The 2022 to 2023 flu season is looking like it
may be the worst one in years in the U.S.
It does seem right now like everyone's sick with
something.
I'm scared about what's going to happen this flu
season because I don't think we've ever seen a
coalition of multiple viruses kind of
manifesting in this way before.
Experts hypothesized that COVID precautions led to
much lower rates of flu-like illnesses
compared to before the pandemic. But now that
many Americans have abandoned preventative
COVID measures, more people than before COVID
are getting sick. One of those flu-like illnesses
is the opposite of COVID in that young children are
most at risk.
RSV is respiratory syncytial virus, so it is
a respiratory virus that especially causes lower
respiratory tract infection and pneumonia.
Both my girls ended up getting RSV in late
September and I was really shocked because
that's extremely early for you to see RSV in the
season, it's usually something that shows up
later. It is an illness that primarily impacts
children, although this year, ironically, we were
seeing it in adults, which we never did before.
People always need to remember that flu and RSV
kill people every year.
And flu is one of those things where people are
like, Oh, it's the flu, it's no big deal.
People die of the flu all the time.
But it's not just respiratory illnesses that
are spreading rapidly.
Monkeypox, now a national public health emergency.
It's not just noise.
We are having more diseases, create illness.
We'll never know if these were around before, but
not being reported. But there's definitely more
diseases out there that are threats to different
aspects of society in the U.S.
and globally.
If President Biden declared:
The pandemic is over
in September, why does it still seem like everyone
is getting sick?
And what can we do about it?
We've been hearing a lot about the rise in
reemerging infectious diseases in the news.
And it's not just respiratory illnesses like
COVID or RSV.
One of the more prevalent reemerging illnesses in
the U.S. is monkeypox.
Reemerge really means that it is a disease that
previously was in epidemic form or in
widespread form in some fashion, became latent for
a while.
This most recent outbreak of Monkeypox was first
reported in the U.S. in May 2022.
It spreads through close contact with an infected
person or animal. Monkeypox was first
discovered in humans in 1970 in the Democratic
Republic of Congo.
It was first detected in the U.S.
in 2003.
Humans can spread viruses to each other through
contact, through secretions, and touching
your eyes and getting it into a mucosal service,
from breathing it in, from just being around it
and getting into your system in some way, some
breach, some open cut, etc.
And the same way it spreads from animals to
humans.
Reemerging infectious diseases have been a
consistent problem over the past two decades, even
before COVID.
Some shifts in lifestyle have made humans more
vulnerable to these sorts of communicable diseases.
One factor may be that there are more people
living in cities now.
The UN projects that nearly 70% of the world
population will live in urban areas by the year
2050.
Industrialization is certainly a cause of the
spread of disease. And think about where this
spread. New York City was the initial American
epicenter. Milan was the European epicenter.
These are areas where it's not just population
density. So you're living in multiple generational
families and multiple people in the same
household. 5 to 10 people in some of these
households. And the more people that spread there
and then they all have their own contacts, they
can spread to other people.
On top of that, the major cities are also
international hubs for travelers, which can lead
to higher risk.
There's also the notion, and I don't know if it
applies to 2020, but this notion of globalization
and just kind of travel and being able to be in
lots of different places and everyone able to be in
lots of different places, having an impact on
infection transmission patterns.
And I think that's kind of what's happened with
monkeypox.
Traveling was a major issue with the beginning
of the COVID pandemic.
Many of the workers in China went to Western
Europe, and northern Italy was regarded early
as a source of many migrant workers.
And from there, I mean, those folks went on global
travel and global work, and that spread from other
travelers to the United States and abroad.
And that's really how it accelerated.
Another factor could be the global increase in
meat consumption.
There's more livestock that's feeding more people
and they're kept in closer quarters.
And there's all these different ways that they
are trying to grow these populations of animals
even more. And when that happens, they're in much
more confined spaces.
And a lot of viruses, if they are present in part
of that population, will spread rapidly throughout
animal populations.
There are other potential contributing factors to
the rise in reemerging diseases, many to do with
environmental disturbances and climate
change.
Whenever you take away forests, you move the
animals that would normally be there into an
encroachment closer to the human populations.
When you do that, you also change a lot of other
issues with the biodiversity. Insects
change in population, insects get closer to
humans and we all know that a lot of these viral
pathogens are insect borne.
I think it's been a collective trauma and it's
been hard to navigate our way through it.
I think that maybe we just have to have no
expectations because you can't really predict
infections. Monkey pox has seemed to go down, but
will it stay down or not?
I don't know.
An early surge in cases of the flu and RSV are
putting a huge burden on the health care system.
Researchers estimate the flu cost the U.S.
economy an average of more than $11 billion a year.
Flu and RSV season usually start in the fall
and last through the spring with a peak between
December and February.
