'Tripledemic' risk spurs renewed capacity crisis concerns

Reports of hospitals operating over capacity are creeping up — a situation that could become more widespread over the next few weeks if COVID-19, flu and respiratory syncytial virus levels continue to rise, the CDC recently warned

Hospital leaders, physicians and virus experts are monitoring virus trends, acknowledging the possibility of a "tripledemic" in which flu, COVID-19 and RSV peak all at once. Flu and RSV peaked unseasonably early last year, while COVID-19 activity did not reach a high until January. Experts have warned that the three virus peaks may overlap this season, though there is some uncertainty in the forecast. 

New hospitalizations for COVID-19 have risen more than 50% over the past four weeks, while flu admissions have jumped 200%. There were more than 23,000 new COVID admissions reported for the week ending Dec. 9 and more than 7,000 new flu admissions in the same week. Meanwhile, RSV has hovered near a peak for several weeks. Respiratory virus metrics are still rising overall, meaning the season's peak likely is yet to come.

The spike in COVID activity also comes as a new variant, JN.1, grows rapidly. The World Health Organization designated the strain as a variant of interest on Dec. 19, separating it from its parent lineage, BA.2.86. The current public health risk posed by JN.1 is low as there has been no evidence of increased disease severity and current vaccines are expected to be effective, though health officials believe its prevalence could lead to higher numbers of infections. 

Given low vaccination rates in the U.S., health officials anticipate higher levels of severe disease from respiratory illnesses, which may place significant strain on the nation's healthcare systems already managing high volumes. As of Dec. 9, a weekly average of about 77% of the nation's inpatient beds were occupied. Zooming in on ICU beds, about 73% were occupied. 

"In some parts of the country, hospital beds for children are already nearly as full as they were this time last year," the agency said in a Dec. 14 update. "If these trends continue, the situation at the end of this month could again strain emergency departments and hospitals. Strain on the healthcare system could mean that patients with other serious health conditions may face delays in receiving care."

Children's hospitals are not alone — adult acute care facilities are also feeling the strain on their emergency departments and intensive care units, The Atlantic reported Dec. 19.  

In California's Fresno County, ED wait times are regularly exceeding 10 hours for patients with nonemergencies. Health officials in the county are pleading with the public to avoid emergency rooms for nonemergency conditions as its hospitals grapple with a "historic number" of admitted patients amid a sharp rise in respiratory illnesses. Some patients who are waiting to be admitted are being held in EDs for up to four days as hospitals operate over capacity by a minimum of 20% to 40%, officials said in a Dec. 19 news release. 

UVA Health is seeing a mix of patients in the intensive care unit with COVID-19, flu or RSV, nearly half of whom required ventilators or high-flow oxygen as of earlier this month, according to Taison Bell, MD, a pulmonary critical care physician at the Charlottesville, Va.-based system. 

The last time Dr. Bell saw this trend was in early 2022, when the original omicron strain was spreading nationwide, spurring a record number of cases and forcing many hospitals to ration COVID-19 treatments. 

Sallie Permar, MD, PhD, chief pediatrician at Weill Cornell Medical Center and NewYork-Presbyterian Hospital in New York City, said her teams are managing capacity well for now, though that could change if virus cases continue to rise. 

"We're treading water OK right now," she told The Atlantic. "Add much more, and we're thrown into a similar situation as last year."


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