As we approach the upcoming respiratory virus season, the memory of last year’s harsh ordeal remains fresh. After experiencing two remarkably light flu seasons due to pandemic precautions like social distancing and masking, the return of influenza was fierce, arriving early and causing a widespread impact.
In tandem, the respiratory syncytial virus (RSV), which had sporadically appeared throughout the year, surged during the winter months, resulting in one of the most severe RSV seasons in recent memory. To compound matters, COVID-19 cases showed a resurgence, a familiar situation after three years of successive waves.
This time, however, there’s optimism that the forthcoming season won’t mirror the distress of the past. Anticipations point to a return of RSV and flu to their typical seasonal patterns, given their current low levels. While COVID-19 could witness a winter surge, many experts believe that it won’t reach the peaks seen in previous years, barring the emergence of a new variant – a probability estimated between 10% and 20% within the next two years by virus evolution experts.
Encouragingly, there are now tools available to safeguard the most vulnerable, thanks to vaccines and antibodies. These resources are already accessible, with additional options on the horizon.
Dr. Buddy Creech, a pediatric infectious disease specialist at Vanderbilt University, states, “We have three respiratory viruses that we think will be the major players for wintertime colds: COVID, flu, and RSV. And for the first time in human history, we have vaccinations against all three of them.” Nevertheless, he stresses that the effectiveness of these vaccines depends on their widespread utilization.
The road ahead presents notable challenges in ensuring equitable access to these vaccines and addressing vaccine hesitancy. As the government ceases to purchase COVID-19 vaccines for all citizens, the responsibility of covering costs may shift to insurers and potentially patients themselves. The complexity of determining who covers the expenses remains until the latest vaccine version gains FDA approval and CDC recommendation.
Challenges also encompass vaccine delivery systems for adults. The expansion beyond existing pharmacy chains and hospitals, especially in rural and low-income areas, remains an unresolved issue. Vaccine hesitancy fueled by anti-vaccine activism, compounded by the COVID-19 pandemic, could result in low uptake rates for the three adult vaccines this fall.
Looking ahead, several predictions have been made for the upcoming respiratory virus season.
COVID-19
As summer draws to a close, COVID-19 cases are experiencing a seasonal increase as people engage in travel and seek indoor shelter from extreme heat. This behavior facilitates the sharing of germs, a phenomenon evident in the current surge of COVID-19 cases.
The rise in COVID-19 hospitalizations since early July is evident through CDC data. In the initial week of August, over 10,000 individuals were hospitalized due to COVID-19, marking a 60% increase over a month and a 14% increase in the past week.
Although rates now resemble those of April, this surge differs from past waves. Weekly COVID-19 hospitalizations currently stand at approximately a quarter of last year’s levels and lower than 90% of the pandemic’s duration.
While updated COVID-19 vaccines designed to enhance immunity against specific variants are underway, their availability is still a month away. Dr. Creech highlights the challenge of enduring the surge without the aid of these boosters, expected to arrive in mid-to-late September.
However, there are antiviral medications like Paxlovid and molnupiravir available to prevent severe disease, primarily for high-risk individuals. The challenge lies in encouraging usage, as these drugs are often not prescribed early enough due to patients not exhibiting severe symptoms initially.
Dr. William Schaffner, an infectious disease expert at Vanderbilt, anticipates a temporary dip in the current summer COVID-19 surge before a subsequent increase. He believes that this winter’s COVID-19 resurgence won’t be as severe as previous years, yet he emphasizes the importance of obtaining updated COVID-19 vaccines upon their release.
Flu
If the flu season follows a conventional pattern, cases will start surging in November, peaking after the New Year. Information from Australia’s flu season, currently underway, might provide insight into the potential trajectory of the US flu season.
This year’s flu vaccine includes an updated H1N1 strain, aligning more closely with emerging flu viruses at the previous season’s end. The vaccine appears to be a suitable match for the current circulating viruses.
Despite the expected return to seasonal norms, the CDC estimates that flu-related hospitalizations and fatalities will persist. Between 2010 and 2020, the flu resulted in an estimated 140,000 to 710,000 annual hospitalizations and 12,000 to 52,000 annual deaths in the US.
The challenge will be increasing flu vaccine uptake, which experienced a decline similar to bivalent Covid-19 vaccines. To boost vaccination rates, experts emphasize testing for the flu when symptoms arise.
RSV
Respiratory syncytial virus (RSV) can lead to respiratory distress, particularly in newborns, causing congestion, coughing, sneezing, and fever. Although RSV is typically mild in older children and healthy adults, it can lead to serious issues in infants.
Experts predict that RSV will return to its seasonal pattern this year, with cases increasing in October and peaking between late December and mid-February. RSV commonly causes hospitalization in children under one year of age and older adults, with estimates of 80,000 hospitalizations in children and twice as many in adults over 65.
New antibody shots for babies like Beyfortus and RSV vaccines from Pfizer and GSK offer potential solutions to reduce severe disease and hospitalization. The CDC’s recommendation of Beyfortus for infants and its inclusion in the Vaccines for Children program aims to address RSV’s impact on vulnerable groups.
A vaccine designed to protect newborns by immunizing mothers late in pregnancy is also under consideration by the FDA.
The protection afforded by the RSV vaccine for older adults extends into the second virus season. Both GSK’s and Pfizer’s RSV vaccines for seniors are now available at pharmacies across the nation.
Dr. Schaffner encourages individuals to consider taking the RSV vaccine for a protective head start. With these tools in hand, the potential impact of this trifecta of vaccines can contribute to a more resilient respiratory virus season.