There have been more reported cases of RSV in
each week of October 2022 than any week in the past
two years. Doctors around the country are raising
the alarm about hospitals being overwhelmed.
Just like with RSV, cases of the flu started surging
earlier this year, with the CDC reporting at least
1.6 million cases, 13,000 hospitalizations and 730
deaths as of October 29, 2022, which is high for
this early in the flu season.
I've been cautioning parents everywhere to be
really careful about all of the viruses that are
going on right now. We are seeing a very early
rise in both RSV flu as well as COVID cases in the
pediatric population.
We think this is happening really because
this is the first winter season that we're going
into where kids are largely back in school
unmasked. And so both adults and kids are
interacting in a way that's more similar to
pre-pandemic environments. And so we
think there's a lot of different viruses that
maybe kids have not been as exposed to in the last
two years that are popping up and really
hitting the population hard.
Here's your other st ethoscope. I'm not only
an emergency physician, but I'm also a mom of a
two and four year old.
Both my girls ended up getting RSV in late
September, and I was really shocked because
that's extremely early for you to see RSV in the
season, it's usually something that shows up
later. And I was suspicious they had some
viral illness, but I wasn't able to confirm
what it was until I took my eldest into the
emergency department when she got into respiratory
distress and she tested positive at that time.
As people started moving around, being in contact
with each other, and transmission started to
kind of happen more, that could explain why RSV
surged. It did kind of catch us off guard because
we just think of RSV as such a seasonal disease.
Leida is a good example of a Corona baby who spent
really the first year of her life just home.
And because I am a doctor, she also, it was hard to
even get a play date as you can imagine.
I wasn't necessarily the mom that other moms wanted
to hang out with. So I tended to only go around
families that were also in health care, who
understood the risks that we were taking in order to
do our job and take care of those that were sick.
2022 isn't the first year we're seeing an early
surge in RSV.
Cases also rose in the spring of 2021 as COVID
vaccines became widely available to the public
and society began reverting to pre-pandemic
behaviors such as not wearing masks.
This year's is also earlier.
But what's especially making it remarkable is
that it's so high.
The danger with that is that our health care
system is just really crippled right now in the
sense that we don't have the staff we need to take
care of everyone. And so any kind of surge or peak
in incidence like with RSV maxes out our
resources. And so when I'm seeing sick kids with
RSV and I need to transfer them to a
pediatric hospital, I cannot find them a bed.
And that means that I'm forced to board them in
the ER for hours trying to look for a place for
them to get a higher level of care.
And that means waits go up.
And in some cases, it makes it really hard for
us to take care of these sick kids.
There's no cure for RSV, but its symptoms can be
managed.
All viral illnesses are really managed in a
similar way. We support the patient by controlling
their fever with medications like Motrin
and Tylenol. We give IV fluids if the patient is
dehydrated. They might be given oxygen to help them
breathe. And then we might even give oral or IV
steroids if they're particularly sick.
The ultimate solution for dealing with RSV is a
vaccine which researchers have been working on for
decades.
An important point about RSV is that this is a
virus that we have known about.
It was identified in 1955.
And so vaccine development for RSV has
actually been an ongoing goal.
Pfizer reported in early November 2022 that its RSV
vaccine, which was given to mothers during
pregnancy, was nearly 70% effective at protecting
severe symptoms in infants less than six
months old.
For RSV, because the children at risk are
newborns and very young children who might have
trouble developing a good immune response to a
vaccine to begin with and also are at risk during
the time that we typically vaccinate young
children. And so one of the strategies is to try
to get the pregnant mother to have a good
immune response and help carry that through to the
baby.
I know that we are working hard and diligently to get
an RSV vaccine, and if and when that becomes
available, I absolutely will be vaccinating my
children. And my child actually does not mind
taking shots. She smiled through every COVID
vaccine that she got.
All three of her COVID shots.
Yay! Good job, Ada.
The U.S. began rolling out the Monkeypox vaccine in
May 2022 to those who were the most at risk of
contracting the virus.
Unvaccinated people have 14 times the risk of
contracting Monkeypox compared to those who are
vaccinated, according to preliminary CDC data.
Vaccines may be the ultimate preventative
solution, but there are other measures people can
take to slow the spread of illness.
There's so many other diseases out there, and a
lot of these are also related to hygiene and
hand washing.
What I emphasize to everyone is that
prevention is the best method to protect
yourself. Basic hygiene.
Hand washing. If you are sick, stay home from work,
stay home from school.
And then, most importantly, to vaccinate.
We are in a flu season again, so you should also
be getting your flu vaccine. If you're older,
you should be getting a pneumonia vaccine.
We're not really sure what this winter is going
to bring us. So I really ardently propose that
everyone does what they can to protect themselves
now.