Episode 20: The New Year Tripledemic, Hosted by Rainaclare Sibal

Public Health Podcast Report, Ep. 20: The Triple Threat of RSV, COVID-19, and Flu (the “Triple-demic”), with Rainaclare Sibal

Welcome to this episode of the Public Health Report. I am your host, Rainaclare Sibal, and today’s episode is a holiday/year-end special!

With the holiday season here and quickly passing, one of the biggest public health concerns is the “Triple-demic”, the simultaneous rise in cases of RSV (or Respiratory sin-SISH-ul virus), COVID-19, and the flu. This is especially concerning for children under 5 years old whose immune systems are still underdeveloped. Added on to this is the recent addition of the rise in infection of a certain Streptococcus bacteria in the United States and Europe, compounded by the shortages of over-the-counter children’s fever medications across the US.

The holidays have not been the same over the past two years, but with the relaxation of masking mandates across the country, families and friends are returning to pre-pandemic traditions of gathering and celebrating together. Many families do what they can to stay safe, and the CDC even has a Holiday Gathering guideline page available with recommendations for party hosts, which includes suggestions for masking, good ventilation, self-testing, and symptom checking. A significant contribution to safer gathering is the updated COVID-19 vaccine, but even with emergency approval of the most current one now extended to children at least 6-months old, vaccine hesitancy persists across all age ranges.

Public health professionals face the challenge of reminding the public that the pandemic and its impacts are still real concerns, and added onto this are the threats of other infections. In a recent publication from Oxford Journals, through Open Forum Infectious Diseases, researchers performed a repeated cross-sectional survey in both English and Spanish over 3 years. This survey examined caregivers’ knowledge of the influenza and SARS-CoV-2 viruses, and what types of attitudes and behaviors were linked to vaccine hesitancy in 6-month old to 18-year old children in a large pediatric medical institution. Vaccine hesitancy was measured through the Parent Attitudes about Childhood Vaccines survey, or PACV survey, which showed subsequent increases in vaccine hesitancy by parents each year over the study period.

The results from this study showed that after the height of the COVID-19 pandemic, caregivers were less likely to consider flu infection to be dangerous for children and were less likely to agree that children over 6-months old should receive a yearly flu shot. Through the pandemic, the researchers discovered that the lowered level of concern for the flu remained low.

On top of COVID-19 and the flu, RSV is a big threat to small children, while pediatric hospital units are struggling to sustain heightened loads of pediatric patients. RSV, an infection that typically results in symptoms similar to cold and flu symptoms, was once common in young children, who would normally recover before reaching 2 years old. Daniel Rauch, the chair for the American Academy of Pediatrics Committee on Hospital Medicine with Tufts University School of Medicine, Boston, told the Lancet in a recent publication that hospitalization of three, four, and five-year olds is not supposed to be common. A possible reason for the increased hospitalizations in children this young is that children who are now older were protected from RSV infection by increased COVID-19 precautions over the past few years, according to Tina Q Tan with the Ann & Robert H Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine.

Worsening the ability to care for children who need to be hospitalized is the profit-motivated closures of pediatric hospital units across the United States, putting a strain on existing ones that are already short-staffed and short-resourced, according to the Lancet. The closures themselves are often in exchange for sustaining adult hospital units and surgeries on adult patients, which generate higher profit than smaller beds and pediatric surgeries.

Compounding the limited resources available to pediatric hospital care are a lack of resources to address other concerns that cause young children to land in the hospital without an alternative option. A large concern discussed by the Lancet is the growing number of children experiencing struggles with mental health, especially attempts at suicide now the leading cause of death in the US among children 10 years and older. Mental health struggles continue to push pediatric hospital units to capacity.

As we close off: 2022

To wrap up: 2022

References:

What the Triple Threat of COVID, RSV and Flu Means for Children:

https://www.scientificamerican.com/article/what-the-triple-threat-of-covid-rsv-and-flu-means-for-children/

ive Group A Strep Infections,: 2022

https://www.cdc.gov/groupastrep/igas-infections-investigation.html

Increase in invasive Group A streptococcal infections among children in Europe, including fatalities:

-: 2022

Holidays and COVID-19:

https://covid19.ca.gov/holidays/

Triple-demic overwhelms paediatric units in US hospitals:

m/journals/lanchi/article/PIIS: 2352

580. Influenza, SARS-CoV-2, and routine childhood vaccines – trends in vaccine hesitancy in hospitalized children before and during the COVID-19 pandemic:

/: 690305

US faces triple epidemic of flu, RSV, and covid:

/bmj.o: 2681

As Hospitals Close Children’s Units, Where Does That Leave Lachlan?:

https://www.nytimes.com/: 2022