State of union on virus season: Where COVID-19, flu & RSV stand

It's still unclear how a COVID-19 surge may play out this winter, but already, many U.S. hospitals are under capacity strain from an influx of patients sick with the flu and respiratory syncytial virus. 

Respiratory viruses have dominated healthcare headlines since August. Here's a look at where things stand with each of the "tripledemic" viruses as of mid-November: 

COVID-19: Cases are projected to jump more than 100 percent over the next two weeks, according to modeling from Rochester, Minn.-based Mayo Clinic. The nation's seven-day case average was 39,489 as of Nov. 13, HHS data compiled by The New York Times shows. Forecasts suggest that could jump to more than 70,000 by Nov. 23. 

What's less clear is how hospitalizations may shift as omicron subvariants BQ.1 and BQ.1.1 — which now account for about 42 percent of cases — continue to grow in prevalence. Hospitalizations are up about 2 percent over the last two weeks, with a daily average of 27,943 people hospitalized as of Nov. 13. The general expert consensus is that the strains will spur a winter wave less severe than last winter's omicron surge, assuming a completely new variant doesn't emerge. 

Flu: The CDC estimates there have been at least 2.8 million flu cases, 23,000 hospitalizations and 1,300 flu-related deaths so far this season. The nation is seeing unseasonably high levels of flu activity, with 6,465 lab-confirmed flu cases admitted to a hospital for the week ending Nov. 5. The overall cumulative hospitalization rate is 5.0 per 100,000 — the highest it's been this early in the season since the 2010-11 flu season. Southeastern and South-Central states are reporting the highest levels of flu activity, followed by the Mid-Atlantic region and California. 

The rise has started to affect hospital capacity. At least three hospitals in Southern California recently stood up overflow tents to handle an influx of flu patients. Health experts say it's still too early to tell whether influenza's early arrival will fizzle out by Christmas or persist through February. 

RSV: Capacity issues are intense at U.S. children's hospitals, with many operating at or above capacity amid a surge in respiratory syncytial virus. Seventy-six percent of the nation's pediatric beds were occupied as of Nov. 7, according to HHS data cited by NBC News. To manage the increased volume, some children's hospitals have erected overflow tents outside of their emergency departments or delayed elective surgeries, and others are reaching out to neighboring states to try their luck at finding an open transfer bed. RSV cases began ticking up in late August, though they usually don't peak until late winter. 

In October, some hospitals reported case increases of 300 percent or more compared to the previous month, and the emergency department at Cook Children's Medical Center in Fort Worth, Texas, recently saw 564 patients in a 24-hour period. 

"It all has a very COVID-esque feel to it," Meghan Bernier, MD, pediatric intensive care unit medical director at Johns Hopkins Children's Center in Baltimore, told The New York Times earlier this month. "This is the pediatrician's COVID. This is our March 2020."


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