The Daily - The ‘Tripledemic’ Explained

Episode Date: November 22, 2022

This winter, three major respiratory viruses — respiratory syncytial virus or R.S.V., the flu and the coronavirus — are poised to collide in the United States in what some health officials are calling a “tripledemic.”What does this collision have to do with our response to the coronavirus pandemic, and why are children so far the worst affected?Guest: Apoorva Mandavilli, a science and global health reporter for The New York Times.Background reading: Most cases of Covid, flu and R.S.V. are likely to be mild, but together they may sicken millions of Americans and swamp hospitals, public health experts warned.For more information on today’s episode, visit nytimes.com/thedaily. Transcripts of each episode will be made available by the next workday.

From The New York Times, I'm Michael Barbaro. This is The Daily. This winter, three major respiratory viruses, RSV, the flu, and COVID, are colliding in the U.S. in what health officials are calling a tripledemic. health officials are calling a triple-demic. Today, Apoorva Mondavili on what this collision has to do with our response to the pandemic and why, so far, the worst impacts are on children. It's Tuesday, November 22nd. So I think just for, you know, starters, can you tell us your name, who you are, where you live?

Yeah. My name is Sarah Stuckey. I live in Bowie, Maryland, so just outside of D.C. Daily producer Sydney Harper recently spoke with a woman whose infant daughter was infected with RSV. Yes, her name is Caroline. She turned nine months old while in the hospital. So Tuesday morning, she had a cough and took her to the pediatrician. The doctor looked at her and said, like, yeah, she probably has RSV. It's really going around, but there's nothing that we can do for it.

And they sent us on our way. But Friday morning, she started having trouble breathing. So we took her to the emergency room and we got there about two o'clock in the afternoon. They were taking her oxygen levels. Her oxygen levels were so low that they thought their pulse oximeters were broken. But once they realized that's what her oxygen level really was,

they took her back right away. And it was like all hell broke loose in this room. They intubated her. I mean, it was just like mass chaos to get a ventilator in her, and they had, you know, an oxygen bag. They were literally pumping oxygen by hand into her. And then they started telling us that the hospital that we were at did not have a ventilator that could support her needs. She needed a really nuanced ventilator

and they just didn't have it. So the doctor started calling hospitals to see where we could go. And, you know, she just kept coming back saying, like, there's nowhere that has a room. There's nowhere that has a room. There's nowhere that has a room. And I could see the fear on her face and seeing that on her face and just sitting there, you know, watching my baby barely being kept alive and knowing that there was no more that they could do for her at this hospital.

I just had the thought, like, if she dies in this moment, I just can't, I can't do anything to help her. And no one else can do anything to help her. Finally, around, gosh, probably 8 or 9 p.m., we secured a room in Baltimore. Then we had to wait for a life flight team. So we waited, and I rode the helicopter with Caroline to Baltimore, and we were in the ICU that night. So it was just this past weekend that she came off the ventilator. And so we're just there watching her wean from some meds.

But otherwise, she's good. She's playing and happy and back to herself, which is just, I don't even have words to say, like, how wonderful that is. So, we're on the way home, but it'll be another couple days, we think. Apurva, we just heard the story of a mother whose nine-month-old daughter ended up in the hospital with RSV, which is a virus I don't think a lot of people know that much about. I say that because I didn't know that much about it until my 18-month-old son got it a few weeks ago. And like this woman's daughter, he ended up in the hospital

with it. So you can consider me very invested in this story. And so that's where I want to begin this conversation with RSV and how it fits into the viral landscape of this moment. I'm sorry to hear about your son, Michael. I hope he's okay now. He is. He's much better. I appreciate that. Michael. I hope he's okay now. He is. He's much better. I appreciate that. So yeah, RSV is sending a lot of kids to pediatric hospitals. A lot of young, young kids are ending up in emergency rooms, needing help with their breathing and so on. The problem is that RSV is really making its way around the country when we're also looking at new variants of COVID that are coming up and COVID cases are starting to pick up. And this is one of the most intense flu seasons we've seen in a very

long time. So you've got basically three big respiratory viruses all competing for attention and sending a lot of people to hospitals and making people very sick. Right, a kind of public health trifecta. If you will, or a tripledemic, or a tridemic, or all these words that are floating around. Well, let's start with RSV and what we need to know about that particular virus. Give us the background we need to understand it. RSV is not a new virus. It stands for respiratory syncytial virus. It's a respiratory virus.

