What to Know About the ‘Tripledemic’

The 2022-23 cold and flu season is underway, and the U.S. is seeing more cases of respiratory syncytial virus (RSV). With COVID-19 also still around, some medical experts are warning of a potential “tripledemic” this winter.

Combined, COVID-19, the flu, and RSV could cause millions of infections in the United States this fall and winter. Some people are at higher risk of severe illness, hospitalization, and death.

It’s important to note that a tripledemic is not guaranteed. At UPMC, we are preparing to respond to whatever does happen.

“I don’t know that we’re going to have a tripledemic in the sense that the health systems are going to be totally overwhelmed and we’re all going to be sick,” says Graham Snyder, MD, medical director, Infection Prevention and Hospital Epidemiology, UPMC. “We are seeing many infections, and there are some people who have multiple infections. I do not expect a super illness that debilitates millions.

“All we do know is that the prevalence of these viruses is going up, so the probability that you’re going to encounter them is also going up.”

There are ways you can lower your and your loved ones’ risk of getting COVID-19, the flu, and RSV. Find out more about the causes of the tripledemic and what you can do to protect yourself.

What’s Causing the Tripledemic?

The continued presence of COVID-19 and earlier peaks of the flu and RSV are causing higher-than-normal respiratory illness cases in fall 2022. A large factor is that the population is more vulnerable now than it was in the previous two years due to lack of exposure and waning immunity.

The flu, RSV, metapneumovirus, and other respiratory illnesses were around in the 2020-21 and 2021-22 seasons. But they occurred in much lower numbers because of COVID-19 prevention efforts like masking and physical distancing. With many of those prevention efforts beginning to relax, it provides more of a risk for infection.

“The respiratory viruses now have an opportunity to spread again because we’ve stopped distancing, resumed usual activities, and we’re unmasking,” Dr. Snyder says.

Although COVID-19 cases are not at their earlier peaks, the disease is still circulating throughout the U.S., Dr. Snyder says. With the holiday season coming up, cases could rise this winter because of travel and other factors.

Vaccines and treatments have helped to lower severe illnesses, hospitalizations, and deaths. But certain groups of people are still at higher risk, including those who are:

  • Immunocompromised.
  • Older.
  • People with underlying health conditions.
  • Unvaccinated.

“It’s still quite prevalent,” Dr. Snyder says. “And for an increasingly smaller proportion of people, you can get seriously ill. You could still be hospitalized. You can still die.”

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What’s Behind the Rise in RSV Cases?

Most children get RSV by the time they’re 3 years old. But because of COVID-19 prevention efforts, the number of RSV cases dropped the last two years. That means a large group of children who had no previous exposure to the virus are now getting infected and becoming sick.

“The RSV data show that the number of infections with the virus is nearly double what we would normally see, and that’s because of that basically double-sized susceptible pool,” says John Williams, MD, chief, Pediatric Infectious Diseases, and director, Institute for Infection, Inflammation, and Immunity in Children, UPMC Children’s Hospital of Pittsburgh.

“We’re not seeing 10 times the RSV cases we normally would. While we usually see mostly babies, we’re now seeing the babies and the toddlers who didn’t get RSV last year.”

For the same reason, Dr. Williams says the flu and metapneumovirus — another common respiratory illness — are also concerns in pediatrics this season. A larger group of children are vulnerable to those illnesses this season because they haven’t experienced them the past two years.

After a first infection, people continue to get RSV, the flu, metapneumovirus, and other respiratory illnesses throughout their lives, Dr. Williams says. But the first illness often is the most severe.

“There’s a big difference between some immunity and no immunity,” he says.

Most cases of RSV are mild and go away within a week or two. But some people are at greater risk, including:

  • Infants (including premature babies) and young children.
  • Immunocompromised people.
  • Older adults.

People with underlying health conditions like heart disease or lung issues.

“From a pediatrics standpoint, it’s really all about the small number of severe cases,” Dr. Williams says. “Most children are going to get these infections fairly early in childhood and most will be fine, but a small number of otherwise healthy children will have severe disease.”

Should I Worry About the Tripledemic?

The flu and RSV are here earlier than normal, COVID-19 is still around, and metapneumovirus usually follows the flu. But it’s not a guarantee we’ll have a worse fall and winter than usual. Dr. Snyder says it’s possible the numbers of RSV and flu cases could drop after early peaks.

But with COVID-19 prevention efforts more relaxed now than in the previous two seasons, it’s possible we’ll see higher numbers of respiratory illnesses. With that in mind, it’s important to take your own precautions to protect yourself and your loved ones.

