State of Affairs: November 16
RSV activity is high. Covid and flu are increasing.
Well, we are officially in full-on “epidemic” mode for our fall and winter respiratory season. RSV, Covid-19, and flu are increasing across the nation.
Here is your State of Affairs.
Influenza-like illnesses
The climate of respiratory health in the United States (coined “influenza-like illnesses by CDC) reached the “epidemic” level threshold this week. This year continues to land somewhere between pre-pandemic years and last year.
We’ll start with the star of the show…
RSV: Very high
We have a bad RSV season.
RSV moves through the nation like a wave, starting in the South and spreading outwards nationally. So, on a national level, positive RSV tests are exponentially increasing but not yet as high as last year.
In Southern states, hospitalizations are as high (or higher) than last year. For example, Georgia hospitalizations below have exceeded the past two years. It looks like it’s starting to peak in the South.
This is surprising. We had such an intense RSV season last year that we thought things would be calmer this year. Mainly because RSV immunity lasts longer than, for example, Covid-19 or flu. Two possible explanations:
Georgia and Tennessee are anomalies, and the other states won’t be as bad.
We haven’t fully re-synchronized immunity dynamics. In other words, last year’s bad season wasn’t enough to get “back on track” after immunity largely disappeared during the pandemic.
Unfortunately, the new RSV vaccines and monoclonal antibodies also aren’t impacting the population-level viral transmission because coverage is poor (see more below).
Covid: Increasing
Covid-19 wastewater—the earliest transmission indicator—is slowly creeping up nationwide. ED visits remain plateaued for now.
Covid-19 hospitalizations are decreasing but lag cases by about 3-4 weeks, so this will change soon. Covid-19 hospitalizations today are lower than last year but remain the leader compared to other respiratory viruses.
The NYT published some pretty jarring graphs showing an increase in young adults having “serious difficulty” remembering, concentrating, or making decisions. This is undoubtedly long Covid, but I think various other factors, like managing full-time childcare on top of full-time work, could also drive this. It’s worth probing (as some have); this is concerning.
Flu: Increasing
Flu is increasing, too. The number of positive tests and the percent positivity rate are increasing exponentially. Hospitalizations remain low for now.
Vaccination rates
Vaccine uptake for respiratory diseases is not great, to say the least. The latest data shows Covid-19 (among those 18+) and RSV vaccination (among those 60+) remain significantly lower than flu (among those 18+). Rates are tracking last year’s.
There are significant sociodemographic disparities—more so than during the pandemic—due to suboptimal access and cost. Data will be coming out very soon.
Bottom line
Respiratory season is officially in full throttle. It’s not too late to get your vaccines. I have also started wearing a KN95 mask again in crowded indoor areas, like airports. As a working mom, I just don’t have time to get sick. Risk reduction is the name of the game.
Love, YLE
“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH Ph.D.—an epidemiologist, wife, and mom of two little girls. During the day, she is a senior scientific consultant to several organizations. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below:
Risk reduction is the "name of the game": socially, I do feel awkward being the lone mask in many situations, but it's just not worth getting sick. A close friend didn't mask on a flight due to embarrassment, and is now quite ill with Covid--that's a no brainer for me (and his primary care provider)--it's the social situations that are so difficult to navigate right now, for me.
Another reason for the bad and worsening respiratory virus season this year… we know that COVID causes immune dysregulation. My guess is that we’re seeing the effects of a population-level decline in immune system health.
Also, we shouldn’t be surprised that there’s been low uptake of COVID vaccines, given that the Biden Administration “declared the pandemic over” (*snort*) and the CDC director herself— Maskless Mandy— parades around without any kind of respirator on. We are seeing zero good respiratory hygiene behavior from our “leadership” to model. People are getting attacked and mocked for wearing masks.
Also, I am in a lot of COVID cautious groups where parents cannot find places that will vaccinate their kids for COVID. Pharmacies would vaccinate kids under 5 while the pandemic emergency was going on, but with the end of it, pediatricians won’t order COVID vaccines— no pediatricians in my area in Georgia will carry COVID vaccines and never have, and I live in the 2nd largest city in this state— and pharmacies won’t vaccinate kids under a certain age. Many parents who WANT this protection for their kids simply can’t find anyone willing to vaccinate their children.
This Administration and the CDC have messed up this entire rollout and this entire pandemic. What we are seeing is the effects of their shoddy handling of every facet of the pandemic. It shouldn’t be a surprise. You can draw a direct line from their public proclamations and their behavior to the downstream effects we are seeing now. Idiocy.