It's like all the other ones. You know, it causes you to get the sniffles, get a sore throat, get a cough. And it's not a big deal for most people. It's a big deal for people who are older than 65 and especially for really young kids. Why? Well, if you think about young kids and their respiratory pathways, like their little airways are so tiny that all you need is a little bit of congestion

and they're going to have trouble breathing. They'll have a fever, they'll cough a lot. And if they're really, really sick, they can have wheezing, their skin may turn a little bluish. I mean, those are really the danger signs. That's when you want to take the kid to the ER. And that's because their airwaves and their whole respiratory system are just kind of working overtime.

Right. And they have very little breathing capacity to begin with, so it can be very easily overwhelmed. So we are talking about, you know, kids under one. I mean, by the time most kids are two, in normal times, they are already infected with RSV. What's happening this year, though, is that this is really our first pandemic winter when we are not wearing masks, when we're not doing social distancing, right? We're not really taking precautions. Right. And so what's happening is that all the viruses that were pushed aside by COVID or by our precautions the past couple of winters

are now back in full force. So there are a lot of kids in the country who are two, three, four, who've either never been infected with RSV at all until now, or were infected maybe once and didn't get a chance to build up a lot of immunity. So you're seeing just a much bigger pool of kids who can get infected with RSV and get pretty sick. That's interesting. So we should think of RSV as a pretty run-of-the-mill virus that under normal circumstances might not do all that much damage, might not be something we would devote an episode of The Daily to, that has been kind of supercharged by the pandemic because the pandemic, like you just said, kept so many kids protected from viruses.

So it's washing over a bunch of kids who have kind of emerged from the basement of America's collective pandemic experience and are now getting sick at once. Right. I mean, in a normal year, you know, RSV is something that pediatricians think about and maybe some parents will think about. But come to this winter, you've got the kids who would have gotten it in 2020, the kids who would have gotten it in 2021, and the kids who would have normally gotten it now all getting RSV at the same time. So it's just a giant pool of susceptible kids.

Well, Apoorva, give us a sense of the scale of children being hospitalized because of RSV and maybe give us some numbers around that. As of a couple of weeks ago, 80% of the country's pediatric hospital beds were full. And in many parts of the country, there are no pediatric beds available. Like the mom we heard from earlier in this episode, you know, there are parents who are having to drive hundreds of miles to get their kid to a doctor. And, you know, big hospitals like Johns Hopkins Children's Center in Baltimore, Maryland, they're getting transfer requests from New York and West Virginia. Hours and hours away. Exactly. Hundreds of miles away. And they don't actually have extra beds to spare anyway.

And it's starting to pick up in parts of the country where it was actually a little bit slow. So in Oregon, the season officially began October 29th, and already the numbers have more than tripled. Wow. In just two weeks. Exactly. And on Monday, the governor issued an executive order that would allow hospitals to staff pediatric wards with volunteer nurses and doctors because they simply don't have enough staff. Wow. I mean, these sound like descriptions that are as worse, if not even worse, than what we talked about during the pandemic. You know, that's partly because during the pandemic, kids were not at high risk. Right. Because during the pandemic, kids were not at high risk. Right. So we really got away from the idea of kids being at risk of respiratory diseases,

even though in a normal year, they are at risk of things like flu. So this year, we've got a whole bunch of kids who are all getting very sick with RSV, with flu, and ending up in these hospitals. If hospital beds are that full, like you're saying, I have to imagine that a kid coming into the emergency room with just about anything else is not getting a bed. Absolutely. This is actually really a precipitation of a problem

that's been brewing for many years now. Pediatric hospitals have been shutting down in big numbers because kids are just not as profitable to treat as adults. And so hospitals have been closing them down. In Illinois, there are something like 48 counties that have no pediatricians at all. So RSV is squeezing a system that is already smaller than it probably should be. Smaller than it probably should be, and that got even smaller during COVID when a lot more pediatric resources were pivoted to treating adults

because that's where they were needed. Got it. So when a kid gets sick with RSV, a poor of a, what kind of treatments are available? There actually aren't any. So the best thing to do is to do things for the kids that just makes their symptoms a little bit better, like a steam shower.