Preventing COVID-19, RSV, and the Flu

There are several ways you can lower your risk from respiratory illnesses:

  • Get the COVID-19 vaccine. The Centers for Disease Control and Prevention (CDC) recommends all Americans 6 months and older get the COVID-19 vaccine. Americans 5 years of age and older are eligible for the bivalent booster of the COVID-19 vaccine, which protects against the original virus and Omicron subvariants. The vaccines and booster vaccines are safe and effective, especially in preventing severe illness, hospitalization, and death.
  • Get your flu shot. Likewise, the CDC recommends everyone 6 months and older get the flu vaccine. Doing so can lower your risk of infection and severe illness from the flu. The typical flu vaccine protects against common circulating strains of the virus. “The vaccine is important, as it is every year,” Dr. Snyder says. “It’s not too late, but it will be if you wait.”
  • Stay home if you’re sick. Respiratory diseases like COVID-19, the flu, RSV, and metapneumovirus spread through close contact. To prevent spreading these viruses, you shouldn’t go to work or school if you have symptoms of these illnesses. Likewise, you should avoid close contact with people who are sick.
  • Get tested. If you have symptoms of the flu or COVID-19, it’s important to get tested. If you test positive, you may be eligible for treatments that could lower your risk of severe illness. “More than ever, you can’t tell the difference between these viruses,” Dr. Snyder says. “So getting tested is important.”
  • Consider masking in certain circumstances. Masking regulations have relaxed in many places around the country. But you may want to wear a mask in certain situations, such as when you’re in a crowded indoor space. “You don’t need a mask outside at the park when you’re going for a walk,” Dr Williams says. “But when you’re standing in a crowded line at the grocery store, that might be a good time to put on a mask.” Please note: UPMC still requires patients, staff, visitors, and all others to wear a facemask in our facilities.
  • Remember hand hygiene. Many of these illnesses can spread after touching an infected person or object and then touching your nose or mouth. Washing your hands often with soap and water or using hand sanitizer can help prevent disease spread. Dr. Williams recommends carrying a bottle of hand sanitizer and using it often.

If you are feeling sick, a good first step is to call your doctor. Or, you can use a UPMC video visit or UPMC AnywhereCare to get advice on what to do next. Your provider can assess your condition and provide the best next steps for you.

If you are experiencing severe symptoms, seek help right away by calling 911 or visiting the emergency department. Severe symptoms may include:

  • Fever.
  • Persistent chest pain.
  • Trouble breathing.

In children, Dr. Williams says the most concerning symptoms to watch for are trouble breathing and signs of dehydration. Call your child’s pediatrician if you notice those symptoms.

How UPMC Is Ready to Care for You

If you have COVID-19, the flu, RSV, or any other illness, UPMC is prepared to provide compassionate, expert care. Our providers throughout all of our communities can get you the care you need when you need it, at a location close to home.

Our services include:

  • Care for COVID-19, such as vaccinations and other treatments. You can schedule a vaccine at UPMC by visiting our website. You also can talk to your doctor about testing and treatment if you have symptoms.
  • UPMC Primary Care, UPMC Urgent Care, UPMC Children’s Community Pediatrics, and UPMC Children’s Express Care can provide care for the flu, including immunization.
  • With the rise of RSV cases, UPMC Children’s has set up a tent to supplement its emergency department. The hospital has previously taken this approach during peaks of other respiratory diseases, including COVID-19. Our Children’s Express Care locations also provide care.

If you need care, do not hesitate to call or visit us. We are here to help you. To find UPMC services in your community, visit our website.

About Infectious Diseases

If you have a disease caused by bacteria, fungi, parasite, or virus, the UPMC Center for Care of Infectious Diseases can help. Our team of experts is specially trained in the prevention and treatment of infectious diseases, including of HIV-AIDs, postsurgical and transplant infections, illnesses caused by international travel, and more. We research infectious diseases and participate in clinical trials to learn more and develop better treatment and prevention methods. Visit our website to find an expert near you.

About Pediatrics

From nutrition to illnesses, from athletics to school, children will face many challenges growing up. Parents often will make important health care decisions for them. We hope to help guide both of you in that journey. UPMC Children’s Hospital of Pittsburgh is a national leader in pediatric care, ranking consistently on U.S. News & World Report’s Best Children’s Hospitals Honor Roll. We provide expert treatment for pediatric diseases, along well-child visits, urgent care, and more. With locations across Pennsylvania, Maryland, and West Virginia, you can find world-class care close to home. We also work closely with UPMC Magee-Womens Hospital, a national leader in care for newborns and their mothers. Our goal is to provide the best care for your children, from birth to adulthood and beyond. Visit our website to find a doctor near you.