COVID-19,” Ben-Aderet said. “It’s been shown to reduce the severity of symptoms, shorten their duration and also reduce transmission. Patients should speak with their provider about whether it's appropriate for them.”

Patients with RSV can get supportive care to clear airways, fluids for dehydration, or oxygen support, but there aren’t any medications to treat the virus itself. If RSV or any respiratory infection becomes a medical emergency, patients should visit the nearest emergency department.

Read more on the Cedars-Sinai Blog: Omicron Boosters and Flu ShotsWhat to Know This Fall.