Fighting the trifecta of flu, COVID-19

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If you know or are someone who has been fighting off a case of the flu, COVID-19, or RSV in the early weeks of 2024, you are not alone. “The situation in Utah is quite ugly right now,” says Andrew Pavia, MD, chief of the Division of Pediatric Infectious Disease at University of Utah Health. “We are seeing a lot of influenza, a lot of RSV, and increasing amounts of COVID-19. It’s hitting children particularly hard.”

At Primary Children’s Hospital, where Pavia serves as director of hospital epidemiology, the numbers and conditions of the young patients being admitted has had him especially concerned. “Primary Children’s is running at about 100% occupancy, and some days we are going over that. It’s the fact that the viruses are all hitting at once that makes it particularly difficult. And, moreover, we’re seeing very serious complications.”

Since December 2023, Pavia said he has seen about every known complication from influenza. “It can impact the heart and lead to heart failure in children and adults. The most common way it can cause more complicated illness is to open the door for serious bacterial infections like pneumonia and even infections in the sinuses that track into the brain.”

Pavia acknowledged most patients with the flu won’t face these complications, but it is still important to take the viruses seriously. “Of course, taking these viruses seriously means getting your vaccines,” he said. “We have a totally safe and moderately effective vaccine for influenza, and this year’s vaccine is a pretty good match for the virus.”

Children and adults might still get sick, but Pavia emphasized that if you do get the vaccine, it should reduce the severity and length of the illness.

In December, the Centers for Disease Control and Prevention (CDC) sounded the alarm about low vaccination rates. The agency released figures that show about 7 million fewer adults have gotten their flu shots this season compared with the last virus season. The trends are just as worrisome here in Utah.

“We are concerned because in Utah, the rates of flu vaccinations have gone down in the last two years,” Pavia said. “Young adults are the most likely group not to get vaccinated compared to previous years, but it is impacting children as well.”

Fighting the trifecta of flu, COVID-19 and RSV viruses as Utah cases rise Photo: gpointstudio/Shutterstock.com

Explaining why vaccination rates for flu, COVID-19, and RSV continue to fall is difficult and discouraging for Pavia and his colleagues. Pavia suggested one possibility: “There’s probably an element of general overall fatigue. We just survived a traumatic pandemic. People may just not want to think about it anymore. That’s totally understandable as a society that we have a little PTSD.”

There are also some more insidious and dangerous things going on, according to Pavia. “There’s a lot of misinformation out there, including actual disinformation and lies,” Pavia warned. He likens the reluctance to get vaccinated to choosing not to wear a seatbelt when you and your children head to work or school. “Most days, you are going to get to your destination safely, but one day you are going to be t-boned by a truck. On that day, having worn your seatbelt and having a car with airbags is going to be what saves your life.”

Utah, along with the rest of the nation, is also seeing a “pretty significant” surge in COVID-19 cases, Pavia said. It’s a little harder to pinpoint actual numbers, but there are indicators of what is currently happening.

“We aren’t getting test results the way we used to, so we are getting a partial picture of what is going on,” Pavia saids. “But our wastewater levels are very high, and we are seeing a marked increase in hospitalizations, particularly in those 70 and older and among very young children under 2 years old.”

COVID-19 cases have not reached the level they did when the original omicron variant was spreading, and Pavia does not think they will. However, he is again frustrated by vaccination numbers. “Only 15% of people have gotten the updated COVID-19 vaccine, and that is really distressing.” For some, mainly young adults who have been vaccinated in the past and had a case or two of COVID-19, they have probably built up their immunity and will be fine, according to Pavia.

Of course, there are a lot of other people who have heart disease, lung disease, are obese, have diabetes, are taking medications that suppress the immune system, or are over 70 or under 5 years old. Pavia said these are the people who need extra protection. He understands the confusion, especially for parents, about what vaccination advice to accept and what to ignore.

“Every time we see a child come into Primary Children’s with a severe complication of influenza who didn’t get vaccinated, to us it’s just a failure,” Pavia said. “It is a failure of us to communicate and teach. It’s a failure of our medical system to make it easy for people, and it’s a failure of our information ecosystem to make sure the information that is out there is reliable.”

If medical professionals step up their game when it comes to distribution of reliable information on vaccines, Pavia said he hopes all adults, including parents, will take advantage of the protective measures that are available. “It’s time to use the vaccines. There’s still time. It would have been better to get vaccinated in October, but now is the time to get caught up.”

It can be hard to earn the average patient’s trust when it comes to disease prevention and treatment. But Pavia thinks a good place to start tackling the problem is with the family physician. “One of the best places to educate is in the clinician’s office because year after year, it is clear that the most trusted source is your own health care provider.”

Fighting the trifecta of flu, COVID-19 and RSV viruses as Utah cases rise Photo: Kmpzzz/Shutterstock.com

Pediatricians, family practitioners, and nurse practitioners would need more time and incentives to offer better guidance on vaccines and medications. Pavia believes it would be more productive and cost-effective than asking the medical community to police the information on the internet. “But giving time for the most trusted voice for your family to talk to you about vaccines is not controversial,” Pavia said.

In fact, those talks could be lifesaving ones since researchers continue to develop new forms of prevention and treatment. For the first time this flu and RSV season, doctors have a maternal immunization available to women who are between 32 and 36 weeks into their pregnancies.

“If they are going to have a baby who will be under 6 months during the RSV season, this vaccine will dramatically protect their child,” Pavia said. “It’s about 85% effective for infants during the first three months of life against medically attended RSV or being sick enough to go to the emergency room or hospital.”.

A second exciting development introduced in 2023 is a medication designed to offer passive immunization to RSV for infants shortly after they are born. Pavia described it as a preparation of antibodies but noted it has recently been in short supply. He still encourages new parents to check on availability with their pediatricians.

With or without a vaccine, many Utahns will come down with the flu or COVID-19, and that is when it is worth patients asking their providers about antiviral medications. “These medications block the replication of the virus and can greatly decrease how sick you get,” Pavia said. “In the case of COVID-19, it can greatly decrease the chance of hospitalization or even death.”

For COVID-19, one medication is called Paxlovid and another is an injectable called Remdesivir. These are highly recommended for people with other high-risk medical conditions and for those over the age of 60. “If you fall into one of those groups, and you think you have COVID-19, you should test early and quickly because these medications can prevent serious complications,” Pavia said.

This year and into the future, Pavia suggested it is important to remember that COVID-19 is not gone. “It’s still killing almost twice as many people as the flu. It is something that we need to take seriously, even if we are no longer scared to death of it and it’s not altering our lives and our society. That doesn’t mean it’s just a cold.”

The new normal means people might need to behave a little differently, especially if we are at high risk of COVID-19 complications.

Pavia said there is no reason not to wear a high-quality mask on crowded planes or in theaters. “We think that the people most at risk are someone else. But if you add up all the risk factors, a lot of us really fall into one of those risk categories.” Together, we are all in the fight to protect ourselves from getting seriously ill.

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University of Utah Health

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