“We’re triple busy, but we have less staff. It’s just a disaster. There’s no medicine. It’s like a third world country,” said Dr. Nadia Persheff of Hampton Pediatrics Southampton.
Just when you thought it was safe to leave your house again, the so-called “tripledemic” has arrived. The confluence of Covid, influenza, and respiratory syncytial virus (R.S.V.) is causing people to break out their masks, hand sanitizer, and disinfectant just ahead of the holidays.
Flu hit hard and early this year. If you can remember the pre-pandemic years, back in 2019 at this time in December, New York State had 1,838 confirmed cases of the flu. As of Dec 10, there have been 52,940 cases, a dizzying increase.
A line graph on the New York State Department of Health website depicts flu cases alongside lines representing past years. This year’s steep rise is creating the left side of a mammoth mountain that makes the little squiggles from recent years look like mere foothills.
“It is scary to see that slope,” said Dr. Fredric Weinbaum, chief medical officer at Stony Brook Southampton Hospital. “And we’re just at the beginning of what is typically the season for upper respiratory illnesses.”
“There are a lot of people who don’t pay attention to the flu vaccine because they haven’t had it recently, but it’s a big factor,” he said. “Everybody knows someone who got the vaccine but then got the flu anyway. That happens. But the data from randomized trials shows that the vaccinated may get the flu but they don’t die from it. That’s the ticket for everyone to remember.”
“The old saying is that if you feel like you were hit by a truck, but weren’t actually hit by a truck, then you have the flu,” said Alphonso Scotti, a physician assistant at Weill Cornell Medicine in Southampton. He said early detection and treatment are key. “If you catch the flu within 48 hours, we have antivirals that can help. With Covid, we need to catch it in the first five days.”
“Everyone thinks the flu shot is optional,” said Dr. Persheff. “But the danger with flu is the secondary bacterial infections kids get. The problem currently is that it’s almost impossible to get amoxicillin right now to treat those infections. You might be able to get it in adult form, but you can’t give a sick 2-year-old a horse pill.”
In November, the American Academy of Pediatrics published a document titled “Amoxicillin Shortage: Antibiotic Options for Common Pediatric Conditions” and said the “national shortage is anticipated to last several months.”
“It’s mayhem. None of the rules we had last year seem to apply,” she said, regarding masking. “The flu strain that’s been around is pretty bad. Nobody understands that we’re in crisis. Kids are getting a weeklong fever, then two weeks of cough, and then they come in with a sinus or ear infection. Three visits for every kid and everyone thinks the vaccine is optional. This is just not the year to picket vaccines.”
In the summer of 2021, the federal Food and Drug Administration fully approved the first Covid-19 vaccine, after it was originally available only under emergency use authorization. On Dec. 9, the Centers for Disease Control expanded the use of the bivalent booster for children as young as 6 months. Worldwide, 70 percent, or about 5.6 billion people, have received at least one dose of a Covid-19 vaccine. The C.D.C.’s full vaccine recommendations can be found online at cdc.gov.
But for children, the elderly, and the immunocompromised, R.S.V. is another threat, for which there is no vaccine.
Dr. Persheff said R.S.V. used to have a seasonal pattern but that it was circulating this summer, before really ramping up in the autumn. “It’s not on the wane, and for babies it can be devastating. Older kids get through it, but they can pick up secondary infections,” she said. Those infections are further straining the low antibiotic supplies.
“There’s been a lot of pent-up demand by people to engage in the fun things that they would like to,” said Dr. Weinbaum. “Airports are setting new travel records. But we’re in a precarious position. People were so careful the last few years that natural immunity is at a lower ebb. Vaccines are the only way around that.”
Meanwhile, the regular old Covid-19 pandemic continues to rage, although people have largely become inured to it. While the flu and R.S.V. are spread by droplet, and to a lesser extent surfaces, Covid is aerosolized, lingering in the air itself, making it easier to get. Suffolk County was recently placed on a list of 10 New York State counties where the C.D.C recommends masking when indoors.
“Covid numbers have increased substantially from what they were six months ago, and there has been a jump in admissions with positive tests,” said Dr. Weinbaum. “But the impact of vaccination has been very salutary and outcomes from Covid are nowhere near what we were seeing in the pre-vaccination era. Very rarely do people need the intensive care unit. Those that do tend to have multiple medical conditions.”
Mr. Scotti concurred. “There’s less progression to severe disease in the fully vaccinated group.”
“Less than 5 percent of the ‘at risk’ population hasn’t seen a vaccine or had Covid already,” said Dr. Weinbaum. “You see fewer unvaccinated people in the hospital simply because there are fewer gross numbers of them in our area. People who are unvaccinated tend to have more severe illness.”
“I would encourage anyone who is eligible to get the bivalent booster,” he said.
“Vaccines improved the quality of life more than any other thing; more than computers, cars, or any other technology, because they let us live,” said Dr. Persheff. “The flu shot prevents more hospitalizations, illnesses, and deaths than the entire vaccine schedule. You don’t even have to make a doctor’s appointment. You can get it at any of the big drugstores.”
So, what do you do this holiday season?
A simple thing you can do, medical professionals say, is to make healthy choices. Eat your fruits and vegetables, drink less alcohol, and get regular exercise. It sounds like it will be difficult to dodge some illness this winter, but with a combination of vaccination, good decisions, and recognizing risky situations, the tripledemic could be less of a factor. Also, they say, don’t be selfish: Health isn’t just about you, it’s about your community.
“If you’re young, fully vaccinated, and can tolerate a Covid infection, whatever you do, that’s your choice,” said Dr. Weinbaum. “But if you’re then going to a social gathering and then you visit your grandmother, mask up. The fact of the matter is people that mostly need to be protected are those at highest risk either because of age or immunocompromise. If you engage in risky behavior and then come into contact with vulnerable populations, you’re making it as if they’re taking part in risky behavior.”
“If you have any symptoms at all, just stay home. If you have mezzo symptoms, get tested.”
When asked if there was a light at the end of the tunnel, Dr. Persheff answered with a single word: “Summer?”
