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Respiratory illnesses slam US: “Perfect storm for a terrible holiday season”

An intensive care nurse cares for a patient suffering from respiratory syncytial virus (RSV), who is being ventilated in the children's intensive care unit of the Olga Hospital of the Stuttgart Clinic in Germany.
Enlarge / An intensive care nurse cares for a patient suffering from respiratory syncytial virus (RSV), who is being ventilated in the children’s intensive care unit of the Olga Hospital of the Stuttgart Clinic in Germany.

With SARS-CoV-2 still circulating and seasonal viruses, including influenza and RSV, making up for lost time during the pandemic, the US is getting slammed by respiratory illnesses. And things could get worse as more holidays and associated gatherings approach, health officials warned Monday.

“This year’s flu season is off to a rough start. Flu’s here, it started early and with COVID and RSV also circulating, it’s a perfect storm for a terrible holiday season,” Sandra Fryhofer, chair of the American Medical Association and adjunct medicine professor at Emory University School of Medicine, said in a press briefing held by the Centers for Disease Control and Prevention today. “Over the last few years, COVID-protective measures also prevented spread of flu and other respiratory infections, but we’re really no longer in that bubble.”

Cases of influenza-like illnesses (ILIs) are soaring throughout the country, with 47 states seeing “very high” or “high” activity levels, according to the latest CDC data. The agency estimates that there have been at least 8.7 million illnesses, 78,000 hospitalizations, and 4,500 deaths from flu.


The numbers indicate an exceptionally early flu season—though not necessarily an exceptionally severe one. ILI cases and hospitalizations are higher for this point in the season than they have been at this point in every previous season since the 2010-2011 season. But hospitalizations have not reached previous seasons’ peaks.

Still, there are signs that the season could be particularly bad, as well as early. The CDC is reporting that flu vaccination rates are lagging this year, especially among children and pregnant people. The early season and slow vaccination have led to a jump in hospitalizations. The number of new hospitalizations with laboratory-confirmed cases of influenza nearly doubled in the week ending on November 26 over the week prior, with roughly 19,600 hospitalizations in the week ending November 26 compared with 11,000 in the previous week.

COVID-19 is also jumping up. Though transmission in the US has largely been in a lull in recent months, the Thanksgiving holiday appears to have spurred an uptick, with hospitalizations up 28 percent to a daily average of 35,600 over the last two weeks, according to data tracking by The New York Times. Uptake of the updated COVID-19 booster, which has proven effective at increasing protection against infection, continues to be dismal, with just 12.7 percent of eligible Americans getting their shot.

Meanwhile, RSV—Respiratory syncytial (sin-SISH-uhl) virus—has surged in young children, with cases skyrocketing in recent weeks, filling pediatric beds and overwhelming hospitals. Today, CNN reported that some hospitals are facing a shortage of medical-grade cribs amid the rise in respiratory illnesses. On Friday, New Mexico announced an emergency public health order that requires all hospitals in the state to participate in a “hub and spoke” model, which involves managing resources and transferring patients to where they can best be treated.

“This public health emergency order is necessary now as hospitals and emergency rooms are operating above their licensed capacity due to a surge in respiratory viruses and are now experiencing an unsustainable strain on healthcare providers,” the New Mexico Health Department said.

Wave beyond wave

Some good news is that RSV infections may have already peaked in some areas of the country, namely the South and Southeast, and may be leveling off in the mid-Atlantic, New England, and Midwest, CDC Director Rochelle Walensky said in today’s press briefing.

“While this is encouraging, respiratory viruses continue to spread at high levels nationwide and even in areas where RSV may be decreasing; our hospital systems continue to be stretched with high levels of patients with other respiratory illnesses,” she warned.

Walensky urged Americans to get vaccinated. “First and foremost: Get vaccinated. For two of the three viruses discussed today, there are vaccines,” she said, referring to vaccines against flu and COVID-19 (there is currently no vaccine against RSV available). She also urged other health measures, such as covering coughs and sneezes, hand washing, staying home when sick, improving ventilation in homes and workplaces, and wearing a high-quality mask.

Currently, CDC masking recommendations are based only on transmission levels of SARS-CoV-2. However, when asked today whether the agency would consider basing the recommendation on respiratory illness transmission overall, Walensky said the agency was “actively looking into” it. But, in the meantime, she noted, “one need not wait for CDC action to put a mask on.”

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