Are We In for a ‘Tridemic’ This Winter? A Baptist Health Urgent Care Expert Weighs In

According to public health experts, three respiratory viruses – COVID, flu and respiratory syncytial virus (RSV) — are all expected to surge this fall and winter, once again straining U.S. hospitals. Children’s hospitals around the country are already over capacity because of “an unprecedented wave” of severe RSV infections, while the U.S. Centers for Disease Control & Prevention (CDC) says that “not since the 2009 swine flu have so many Americans been hospitalized for influenza so early in the season.”

And what about COVID? Although no one expects this winter to be as bad as the previous two years, “infections will almost certainly rise in the coming weeks, with a subsequent uptick in hospitalizations and deaths,” according to Leana Wen, M.D., a former public health commissioner for the City of Baltimore and an oft-quoted media source for information about COVID during the pandemic. “BA.5 remains the dominant variant, but its BQ.1 and BQ.1.1 offshoots already make up more than one-quarter of new infections and will displace BA.5 in the next few weeks,” Dr. Wen says.

Resource editors spoke with Ladan Pourmasiha, D.O., a family medicine physician with Baptist Health and medical director for the health system’s Urgent Care centers in Broward County, about the likelihood of a “tridemic” this season, and what people can do to decrease their risks of getting all – or even any – of these viruses.

Resource: We’re seeing references to a “tridemic” this winter, with the triple threat of COVID, flu and RSV. How concerned are you and should we be worried? 

Dr. Pourmasiha: The reality is, there’s always a possibility of getting multiple viruses at the same time. We are a bit more concerned about dual infections currently as it is more common and likely in comparison to a triple infection. Nonetheless, we have seen triple infections in the past when dealing with strep throat, flu and RSV. This year, however, we may see some cases of COVID, flu and RSV instead.

We always want to keep a level of caution during the flu and winter seasons, which is why we recommend that people get their vaccines. This will help you avoid dual and triple infections and, if you are faced with them, you’ll be more likely to experience milder forms. As long as we prepare ourselves, get our vaccines and as a community play our part in trying to avoid the spread of these viruses, then there’s no real reason for concern.

Resource: What have you been seeing with COVID and RSV recently at Urgent Care?

Dr. Pourmasiha: In our Urgent Care centers, we’ve seen our fair share of RSV cases. Luckily, however, those cases have tended to be a bit milder than what’s being seen in our hospitals. The positivity rates for RSV are double that of our current flu cases. COVID cases remain stable for now but we anticipate an increase in the coming months. 

Resource: Are you seeing any flu cases yet?

Dr. Pourmasiha: We started seeing a slow and subtle rise in our influenza cases starting in October and anticipate a continued increase as we get further into the flu season. We have had a six percent positivity rate for Flu A cases and a four percent positivity rate for Flu B in our Urgent Care centers. 

Resource: What are common symptoms for all three viruses and what differentiates them? 

Dr. Pourmasiha: Common symptoms for all three viruses – COVID, flu and RSV – include congested or runny nose; cough; fever; sore throat; and headache. RSV tends to be seen in our infants and younger children but we’re now seeing more adults presenting with it – especially parents of young children who have been exposed. RSV tends to be more severe and can lead to hospitalization in our youngest and our more vulnerable patients. In addition to a cough, runny nose and fever, a unique symptom of RSV is wheezing.

A distinctive sign of the flu is a very high fever. Along with other respiratory symptoms, people with flu usually have moderate to severe body aches and feel miserable – more so than with other viruses. They can also have nausea and vomiting which, though not unique to the flu, is also often worse than with other viruses.

Symptoms of COVID are similar to flu and RSV but, unlike the other viruses, COVID can have serious long-term effects such as loss of taste and smell along with brain fog and fatigue. We’re still learning about the effects of long COVID and will be for decades to come.

Resource: Who is most at risk for any of these viruses – young children? Older adults? 

Dr. Pourmasiha: Typically speaking, regardless of which virus we’re talking about, those who are most at risk are older individuals (65 and above), especially those living in nursing home facilities. Also at risk are immunocompromised individuals; pregnant patients; those with comorbidities, or other serious health issues; and children under five, particularly those age two and under.

Resource: How can people protect themselves from these viruses?

Dr. Pourmasiha: You can protect yourself from these viruses by frequently washing your hands; avoiding exposure, especially to those who are ill; and cleaning and disinfecting high-touch surfaces such as doorknobs, light switches, electronics, and counters daily. Most importantly, you can get vaccinated. We have highly effective vaccines for both COVID and flu and even if you’re not in a high-risk group, you should still get them. They can protect you from an infection and if you do happen to get ill, your symptoms are typically shorter and milder than they would have been without the vaccine.

Resource: How is Baptist Health Urgent Care preparing for what many predict will be one of our worst flu seasons in years?

Dr. Pourmasiha: We offer testing for RSV (for children 5 and under), COVID and flu in all of our Urgent Care centers and urge our patients to get vaccinated for both the flu and COVID. We offer the flu vaccine to patients ages nine and older at all of our locations. We also emphasize wearing a mask whenever ill and making sure to socially distance to decrease the risk of spreading the virus. And if you do get sick, we’re here to take care of you with the high-quality, compassionate care Baptist Health is known for.

Resource: Any advice you can offer readers on staying healthy as we head into the holidays?

Dr. Pourmasiha: As excited as we are about the holidays and finally being able to celebrate them amongst family and friends, we need to still focus on the things we’ve learned over the past two years. That means, in part, adopting healthy habits to boost our immune system, such as taking vitamins; eating well-balanced meals; exercising; avoiding smoking; and limiting alcohol. But aside from taking good care of ourselves, we also need to be considerate of others. Some people may have compromised immune systems or other serious health issues and, for them, exposure to a respiratory virus could be deadly. If you’re not feeling well, mask up and socially distance to avoid any potential spread.