California officials are urging preventative measures to thwart the spread of respiratory disease and mitigate a healthcare system already grappling with the triple threat of COVID-19, influenza and RSV.
For weeks, public health officials in the most populous state have been sounding the alarm about the challenges posed by the simultaneous circulation of the three viruses. With Thanksgiving and the rest of the holiday season just around the corner, the ways residents address these health concerns can help chart the course for the state in the coming months, officials say.
“We are facing three threats at once,” California Health and Human Services Secretary Dr. Mark Ghaly said this week. “In every category we track – whether it’s test positivity, case counts, sewage monitoring, clinical monitoring, hospitalizations – we’re seeing increases for RSV, influenza and COVID.”
RSV is of particular concern, respiratory syncytial virus, which can lead to serious illness and death in young children and the elderly. It hit with full force, sickening so many children that some hospitals reported lack of pediatric beds.
“We’ve seen a sharp increase in all of our RSV cases,” said Dr. Vidya Mony, a pediatric infectious disease specialist at Santa Clara Valley Medical Center. “If you look at a lot of curves, it’s almost linear…so it’s a lot more than what we’ve seen in a few years.”
Complicating matters is the fact that pediatric hospital beds can be scarce, even at the best of times.
“Many hospitals have only a small number of pediatric beds, which means that only a small number of new pediatric hospitalizations have the potential to bring a hospital to full capacity,” said Dr. Muntu Davis, head of the Los Angeles County Health.
Orange County this month declared a health emergency amid a high level of RSV and other respiratory illnesses that required “hospitalization of children beyond the capacity and infrastructure of our designated children’s hospitals,” officials said.
On Tuesday, LA County reported average daily occupancy for staffed pediatric hospital beds at 64%, up from 60% on Nov. 1. For pediatric intensive care beds, the average daily occupancy was 75%, compared to 67%.
Both numbers are higher than at any time in the past 17 months, according to Davis.
“These numbers don’t translate to a dire situation in hospitals right now,” he said, but “the increase in pediatric bed occupancy is concerning, especially as we are still in the beginning of the typical respiratory virus season”.
It’s unclear whether that means the state is in a virulent season, or just an atypically early season.
“We have already experienced levels of test positivity for RSV infections among younger Californians that rival the peaks of other years. And we don’t know if they’re going to keep going up or start leveling off,” Ghaly said.
Added to this uncertainty is the collision of COVID-19 and influenza. The much discussed “twindemic” failed to materialize in the past two years as the state was instead ravaged by horrific waves of coronavirus. But that is not the case this year.
“This is the first year that we have not only faced COVID, but also increased flu activity and unusually high levels of RSV,” said Santa Clara County Deputy Health Officer Dr. Sarah Rudman.
While all three illnesses can cause mild symptoms in older children and young adults, “they are all especially dangerous for our youngest children, older adult members of our community, and people with other medical conditions. “, she told reporters on Wednesday.
“Right now, we’re already seeing these diseases hitting our youngest children and impacting our hospitals and doctor’s offices to get care for these children,” Rudman said. “With the holidays approaching, it is especially important that we do all we can to prevent these illnesses.”
During the week ending November 12, the most recent period for which data is available, influenza activity was considered high in California, according the United States Centers for Disease Control and Prevention. This assessment is based on surveillance for respiratory illnesses that include fever plus a cough or sore throat, not just laboratory-confirmed cases of influenza.
The early hot spot The southeastern corner of the state remains — San Diego, Orange, Riverside, San Bernardino and Imperial counties — but overall flu activity is increasing across California, according to state data.
Pressures from respiratory disease have prompted some San Diego County hospitals to use overflow tents outside of their emergency departments. Ghaly said on Thursday he would not be surprised if other facilities were also in demand or would be soon.
“It’s not at all surprising to me that some facilities – whether it’s because of the flu or because of the flu plus COVID plus RSV plus some other respiratory viruses that are going around – are starting to need to use alternative spaces, whether tents outside or certain areas inside, to help create triage spaces, treatment spaces, to meet the needs of their communities,” he said .
The last two flu seasons were relatively milda development manager attributes in part to infection prevention protocols intended to thwart COVID-19.
But many of them – widespread masking, physical distancing and avoiding crowds – have been abandoned as pandemic conditions have improved.
Instead of stricter measures, health officials say, there are several ways for residents to protect themselves and those around them. Wearing a mask in crowded or indoor public spaces, washing your hands regularly, wiping down frequently touched surfaces, covering sneezes and coughs, and hosting events outdoors — or maximizing ventilation for those standing outside indoors – may reduce the risk of transmission.
Authorities are also urging Californians to get their COVID-19 and flu shots. There are no vaccine available for RSV.
“I realize a lot of people think it’s too late to get vaccinated before Thanksgiving because vaccines need time to be effective,” Davis said. “Although the protection intensifies over one to two weeks after vaccination, this does not mean that you will have no protection so far. You still have some protection and you will be prepared for future events.
Many experts say they expect COVID-19 bounce back this winter.
In LA County, the daily number of new reported cases jumped almost 70% from last month – although it remains well below previous waves.
“Cases are rising, new variants are emerging, and there are concerns that hospitals are reaching capacity,” Davis said. “I encourage everyone to use this information as a reminder that we need to leverage the resources we have and use layered protections to have a safe vacation.”
Meanwhile, the coronavirus landscape continues to change. The CDC estimates that BA.5 – the Omicron sub-variant that has long been the dominant version circulating nationwide – has been surpassed by two of its descendants: BQ.1 and BQ.1.1.
While this may indicate that the new subvariants enjoy a growth advantage over BA.5, some health officials remain confident that existing therapeutics and vaccines will mitigate the worst of any winter surge. Included in this kit now are updated bivalent boosters which target both the original coronavirus strain and the dominant Omicron subvariants, including BA.5.
“It really depends on all of us. We really have this golden opportunity to stay safe during this fall season as we prepare for the holidays,” said Fresno County Acting Health Officer Dr. Rais Vohra.