Will there be another 'tripledemic'? 3 infectious disease experts weigh in

Inching closer to respiratory virus season, physicians are starting to get a clearer picture of what to prepare for this fall — which will mark the first virus season where COVID-19 has not been a public health emergency. 

A first look in June at what nations like Australia and South Africa were experiencing in the Southern Hemisphere — which has an opposite viral season than the Northern Hemisphere — showed clues of what to loosely expect: possible co-circulation of influenza A and B strains and relatively expected RSV and COVID-19 levels. 

Now, one month away from the typical beginning of respiratory virus season, three infectious disease physicians told Becker's that while we won't know exactly what is ahead until we get there, that immunity in many adults is waning from the decreased uptake of subsequent COVID-19 vaccine boosters, and that could play a role in how this season will unfold. 

Vaccination is telling

Importantly, they all underscored, RSV and influenza have co-circulated in the fall and winter for years even prior to COVID-19. COVID-19's addition to that mix presents challenges, but with updated vaccines and the upcoming roll-out of RSV vaccinations population uptake of those aids will be a significant key to what the season may look like going forward. 

"Respiratory viruses like COVID, influenza or RSV are somewhat dependent on the immunity and the exposure of that population previously to the viruses. One of the reasons why we're likely seeing a little bit of an uptick in COVID right now is because of waning immunity across our population, both because we've had a long period of time without a significant COVID transmission. And we've seen less and less uptake of COVID vaccine boosters, as time has continued to move on…" Greg Schrank, MD, hospital epidemiologist and infectious disease physician at the University of Maryland Medical Center in Baltimore said. "I think each year at this point we can expect to see flu, RSV and COVID-19, along with a whole host of other respiratory viruses that like to circulate alongside the primary ones." 

Cloudy with a chance of a 'Tripledemic' ?

What that means for another possible, 'tripledemic' — or co-circulation of all three that strains the public health system — will depend on vaccination rates, but also on data reporting and consistent monitoring, Rebecca Wurtz, MD, infectious disease physician and a professor in the University of Minnesota School of Public Health said. 

Dr. Wurtz is not concerned about another "tripledemic" this year. She said she believes "the answer to that is no, only because, the lack of exposure that happened in the fall of 2020, fall 2021 and what followed in 2022 when people were more isolated have been smoothed out a little bit. So I doubt there will be the same kind of likelihood for exposure that people who haven't gained or who have lost immunity because we were more isolated previously." 

She also noted that a key piece of maintaining a handle on hospital capacity in the event of any surge in admissions is data and that a particular focus on making it readily available and updated in real-time is what should be prioritized. 

For public health experts, she recommends they "monitor the data in as close to real time as you can," Dr. Wurtz explained. "The CDC is still engaged in its data modernization initiative. And certainly a lot of people have recognized now that our ability to collect data from healthcare and community sources, but the infrastructure to do that is less developed than it should be. We need to work toward developing that monitoring system so that it's not on a weekly basis from the CDC but something closer to real time so that as best as possible experts can monitor the real time data from multiple sources, to look for patterns and to identify them as soon as they emerge." 

Return to basics

While real-time, expansive datasets are not yet available for experts in the way experts say they should be, one preventative measure health professionals and the public can take this fall is returning to basic practices like masking in high-risk transmission settings, Paul Thottingal, MD, a national infectious disease leader for Kaiser Permanente said.

"We also know advising patients and the community to mask during surges of viral illness are highly effective in preventing transmission, and a return to masking in peak season protects patients and healthcare workers from transmission in our clinics and hospitals," Dr. Thottingal told Becker's, particularly since in 2023 "we saw a return of influenza and RSV that severely impacted healthcare delivery demand and created pressure on care in hospitals." 

Dr. Thottingal thinks there is a chance for a 'tripledemic' to return again this fall, but also noted like the experts above that vaccination uptake will really be key. 

"We can likely expect the same this fall and winter," he said. "Many healthcare systems have not yet recovered from the acute phase of the pandemic, and there remains a great deal of pressure on healthcare to meet the needs of today's patients, while also attending to the needs of patients who experienced delays in care during our most recent surges of respiratory viral illness."

While predictions vary, the one triple-threat experts have consensus on for fall respiratory virus season is betting on the trio of vaccines that will be available to help curb hospital overload.


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