By Tyrel Linkhorn

After two mild flu seasons, influenza has come roaring back hard and fast this fall, with public health officials reporting high flu activity in Ohio and across much of the United States.

Unfortunately, it’s not alone.

“Right now, we have COVID circulating, we have something called RSV, or respiratory syncytial virus, circulating, and we have influenza circulating in the community,” said Dr. Michael Ellis, an infectious disease specialist and chief medical officer at The University of Toledo Medical Center.

While cold weather generally coincides with a spike in respiratory illnesses including influenza, Ellis and other experts say this year is shaping up to be the worst we’ve seen since before COVID-19.

Masking and social distancing made the flu virtually non-existent during the 2020-2021 flu season. The 2021-2022 season was also comparatively mild. Other viruses, like RSV, were similarly muted.

Not so in 2022, where hospitals in many parts of the country are now experiencing a wave of influenza cases after having already seen a surge in admissions for children with RSV.

“There’s some interesting wrinkles that COVID has created,” Ellis said. “You have a group of children who normally would have seen these viruses a couple of years ago seeing them for the first time. That’s probably something that is contributing to not just the frequency of the cases but maybe even the severity.”

Influenza activity typically peaks in February but with cases already sharply on the rise, Ellis said it’s likely to peak sooner and result in far more cases than we’ve seen in the past two years.

The U.S. Centers for Disease Control and Prevention influenza has already caused at least 8.7 million illnesses and 78,000 hospitalizations this flu season. The current U.S. hospitalization rate for influenza is the highest for this time in the flu season in more than a decade.

As of the week ending Nov. 26, the CDC reported 44 states with high or very high levels of influenza-like illnesses. At the same time last year, the CDC reported only two states with high levels of influenza-like illnesses.

Part of the reason may be a slow uptake of vaccines, Ellis said.

“It seems that nationally there is a lot of vaccine fatigue,” he said. “Not everyone who might normally have gotten a flu vaccine has gotten one this year.”

The CDC recommends everyone 6 months and older get an annual flu vaccine, something Ellis also strongly encourages.

“Nearly everyone should get a flu vaccine. It takes a couple of weeks for people to ramp up their immune system from a flu vaccine, so it’s important you get it early, particularly with flu already so widespread,” he said. “People should also be staying up to date with their COVID-19 booster shots. The vaccines may not prevent you from getting an infection, but they definitely prevent you from having a severe infection.”

No vaccine is available for RSV, though there are multiple candidates in clinical trials.

Most healthy adults who contract influenza, RSV or COVID-19 will fight off the illness without any significant complications. However, RSV can be particularly dangerous for younger children, and any of the three viruses can cause serious illness in those with compromised immune systems, including pregnant women and the elderly.

Right now, the number of new COVID-19 cases appears to be increasing modestly in Ohio after hovering around 10,000 new cases per week for the past month and a half. Nationally, the CDC is reporting about 300,000 new cases per week.

Ellis said it’s difficult to know what the upcoming months will hold, but he expects COVID to remain common throughout the winter.

One of the difficulties of having three potentially dangerous respiratory illnesses on top of other common seasonal viruses is telling them apart.

With such similar symptoms, short of a lab test, it is nearly impossible to know what you have — and what you may be at risk of spreading to others.

“If you're sick, especially if you have a fever, you should not be around other people,” Ellis said. “A good way to show the people you love that you love them is if you're sick, especially with a fever, you might want to stay away.”

Recognizing people are eager to get together with family and friends this time of year, Ellis advises people to use good judgment, practice good hand hygiene alongside proper cough and sneezing etiquette, and consider wearing a mask.

“It's easy for doctors to talk about what people shouldn't do, but where the rubber meets the road and you want to be with your family, you really have to weigh the pros and cons and do whatever you can to make it a good experience for as many people as you can,” he said. “Those are tough things that families have to sort out, and I usually advocate for finding the safest way for everybody to get together and enjoy themselves.”

First Published December 8, 2022, 2:33 p.m.