Expert Tips to Prepare for Fall ‘Tripledemic’: Flu, COVID and RSV

The United States should prepare for yet another “tripledemic” this fall, in which three respiratory viruses—COVID-19, influenza and respiratory syncytial virus (RSV) converge at the same time.

Public health officials are already urging Americans to protect themselves for the season ahead, even though we’re still in the middle of summer. 

All three viruses cause respiratory symptoms, such as a cough, runny nose, fever, sore throats, aches and pains. Last winter, the “tripledemic” overwhelmed many U.S. pediatric wards.

It’s unclear when each virus will peak. Medical researchers are currently monitoring the southern hemisphere to see how their season is shaping up so they can hopefully predict what to expect in the U.S. 

“It's always challenging looking into the crystal ball,” Thomas Russo, M.D., chief of infectious diseases at the University of Buffalo Jacobs School of Medicine and Biomedical Sciences, told The Messenger. 

Based on the current data, the U.S. can expect an increased number of RSV, influenza, and COVID cases. Since viruses were so rampant last year, Dr. Russo anticipates the nation will be in a better state from an immunologic point. Basically, some adults might have a bit of “leftover immunity” from last year. 

That means experts don’t predict any lockdowns or drastic measures, and overall, they believe it will feel more “normal” than what Americans experienced during the pandemic.

RSV, however, seems to be the wild card. Peter Chin-Hong, M.D., professor of medicine and infectious disease specialist at the University of California, San Francisco, said RSV has been a bit more unpredictable in the last three years because of differences in the way people have protected themselves.

“We're not really sure about when [RSV] will start, but it's likely that it may start back in the same seasonal pattern, which is starting in the late fall and peaking in winter,” Dr. Chin-Hong told The Messenger. The flu, meanwhile, usually peaks around January or February.

While “tripledemic” might sound rather scary, medical experts note that there’s no reason to panic: there is plenty the average American can do to prepare and protect their loved ones.

Get vaccinated

Americans are urged to reach out to their doctor now to inquire about when they can get their influenza shot and COVID boosters. As of now, the RSV vaccine is reserved for adults 60 years and older, in discussion with their medical provider, per the CDC’s recommendations. 

“The benefits of vaccination for all three of these viruses far, far outweigh any risks,” stressed Dr. Russo.

Major pharmacies and retailers have already announced their vaccine availability and scheduling information. Walgreens, for example, is now offering both the flu and RSV vaccine.

Ideally, people would time their age-appropriate shots right before viruses begin circulating in one’s community, a “sweet spot” to maximize the flu vaccine response before it wanes over time. That could be January or February of 2024. 

But Mark R. Schleiss, M.D., a professor of pediatrics at the University of Minnesota Medical School, cautions that attempting a “perfect” time or spacing them out can often be counterintuitive. “The problem with that is if you wait, you can wait too long — you can wait forever,” Dr. Schleiss told The Messenger. “Life gets busy … so the sooner, the better.”

One can get all three shots at once, if necessary, said Dr. Chin-Hong.

Keep kids’ immunizations up to date

Children over 6 months of age are eligible for both the flu shot and COVID vaccine. And kids ages 5 and up can get an updated COVID shot, per the CDC’s recommendations.

When it comes to the flu, some children 6 months to 8 years of age will need two doses of the vaccine this season if they did not receive two doses of flu vaccine previously — and the doses will need to be given four weeks apart, explained Monica Ardura, M.D., a member of the American Academy of Pediatrics Committee on Infectious Diseases. 

“For these children, it is important that the first dose be given as soon as the vaccine becomes available in September so they can receive both doses by the end of October – just in time for Halloween,” Dr. Ardura told The Messenger in an email. 

 In July, the Food and Drug Administration (FDA) approved a monoclonal antibody injection to help prevent RSV in children 24 months old or younger. But the shot is still awaiting review by the CDC panel. 

Practice good hygiene

These highly contagious viruses are spread by either close or direct contact with other people (like hugging or sneezing), or via infected hands and surfaces. Come fall, Americans should practice good cough etiquette and frequently wash their hands. 

Dr. Ardura notes that RSV can persist on surfaces for several hours and for up to 30 minutes on a hand, which means people should be careful not to touch their eyes, nose, mouth, or face. Parents will also want to clean infected surfaces, including toys, regularly.  This is especially pertinent to children since RSV is the second leading cause of death during the first year of a child's life.

“Teaching children to cover their nose and mouth when coughing and sneezing, throwing away used tissues, and then performing good handwashing with soap/water or hand sanitizers will help prevent virus spread,” said Dr. Ardura.  

Stock up on testing kits

 In general, it’s hard to distinguish the viruses apart due to similar symptoms, noted Dr. Ardura, but there are some differences.

The flu and COVID are more likely to cause vomiting, diarrhea and body aches, whereas a loss of taste or smell is more frequent with COVID. Children might exhibit more severe symptoms with all three viruses, depending on how much the virus affects their lungs.  

“When these viruses are circulating in communities at the same time, the only way to know for sure which one is causing symptoms, is to undergo viral testing,” said Dr. Ardura.

Americans should stock up testing kits for COVID since it’s hard to tell which virus is presenting. There is still no home-testing option for RSV and not one widely available for the flu.

It’s especially vital to test for COVID since people might come into contact with those who are more vulnerable, immune-compromised, or have underlying diseases.

“I heard so many anecdotes recently of people giving it to their parents or their grandparents,” said Dr. Chin-Hong.

Rely on protective tools

Tried-and-true preventative flu season measures, like using hand sanitizer, will work just as well this time around.

Medical experts also recommend an affordable and well established intervention should you live or come into close contact with vulnerable populations: a mask. Dr. Chin-Hong refers to masks as a “three-fer” in that you can simultaneously reduce the chances of getting COVID-19, the flu and RSV. “It’s one-stop shopping.”

Consider limiting exposure

The elderly and babies are particularly high-risk groups and might require extra precautions. 

For indoor situations, which are less ventilated, at-risk adults might consider masks and limiting additional exposure should viruses be circulating within the community. For example, they might want to wear a mask while seeing a movie at a theater and skipping beverages and snacks (which require removing a mask).

“It needs to be an individual assessment and it really has to do with how risk averse you are,” advised Dr. Russo, noting the difference between, say, a movie or a close family member’s wedding. “There's also the mental health aspect of things where you don't want to be a hermit: we're social creatures.”

Newborns are particularly vulnerable. Although everyone will want to meet and cuddle a new baby, parents may want to restrict visitors who are ill or showing symptoms. Friends and loved ones may be contagious with the flu for 24 hours before they even develop symptoms.  

“For this reason, parents may want to avoid having the newborn baby around large groups of people and ask individuals, including siblings, to wash their hands before touching the infant and avoid kissing the baby on the face,” stressed Dr. Ardura. 

Despite all the precautions, Dr. Russo said that, overall, the “tripledemic” is “not grounds for panic.” There’s plenty Americans can do to mitigate risks and navigate the fall smartly. “I'm hoping it won't be as impactful as the last few respiratory virus seasons.”