By Dr. Stephanie Paulmeno, DNP, RN, NHA, CPH, CCM, CDP, Public Health Promotion Specialist
Health and Public Health experts are predicting a bad flu season for 2022-23.
Forewarned should be forearmed. This prediction is based in part on the observed experiences in Australia (the Northern Hemisphere); Director of Health, Caroline Baisley, explains that our American influenza experience tends to follow theirs. If that warning weren’t worrisome enough, this year both Connecticut and the nation are facing a triple whammy in the form of what is being called a “tripledemic” or tridemic” comprised of morbidity and mortality (illness and death) from influenza, COVID-19, and respiratory syncytial virus (RSV).
So let’s explore these three ailments, all of which have the potential for severe respiratory impact and death across the age span; Seasonal Influenza, COVID-19 and Respiratory Syncytial Virus (RSV). Cases of Seasonal Influenza are already appearing. The fact that they appeared early is worrisome. Many persist in discounting the severity of influenza (the flu); however it is a highly contagious disease. It spreads easily through the air in the respiratory droplets breathed out by those who are infected. Flu is responsible for the hospitalizations and deaths of thousands of people across the country every year (CDC, 2022). The start and end of flu season varies based on geographical location, but the season typically begins in or around early October, peaks between December and February, and persists into May. The virus responsible for our annual flu outbreaks varies due to the nature of viruses. They mutate and change; many different variations of influenza are all circulating at the same time; all are tracked by the WHO, CDC, and State and local health departments’ staff and epidemiologists. Based on what is learned through tracking, the vaccines are updated accordingly. This year’s vaccine offers protection against four of the known circulating flu strains. The senior/high-dose vaccine will be available. The CDC (2022) reminds us each year that the best protection against the ravages of influenza is to get vaccinated. This is true for children, adults and seniors. Those 6-months of age and older are advised to get vaccinated. You CANNOT get the flu from getting a flu vaccine; it is not a live virus (CDC, 2022).
People with disabilities, compromised immune systems, and conditions like asthma, cerebral palsy, diabetes, heart, and pulmonary diseases, and strokes are especially advised to get a flu vaccine. Those heeding that advice will have enhanced protection against influenza’s potentially serious consequences.
It is now early November and influenza is circulating. If you or your loved ones have not yet been vaccinated against influenza, the time to do that is right now! Influenza sickens and take the lives of infants to adults, every year including right here in Connecticut.
We have been lucky in regard to flu during the COVID-19 pandemic because the same masking and social distancing interventions practiced by many for COVID-19 also protected us against the spread of influenza. By the end of our last flu season (2021-22) 8,365 people in Connecticut had become ill with the flu but only 564 required hospitalization, and only 12 lost their lives (CT-DPH, 2022). Contrast that against prior years. The State of Connecticut produces annual influenza summaries going back to 2006/7. It offers an interesting look into the value of masking and social separation during infectious disease outbreaks. (https://portal.ct.gov/DPH/Epidemiology-and-Emerging-Infections/Influenza-Annual-Summaries ).
In our 2017-18 flu season, Connecticut had 184 flu-related deaths and 3,895 hospitalizations. In 2018-19 there were 88 flu-related deaths and 3,506 hospitalizations. These were two of Connecticut’s worst influenza years over the last decade. The CDC (2022) reminds us that a seasonal flu infection can result in death from secondary complications such as pneumonia, chronic obstructive pulmonary disease, and congestive heart failure. While you are at it, if you have not had your pneumonia vaccine, consider doing that now, too. Please recall that Flu and COVID are not the same. Getting vaccinated against influenza will not protect you against COVID-19, and vice versa. You need both.
We have many COVID-19 variants circulating right now, and new ones are emerging. Our positivity
rate is dropping across the state, as well as in Greenwich where we are now just above 5% Connecticut is at 7.47%. This is great, but it is not the whole picture. We have to guard against a false sense of security and use our common sense, especially as the cold weather brings more people indoors and the family holidays are upon us. If you are sick, stay at home and away from others. The positivity rate compares the numbers of people who test positive for COVID against the total number of people who get tested, but it only includes people who get tested through laboratories, not with home test kits. We have way more COVID-positive people than the positivity rate shows. Knowing this, and as is also the case with influenza, the best way to minimize the impact of a COVID-19 infection is to get fully vaccinated and boosted against COVID-19. The CDC reported in October that they are tracking over a dozen Omicron sub-variants including the new BF.7, BQ.1 and BQ.1.1. They note these to be among the most immune-evasive variants yet (CDC, 2022), so we are not out of the woods with COVID. If you or your children are unvaccinated or not fully vaccinated, now is a great time to give you and your loved one’s that added protection. The CDC (2022) recommends vaccination for people 6 months of age and older, and that boosters be given to every eligible person 5 years of age and older. The CDC considers you to be fully vaccinated if you have completed your primary series of Moderna, Pfizer, or Johnson and Johnson (also called Jansen & Jansen or J & J), and have taken the most recent mRNA booster dose.
Selectman Fred Camillo shared that as of 11-4-22 Greenwich Hospital had 11 COVID-19 patients; Yale New Haven Health, which includes Greenwich Hospital, had a total of 123 patients. Many Greenwich residents, however, use Stamford Hospital and I could not identify how many more Greenwich COVID patients are hospitalized there. The total number of Greenwich COVID-19 cases since March 2020 is now 16,215; the total Greenwich death toll attributed to COVID-19 has remained at 127.
Governor Lamont noted in his weekly report (11-3-22) that Connecticut has had a total of 992,764 COVID-positive people, including the 2,459 people diagnosed last week. Connecticut had 372 hospitalized patients and we have lost a total of 11,478 people to COVID-19. That is a sobering death toll. It would equate to about 14 airliners each with about 800 passengers going down in a crash.
The third column of the forecasted tripledemic or tridemic is Respiratory Syncytial Virus (RSV). It is not a new virus; we see it every year, but this year, beginning over the summer months, children infected with RSV began filling pediatric units beyond capacity across the country. There was actually an increase seen in children last year as well. The CDC notes that in the U.S.A., about 58,000-80,000 children under the age of 5 get hospitalized each year due to RSV. Those at greatest risk include premature infants, those under 6-months of age, children under 2 who have chronic lung or congenital (born with) heart disease, as well as youngsters with compromised immune systems and neurological disorders that would have trouble swallowing or clearing mucous secretions. There is a downloadable poster in English and Spanish: RSV in Infants and Young Children (www.cdc.gov/rsv). Some theories about why this is happening include that, because of COVID-19, young children did not get early exposure to common viruses, including this one. Also, the immature lungs of such young children often can’t respond like an older child or adult could; they may have difficulty coughing up secretions or clearing their own airways (Romo, 2022). Early symptoms include a runny nose, loss of appetite and a cough, which may lead to wheezing or difficulty breathing. Very young infants may also have pauses in their breathing, decreased activity and irritability (CDC, 2022). See the child’s healthcare provider!
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