Covid, flu, RSV are on the decline in hospitals as the ‘triplemic’ threat recedes

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So much patients sick with RSV had swamped the Connecticut Children’s Medical Center to be treated in hallways and playrooms. Facing their busiest season in memory last fall, hospital leaders came up with a plan to enlist the National Guard to set up tents outside. Doctors are bracing for a harsh winter — a looming disaster some have dubbed a “tripleemia” — with a flu season uptick, a coronavirus flare-up, and the holidays that provide fuel for viruses to spread.

But no such a wave came about. The RSV surge has abated in Connecticut and across the country. Flu cases have declined rapidly. Covid hospitalizations rose shortly after Christmas, only to fall again.

“We’re seeing the normal crowds, but not the very busy ones I thought we’d see,” said Juan Salazar, chief physician at Connecticut Children’s in Hartford. “I am just so happy that we can now go back to normal occupation. Busy staff, but nothing close to what we saw in the fall.”

It turns out that early waves of respiratory syncytial virus and flu peaked before the new year, according to new data from the Centers for Disease Control and Prevention. And the expected winter resurgence of the coronavirus is nowhere near overwhelming hospitals, as in 2021 when covid wards were filled with unvaccinated people struggling to breathe and last winter when the highly transmissible Omicron variant caused a massive wave of illness.

The seven-day average of hospital patients testing positive for the coronavirus has fallen to 39,000 as of Friday, after peaking at 47,000 around January 10. Covid-19 patients occupy 5 percent of hospital beds, compared to 21 percent at this time last year, according to CDC data.

Weekly emergency room visits for all three viruses combined peaked in early December — with no post-holiday rebound, according to a new CDC dashboard. For seniors, emergency room visits due to covid and flu peaked in late December.

“It is possible that the drop would have been even greater without the holiday mixing,” said Barbara Mahon, a CDC official who oversees the response to the coronavirus and other respiratory viruses. “It doesn’t look as bad as it did a few weeks or months ago, but we are still in the middle of winter.”

Experts warn the country could see an additional increase in flu, which sometimes has two spikes, and another RSV season in the spring. The highly transmissible and immune-evasive XBB.1.5 subvariant of the coronavirus, which accounts for half of all new U.S. infections and is dominant in the Northeast, could spread elsewhere.

Despite the declines, it’s still a busy winter for hospitals battling a new unpredictable rhythm of infectious diseases. The viral attacks have happened a toll on a depleted healthcare workforce and jeopardized their ability to care for patients with non-respiratory emergencies, hospital administrators say.

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Heading into the third anniversary of the coronavirus reaching the United States, many hospitals are resigning themselves to the fact that it will never go away.

“We have almost three full years of going nonstop, of peaks, peaks, downhills, reaching a valley,” said Cathy Bennett, president and CEO of the New Jersey Hospital Association. “It’s rinse, wash, repeat.”

Comparisons to the devastation of the first two pandemic winters may mask the ongoing toll of the elderly and severely immunocompromised. Covid deaths are rising and are averaging around 670 a day, well below the peak of 3,300 a day in the midway pointJanuary 2021.

The United States is now better equipped than earlier in the pandemic to weather the coronavirus spikes because most people have some degree of immunity, and early treatment keeps the most vulnerable people become seriously ill.

“As awful as omicron was, it left a tremendous amount of immunity,” said Jennifer Nuzzo, an epidemiologist at Brown University School of Public Health.

Even though the omicron subvariants that are now in circulation are causing concern because of their ability to evade antibodies, the immune systems of those who have been vaccinated or previously infected are still effective at keeping cases mild, especially if they have recently received booster injections, doctors say.

At Our Lady of the Lake Regional Medical Center in Baton Rouge, covid cases peaked in the first week of January, with 170 patients testing positive, compared to 1,338 the same time last year. Doctors there believe covid is still rampant in the community, but not as many people need hospital care.

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Even after XBB.1.5 got fast the dominant coronavirus strain in Massachusetts in December, the temporary one The rise in the number of patients testing positive in the state’s largest hospital system was modest and did not exceed the last wave of winter. The Mass General Brigham System, headquartered in Boston, now averages about 400 patients per day testing positive for the coronavirus, compared to about 2,100 patients per day around this time last year.

Nearly three-quarters of patients admitted during the most recent peak with covid were “secondary” diagnoses, meaning the patient tested positive while admitted for other causes. While such cases still present complications for hospitals to isolate the patient and prevent spread, they don’t exhaust as many clinical resources, doctors say.

“Overall, this is all good news,” said Erica Shenoy, the system’s medical director of infection control. “One question we all have is, ‘Where is this going? Will we settle into a typical breathing season where things settle down?’”

Flu is known for being unpredictable in terms of public health, but experts following its trajectory say it appears to be consistent with previous flu seasons and is starting to decline early because it started early. Outpatient visits with respiratory illness have fallen below baseline in parts of the country, including the Upper Midwest, Great Plains and south central United States, the CDC said Friday.

“Now the question is, are we getting a typical spring or a late season influenza B spike?” said Scott Hensley, a microbiologist who tracks flu viruses at the University of Pennsylvania Perelman School of Medicine. He urges people who haven’t gotten the flu shot to do so because Americans have less immunity given the low number of influenza B cases in recent years.

It is important that public health experts and the media be transparent but not alarmist in their coverage and reporting, he said David Rubin, a pediatrician who tracks national respiratory virus trends as director of PolicyLab at Children’s Hospital of Philadelphia. The public fixation on a “triple disease” has always been a misnomer, he said, because viruses are typical not rising at the same time, but ebbing and flowing as they compete for hosts.

“It can become a howling wolf,” he said, “And if there really is another public health emergency, like a new pandemic, will people listen?”

Jacqueline Dupree and Dan Keating contributed to this report.

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