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COVID-19, RSV, influenza transmission surge during holiday season, hospitalization plateaus

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While the holiday season has seen an increase in cases of RSV, influenza and COVID-19, hospitalizations from severe illness have plateaued.


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DECEMBER 20, 2022

Public health officials say that transmission of COVID-19, RSV and influenza will increase during the holiday season; however, this may not correlate to a significant increase in hospitalizations for severe disease, according to public health experts.

According to UC Berkeley School of Public Health professor emeritus John Swartzberg, there has been a significant increase in COVID-19 hospitalizations in the Bay Area and nationwide, which began around the Thanksgiving holiday. Hospitals have been “stretched very thin,” because of COVID-19, RSV and influenza, Swartzberg said; however, hospitalization rates for COVID-19 have plateaued.

“Holiday travel has exacerbated COVID the last two years, and we know it plays a role in spreading all respiratory viral infections,” Swartzberg said. “There’s every reason to think holiday travel is going to increase things.”

Swartzberg emphasized the importance of getting vaccinated against influenza and COVID-19, and said one shouldn’t be wearing “any old mask” but an N95 or KN95 mask in indoor public spaces.

While people are celebrating the holidays, it is important to keep in mind that COVID-19 and influenza can be very serious diseases for people of any age, “especially older people and the very, very young,” Swartzberg noted.

According to Jeanne Noble, UCSF emergency medicine professor and director of COVID-19 response for the UCSF emergency department, there has been a “very manageable increase” in COVID-related hospitalizations at UCSF, and hospitalizations from COVID-19 have actually been declining over the past month.

This is demonstrated in a UCSF COVID-19 database which tracks those who are hospitalized from COVID-19 and those who test positive for the virus but are not hospitalized for respiratory illness.

Influenza hospitalization rates at UCSF hospitals “have not been terribly overwhelming,” Noble said, citing that only four adults required hospitalization during the month of December. RSV “really hit” the pediatric population hard, but these numbers have come down sharply as well in the last few weeks, according to Noble.

“We are overwhelmed in the emergency department, but it’s not because of COVID,” Noble said, referencing historically high rates of “boarding,” where patients admitted to the hospital wait in the ER for hours and sometimes days.

With the exception of rare cases of severely immunocompromised patients with COVID-19, the vast majority of COVID-19 cases at UCSF don’t require hospitalization. COVID-19 has become very similar to other seasonal respiratory viruses, such as the common cold, Noble said. She added that over time, vaccines have remained strong in preventing severe disease that requires hospitalization and the use of ventilators, but they’ve lost a lot of their ability to prevent infection itself and transmission.

According to Noble, there is not likely to be a COVID-19 surge in hospitalization due to holiday travel, because people that frequently require hospitalization are typically “the very immunocompromised.” However, there will be an increase in COVID-19, RSV and flu cases due to increased socialization.

“Back in 2020 when we were so overwhelmed with this new disease and no treatment and no vaccine, when somebody tested positive for COVID, that was a really scary thing,” Noble said. “But it doesn’t mean the same thing anymore.”

COVID-19 mortality rates have gone down since the advent of the vaccination, Noble said.

Noble added that the early arrival and “hard-hitting” season of influenza and RSV is due to “immune debt.” There is now more symptomatic illness due to increased socialization, which followed a period of less exposure to the viruses.

“We have had so much deprivation, particularly for our kids, in school closures, reduced social interaction and mask-wearing and everything else, that it is really time on the advent of 2023 to retire COVID from its elite status as a respiratory virus and treat it like we treat rhinovirus or the other viruses that hit us every winter,” Noble said.

Contact Victor Corona at [email protected], and follow him on Twitter at @victorcoronas.

DECEMBER 21, 2022