The United States has already plunged into one of the roughest seasons of winter illnesses in decades. With what’s now being called a tripledemic, which includes SARS-CoV-2 (COVID-19), influenza (flu), and respiratory syncytial virus (RSV) already spreading rapidly, the winter ahead could be worse.

After nearly three years of being sequestered, children and adults are back out in crowds, with no masks, no distancing, and viruses waiting.   

What Is RSV?

RSV, or respiratory syncytial virus, is not new. It’s one of the common viruses that circulate in the environment. Similar to COVID, mutations help these viruses evolve into slightly different and potentially more troublesome versions when they resurface each year. As a result, some strains end up being harsher to humans than others. 

This does not just affect children, but those who typically suffer extreme bouts are young children, predominantly those less than two years old and with risk factors, such as having been born prematurely, with heart or lung disease, or other health conditions.

While adult RSV infections are uncommon, those most vulnerable – as we also saw throughout the COVID pandemic – tend to be older adults with chronic lung or heart disease and/or weakened immune systems. Such conditions can worsen because of RSV. 

Both children and adults can also develop other adverse effects, including pneumonia, as we’ve witnessed previously with COVID and influenza.


Influenza is certainly not a novel virus, and in years past, prior to 2020, the United States would typically see anywhere from 20,000 to 60,000 annual deaths due to complications of the flu. Vaccines to protect against influenza are tailored each season, based on the prior season’s flu strains, to minimize risks of infections, complications, hospitalizations and flu-related deaths. 

Most years, fewer than 50% of the population receives a flu shot, which is approved and recommended for all ages 6 months and up.

What’s the Difference Among COVID, Flu & RSV?

The symptoms of these three respiratory infections can look quite similar. According to UC Davis Infectious Disease specialist Dr. Dean Blumberg, there are several differences to look out for in these three illnesses:

COVID-19 SymptomsRespiratory Symptoms
  Flu Symptoms
-Fever or chills-Respiratory symptoms (cough, sore throat, runny nose)-Loss of taste and smell-Fatigue-Sore throat-Muscle or body aches-Runny nose-Coughing-Fever-Wheezing-Loss of appetite-Sudden onset fever or chills-Respiratory symptoms (cough, sore throat, runny nose)-Muscle aches and pains-Headaches

What Can You Do to Reduce Risk?

Short of sounding like a broken record, the means to reduce risks of illness remain the same as in years past. Keeping up to date on COVID vaccinations clearly reduces risks of complications from COVID infections. This includes the newest bivalent COVID booster vaccine.

Officials recommend all people over age 6 months receive an annual flu vaccine, especially pregnant women, since protection from flu can be transmitted to their newborn in the baby’s first six months, before they are eligible to be vaccinated themselves.

This transmitted protection also applies to COVID-19. Pregnant women who are vaccinated against COVID-19 transfer antibody protection to the fetus. This protection continues in the first months of a baby’s life.

As for RSV protection, there is no vaccine for RSV protection, although Pfizer recently released promising data on RSV vaccine administration to pregnant women, which will provide protection to vulnerable newborns. 

The other means of protection continue to include consideration for masks in indoor environments this winter. Masks have clearly been shown to reduce risk of transmission of viruses, thereby reducing risk of illness. 

For those who remain skeptical of masking, thank your healthcare professionals for keeping their masks on while caring for sick people, not getting sick themselves, and showing up to care for the sick during this surge, during one’s past, and during ones to come.

Black Americans: Still Fighting Vaccine Hesitancy

A study conducted in part by researchers from the Maryland Center for Health Equity at the University of Maryland, College Park, looked at racial disparities in flu vaccinations.

Even though Black Americans stepped up in larger numbers to get their initial COVID vaccine, that commitment hasn’t seemed to transfer to other vaccines, including COVID boosters and the flu shot.  

According to the study, African American hesitancy toward shots remains a lack of trust in vaccines, which looms larger over the risk of getting the flu. Compare that to White Americans who are more likely to not get a flu vaccine because they don’t think the flu is a big deal, the study found.  

The researchers found African Americans are concerned about the safety of the shot more than the health risks of the flu.

The findings are important as the medical community tries to improve vaccination rates. Fewer than half of Americans get the flu vaccine, according to the Centers for Disease Control and Prevention. Just 41% of Black Americans get vaccinated, compared with 47% of Whites. 

The vaccination rate for the bivalent boosters, which protect against the BA.4/5 sub variants and the original virus strain, have been remarkably slow. Only 11% of eligible Americans have gotten the booster since it became available in early September

The new study found that the updated boosters work similar to the original boosters. They protect against symptomatic infection in the range of 40% to 60%.  

That’s about the same range as typical efficacy for flu vaccines. Over the past decade, CDC data shows the effectiveness of the seasonal flu vaccines has ranged from a low of 19% to about a high 52% against the need to see a doctor because of the flu. The effectiveness varies depending on how similar the strains in the vaccine are to the strains that end up making people ill.


We tend to think COVID is behind us, but it’s still active in our midst with the seven-day average new death across the country holding at 360. Here are some other U.S. COVID related stats as of late November 2022: 

  • Cases Since the beginning of COVID:  98,521,273  million
  • Deaths since the beginning of COVID:  1,088,060.
  • 7-day average new cases: 47,438
  • 7-day average new cases: 23,270
  • 7-day average new cases: 360

Flu hospitalizations way up

This year’s flu season appears to be more critical, with a nearly 30% increase of hospitalization prior to the holidays. Flu activity typically rises after Thanksgiving, however, the November case numbers were well above average.   .

The Center for Disease Control and Prevention recorded about 11 out of every 100,000 people have been hospitalized with the flu since early October, the highest level in a decade. More than 6.2 million people have fallen ill, 53,000 have been hospitalized, and 2,900 have died this season.

Prior to 2020, when Americans isolated and masked against COVID, also protecting them from the flu, America experienced between 20,000 to 60,000 deaths per year from the flu.

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