How to prepare for an influx of illness this holiday season with a rise in RSV, flu and COVID-19 cases

Local health officials are warning that for the third consecutive winter, an influx of illness is circling the holiday season.

“We’re actually seeing the same amount of community sickness that we saw a year ago on the same day, and we’re seeing that same volume — the same amount of patients — coming into our urgent care clinics and our emergency department as we did a year ago,” said Chris Lindley, the chief population officer at Vail Health.

“Why that’s important is a year ago at this time, we were on the top of a large surge of community illness that was driven by omicron.”

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However, this year, the surge is not just driven by the omicron variant of COVID-19 but also predominantly by a rise in two other respiratory illnesses: RSV (respiratory syncytial virus) and influenza.

Some nationwide public health officials are referring to this as a “tripledemic,” which Becky Larson, Eagle County Public Health’s deputy director and epidemiologist, is simply a “cute term” referring to the fact that all three of these illnesses are “all circulating at high or increasing levels, all at the same time.”

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“Whether it’s with individuals or communities, they just feel like they’re in a state of sickness from all the different viruses that are circulating,” Larson said. “There’s a lot of illness in the community right now and I know we’re not the only community that feels that way.”

This rise in illness adds extra stress to the local health care system, which is already feeling the pinch of the last few years.

“Across the country, there’s a health care worker shortage. The country had a huge exodus of nurses over the COVID (pandemic) the first couple of years,” Lindley said. “We’re very fortunate here. We have a very strong, engaged, passionate health care workforce. But they’re working long, hard hours.”

From nurses and doctors to care techs and the hospital’s cleaning team, Lindley said these individuals are working holidays and nights amid the spread of these viruses.

“In 2020, health care workers were heroes. We celebrated them and recognized their work. They’re still doing that same job, but it’s harder now because there are less of them,” he added. “We should celebrate them and recognize them even more if we can because we want them to stay here, we want them to keep working.”

RSV vs. Flu vs. COVID

While an increase in rates of respiratory illnesses is somewhat expected in winter, each year brings unpredictable patterns, Larson said.

The prevalence of influenza, or flu, has been increasing, at an “earlier and faster-moving increase in rate” than usually anticipated, Larson reported.

“We saw an early increase — really the whole nation did — and we’re still seeing that increase,” she added. “We have a lot of travelers coming in, part-time residents, so we would already expect this, but we’re starting at a pretty high rate going into the holiday season.”

Specifically, Lindley said that Vail Health is seeing a “two-fold increase” in flu compared to the same time last year.

COVID has also been seeing an increase over the past month, Larson said.

“The good news is we’re not seeing that same type of surge we saw last year when we had omicron. But we also have a bivalent booster that helps protect a little better against omicron-based variants. We have some different protections and immunities in place so I think that’s partly why we’re not seeing that same surge,” she added.

In recent weeks, RSV has been trending slightly opposite these other two illnesses. Larson reported that in the past three or four weeks, there has been a steady decrease in the virus. However, this rate, she added, is still elevated from previous years.

“RSV has been another virus that we typically see in the winter months. However, we also actually saw some summer illness of RSV, which we don’t expect,” Larson said. “This year it’s been much, much higher than we’ve seen probably in the past 10 years.”

Lindley reported that Vail Health is seeing one to two patients a day in the hospital, which is twice as high as the same time last year.

While there are some differences between each of these respiratory illnesses — such as how infectious it is as well as the timelines for when symptoms present and how long they last  — each present with relatively similar symptoms. This can make identifying a sickness, difficult, if not nearly impossible.

“You’re not going to know which one you have unless you get tested,” Lindley said. “And there’s no need to get tested unless you’re really sick because again, we’re busy.”

So what should individuals do if they’re feeling sick?

Larson said that if a person develops respiratory symptoms, ruling out COVID because it’s the most infectious (and has specific precautions on how to prevent the spread to others) should be the first step. Larson recommends taking an at-home test, which the federal and local governments are providing for free.

To find a free at-home test, visit EagleCountyCOVID.org.

While there are specific guidelines and recommendations around COVID, both Larson and Lindley said that staying home when sick and managing symptoms is key.

“If they’re just sick and they don’t need to see a health care provider, it’s the same response for all of them: stay home, get sleep, drink water, rest, try not to expose anybody else, and get over the illness. With all of them it is, isolate yourself, take care of yourself,” Lindley said.

That said “if your symptoms become alarming, we want you to get in to see us right away,” he added.

Larson added that for “any reason where you’re concerned and need to seek medical care, absolutely, please seek medical care.”

