Flu, RSV, and COVID on the rise

It’s flu season and Oregonians, healthier on average than the U.S. as a whole, usually shrug it off as a fact of life. However the season is more complicated when factoring in RSV and COVID, which often look and act like flu.

The flu, COVID-19, and respiratory syncytial virus (RSV) are all highly contagious respiratory infections caused by viruses: The flu by influenza virus, COVID-19 by SARS-CoV-2 virus, and RSV by respiratory syncytial virus. It is possible for a person to be infected with multiple viruses at the same time.

According to the Centers for Disease Control and Prevention (CDC), the flu and COVID-19 share very similar symptoms, and it might be hard to tell which of the two you have. It can take longer for people infected with SARS-CoV-2 to show symptoms, and people stay infectious longer than with the flu. A symptom that seems to be unique to COVID-19 is loss of taste or smell.

While COVID rose to the top of the list of concerns in 2020, 2021, and into 2022, RSV is now more worrisome among many health care professionals. RSV can infect anyone, but is most dangerous in infants and the elderly. Its symptoms are similar to those of the common cold. They tend to run their course with only mild intensity in adults and older children.

In infants and elderly, symptoms tend to be more severe, and can include fevers and wheezing. Some cases may require hospitalization, but most infections run their course within 1 to 2 weeks. A baby contracting RSV may require a lot of attention until recovery. However, be on the lookout for serious symptoms that can indicate a need for emergency treatment. If your baby is unusually tired, breathing rapidly or has bluish fingernails, call 911 or go to the ER immediately.

Hard data is hard to come by but OHA (Oregon Health Authority) and the CDC are beginning to crank out reports of infections and hospitalizations. If you ask a friend or neighbor or family member, most will say they know somebody already showing flu-like symptoms, typical of the season.

Starting with COVID, the number of hospitalizations in Oregon at the end of July was 23 and at the end of September it was over 60, only two of which were in Deschutes county, one of whom died.

In all of Oregon, 73 percent of the eligible population completed the primary series of vaccinations but only 22 percent took the bivalent booster. In Deschutes County the numbers are 72 percent and 23 percent.

OHA will start issuing its weekly surveillance reports beginning next week. Until then, based on antigen testing, the positive results numbers for RSV are spiking.

Since the symptoms are so similar, the best way to determine accurately whether you have COVID-19 or the flu is to get tested with a COVID-19-Flu-RSV combined test. The test determines if you are currently infected with SARS-CoV-2, influenza A/B, and/or respiratory syncytial virus (RSV) and is available through doctors, hospitals, and other authorized healthcare providers nationwide.

As always, the best person to ask is your doctor. The Nugget asked Dr. Cynthia Maree, infectious disease expert at St. Charles Health System. Maree is not alarmed by the numbers, which look worse as a percentage than in actual case numbers.

“We’re about on the same trajectory as 2021 and 2022,” she said.

She expresses some frustration at the amount of available vaccine with the rollout of the newest vaccine. Now that COVID vaccinations are commercially managed, some pharmacies and clinics have reported shortages.

The FDA and the CDC approved the updated vaccines by Pfizer-BioNTech and Moderna in mid-September. Last week they also authorized an updated Novavax vaccine for use in individuals 12 and older.

The vaccines target XBB.1.5, a subvariant of Omicron that dominated the United States—and the world — from November 2021 until earlier this year. The CDC said the updated vaccines should also work against currently circulating variants of the SARS-CoV-2 virus —many of which descended from, or are related to, the XBB strain. This includes EG.5, the dominant strain in the U.S., and BA.2.86, a new subvariant sparking concern because it has more than 30 mutations to its spike protein.

Maree had been hopeful that by now there would have been more treatment protocols. Since April there has been only one. On April 4, 2023, the Food and Drug Administration (FDA) issued an Emergency Use Authorization (EUA) for vilobelimab, an anti-C5a monoclonal antibody.

Maree expresses confidence that the area’s only hospital can meet the needs of the community, having learned so much from the 2020 pandemic.

“Our plans are in place for any surges in flu, RSV, or COVID,” she said.

Caregivers are getting voluntary vaccines now.

St. Charles Health System hopes to have a dedicated web page up this week whereby the community can book vaccine appointments. Meanwhile Maree urges everybody to check with their primary provider or pharmacy as to availability.