By Dr. Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDPPublic Health Education Specialist/Greenwich Department of Health
Over the past week, Connecticut had 140 new patients hospitalized with COVID-19, and 137 more people died in Connecticut this past week from their COVID infection (ct.gov, 2022). Our Positivity Rate, which should be no higher than 5% (Johns Hopkins Bloomberg School of Public Health, 2020) is now at 15.56%, and that reflects only those who were tested in clinics, labs, and medical offices; those who home tested do not show up in the figures. The actual percent of positive tests is much higher than 15.56%. Until now, the predominant strains of COVID-19 in the United States have been offshoots of a prior Omicron mutation.
Now Reuters, an international fact-based news agency, is reporting that a newly emerged, highly contagious subvariant, XBB, has rapidly increased. It is now responsible for over 50% of COVID cases in the northeast. Before the holidays this new variant was responsible for less than 10% of cases across the USA (CDC, 2020; Reuters, 2020). Holiday travel will undoubtedly alter this picture.
Holiday get-togethers are in active swing and people are traveling, or trying to do so, both locally and across the country. Many have been stuck in enclosed airport terminals for days with numerous others from across the country that may or may not have been masked, vaccinated, boosted, or tested. This will facilitate the spread of all types of contagious respiratory ailments. Social separation, another basic protective measure seems a heavy lift when so many are confined in a crowded airport terminal.
Andrew Pekosz of the Johns Hopkins Bloomberg School of Public Health (Reuters, 2022) predicted that our holiday travel will exacerbate the spread of XBB across the country. The next two weeks will tell, and we will continue to monitor.
This flu season we’ve had 29,068 cases of flu, 772 people have been hospitalized, and we have had 33 deaths, including one child, to date. We are just in week 13 of the 2022-23 flu season (CT Dept of Health, 2022). Of concern is that we had a poor turnout of people getting flu vaccines this year. And, at this point we do not have a vaccine for preventing or diminishing the symptoms of Respiratory Syncytial Virus.
So what to do now? It is too late to get vaccinated or boosted for the sake of prevention against this current surge, so the best course of action at this point is to know and to remain aware of the early signs of COVID-19, Influenza, and RSV (Respiratory Syncytial Virus), the three arms of the current tridemic. We need to be able to recognize the signs of these infections, as well as the signs of complications from the infections so that quick medical action can be taken. All three of these highly contagious diseases are viral respiratory infections, so the symptoms are similar.
All are spread through the same means: 1) respiratory droplets that are breathed out by an infected person and breathed in by one who becomes contaminated, 2) by hand-to-hand or hand-to-contaminated-object contact, and 3) by poor respiratory hygiene techniques when one sneezes, cough or blows their nose and then spreads their viral germs to others. Frequent handwashing, masks, and social separation are the easy preventive fixes here. I urge you to use them. If you’ve been in crowds or groups, monitor yourself and your loved ones.
The tridemic diseases (COVID, Flu, and RSV) are also similar in presentation to the common cold, and allergies which many people have. We cannot always easily tell them apart just based on observed symptoms, but our medical providers have lab tests that can diagnose one viral illness from another and diagnostic/radiology exams that can tell when an infection has progressed to organ impact. We also have home tests for COVID-19.
If the person showing signs of emerging illness is a baby or young child, an elder, especially one with underlying health issues, a person with disabilities, a person with a compromised immune system, or even a pregnant person, err on the side of caution and contact your primary healthcare provider. We have so many treatments at our disposal now that we did not have at the start of the pandemic, but there are windows of opportunity to take the medications and treatments. Conditions can deteriorate quickly in compromised people, as well as in the very young and very old. Your Greenwich Health Department is still monitoring at-home people with COVID.
I’ve created a chart based on guidance from the American Medical Association, American Lung Association and CDC on the incubation periods following exposure, and on routine symptoms versus serious symptoms that warrant medical attention. All three of these diseases are contagious so please notify 911, the emergency department or you medical provider’s office if you are coming in so they can take actions to protect others. In many cases a telehealth visit can help the medical provider determine if an in-office or emergency room visit is needed, or a treatment or direct hospitalization. Masks need to be worn for the protection of the care givers and other patients. Parents, please view the American Lung Association video on RSV in children
Resources
American Lung Association. (2022). Respiratory Syncytial Virus in Your Children. YouTube video.
AMA. (2022). Influenza, COVID & RSV cases continue to rise with Andrea Garcia, JD, MPH
CDC. (2022). Similarities and Differences between Flu and COVID-19.