A long winter ahead

While these trends are largely unpredictable year-to-year or even from the start of winter to the end, there are some indications that the current rise in illnesses will continue.

“I’m hopeful RSV will continue this declining trend. As far as flu and COVID, I think it’s too soon to tell what that will look like. I do expect we’ll continue kind of this increase at least through the holidays,” Larson said.

Part of this increase, particularly with COVID, has to do with the influx of residents and visitors this time of year.

“Where our concern is and what we watch is not necessarily just what happens in this valley. Because we’re an international destination, we’re watching what’s happening across the country,” Lindley said.

On a positive note, Lindley added that nationwide hospitalizations for COVID are about half of what they were a year ago.

However, there are new strains and variants that could be cause for concern.

“One of the new strains or variants that we’re all watching, which is XBB, is starting to take hold and is quickly, specifically in New York City, becoming one of the prominent variants. With that variant, specifically, what worries us is in laboratory studies — so not yet in the human population, but when they’ve looked at it in test tubes and stuff — it seems to be pretty evasive against the current vaccines we have as well as treatments,” Lindley said.

Additionally, the current spread of COVID in China has possible implications for the global supply chain.

Lindley — citing recent data from health data company Airfinity — said it is likely to see over one million cases and over 5,000 deaths a day over the next few months. Part of the concern, he added is that the current R-naught for COVID is 16. An R-naught represents how many people, on average, a single infected person can be expected to transmit an illness.

“What we’re watching specifically from China and what we’re preparing for is potential supply chain issues because as these megacities in China get very sick, the factories will be shut down, their economy will shut down,” Lindley said. “Because so many of us in the United States are dependent on shipments and supplies from China, we’re preparing for some shortages of those things and getting ahead of it.”

With that, Lindley recommended that now is a good time for individuals to refill 90-day prescriptions for critical medications. 

“We do think there is a potential in the weeks and months to come that some of those medications that we rely on are going to be in short supply because those supplies come out of China,” he said.

Lindley added that this isn’t the first nor the last wave of COVID the community will see.  

“No one can predict the frequency or the severity, but what we’re doing as a health care system is we’re planning for the worst,” Lindley said. “We’re prepared for that, and we obviously hope it’s something less.”

Staying healthy

With these current projections and the surge of illness, preventing illness and maintaining one’s health is critical not only this winter but all year long.

Lindley has developed a list of 12 actions individuals can take to maintain their health, something that is critical to both staving off and fighting any illnesses.

“People get so focused on what’s the government doing and what the mask orders are, what the travel orders are, et cetera, but at face value, people need to take care of their health and they need to take personal responsibility for it,” he said. “And there’s some really low-hanging fruit, if you will, that people could grab onto that will have huge impacts on their health.”

These 12 actions include:

• Eat a balanced diet, including fruits, vegetables, whole grains, lean proteins and healthy fats
• Exercise frequently, including cardiovascular exercise and strength training activities
• Get enough sleep, aiming for 7 to 9 hours a night, in an effort to bolster your immune system
• Manage stress through meditation, yoga or deep breathing
• Drink plenty of water and stay hydrated
• Avoid tobacco and excessive alcohol consumption
• Check in with your health care provider regularly for screenings and checkups
• Stay up to date on recommended vaccinations, which for COVID includes the Bivalent Vaccine Boosters
• Practice good hygiene including washing your hands and covering your mouth and nose when coughing or sneezing (Larson also recommended disinfecting your phone)
• Stay home when you’re sick
• Take prescribed medications as directed by your health provider
• Seek help if you’re struggling with mental health issues such as anxiety or depression

During the holidays, some of these actions become more challenging amid the gluttony of treats and alcohol, the stress of the season and the sheer number of events and parties.

For this reason, Lindley recommended moderation — and being aware of decisions and behaviors — this season to keep your health front of mind.

“Americans, we like to believe that we can just take a pill and we’ll be OK. But to be healthy, it’s much more than a pill. It’s eating less when we want to eat more. It’s exercising when we don’t want to go outside or we don’t want to go to the gym. It’s not drinking in excess when our other friends are,” he said. “I’m not saying not to enjoy each other and those things, but just practice moderation.”

With the current illness trends and predictions, these actions will be critical in keeping the community healthy this winter.

“It’s going to be a stressful winter for many people,” Lindley said. “My objective is not to cause that, but rather to say, it’s here. It’s already here. We’ve gone through it multiple times. We’re going to get through it again. It’ll be a bumpy winter, and we had a bumpy winter last year. But what we need our community to do is help us by staying healthy. The healthier they are, the healthier we all are.”