But, you know, I don't want to give the impression that this is a really dangerous disease and that it kills a lot of kids. Most kids, if they get really sick and end up in the ER, are going to get a little breathing help, maybe get put on a ventilator, and then they're going to come home within a day or two. Right. get put on a ventilator and then they're going to come home within a day or two. Right. Ideally, what we'd have is vaccines to prevent RSV in the first place. But unfortunately, we don't quite have those available yet either. We are close, but not yet.

How close? As it happens, we have something like four vaccines that the FDA is already looking at and another dozen or so in clinical trials that are in pretty late stage. So in a couple of years, we'll probably have a lot more options. But for now, we're kind of out of luck. So this virus that is infecting children at this unusually rapid rate and filling all these hospital beds

and forcing parents like the one we talked to to make these kind of extraordinary trips out of state by helicopter to get to a hospital, this virus cannot be prevented and it cannot be treated. That is correct. There is one way to prevent infections in really young babies, but that drug is so expensive. It's a monoclonal antibody,

which we saw being used for COVID as well. Right. And because it's so expensive, it's really only used for very premature babies who really need it. So other than that, we have nothing. We'll be right back. So, Apoorva, let's talk about the second virus in this trifecta, as you described it, which is this year's flu. And full disclosure, I have not gotten my flu vaccine. I feel guilty

about it. We can talk about that later. What is the story of this year's flu. And full disclosure, I have not gotten my flu vaccine. I feel guilty about it. We can talk about that later. What is the story of this year's flu? This is our familiar foe, right? We're used to thinking about the flu. But what's happening this year, as with RSV, is that we're seeing it come in really intensely. So according to the CDC,

there have already been more than 4 million infections with the flu, and we've had 2,100 deaths. And hospitalizations for flu are also way up, the highest they've been in a decade, according to the CDC. Why is the flu worse this year than it's been in the past? And maybe that's a naive question, because I know with the flu, it's always kind of a crapshoot, right? Like the flu is whatever the flu is any year, but is there an explanation for why it's rough this year? No, it's a good question because normally the flu doesn't really pick up till December and the peak is sort of January through March. We don't fully know why. Part of it is probably, as we were talking about with RSV, that a lot of people didn't get the flu for the last couple of years.

And so there's just more people, more susceptibility. And part of it is also that COVID has made viruses behave really weirdly. The flu and RSV have sort of come at unusual times of year, too early, too late, all year round. You know, there's just a lot of weird patterns going on with viruses. But what do you mean by that? How does COVID impact something like the timing of when people get the flu or the severity of the flu season? Well, we don't exactly know why. There are some theories. So one is this theory called viral interference, which says, you know, if you get COVID first, your immune system has revved up and that might prevent you from getting sick with something else.

So you wouldn't get sick with the flu. And so the flu doesn't really have a chance against COVID. What has happened in the past couple of years is that we've seen these viruses come at unusual times, right? We haven't seen flu and COVID at the same time. We haven't seen RSV and COVID at the same time. So that's really caused some scientists to think that that's what's happening, that this viral interference is real. Well, we'll see. This winter, it looks like they might all be up at the same time, so that theory might be wrong.

The short answer is really, we don't know. We don't know why this is happening and why these viruses are behaving so strangely. Mm-hmm. But the theory does suggest that viruses might, in a sense, wait their turn. But if this year we have multiple viruses coming at the same time, we don't really know if they're going to be waiting their turn.

They might be very impolite and they might all want to sit at the table at the same time. They might. And some of us might end up getting all of them or two of them or some combination. So yeah, we'll have to see. Okay. But unlike for RSV,

there is a vaccine for the flu. It's widely available. It's generally seen as very effective. Yes, there is, Michael, and you should go get one. And so should everybody else. So, you know, for flu, we do have this vaccine. And actually, this year's vaccine is pretty well matched against the strain that's circulating. So, yeah, I got my flu vaccine, and I would say everybody who can get one should get one as soon as possible. Okay, I'll get my vaccine. Let's finally talk about COVID. This is our third year with that virus in the United States and it's in this conversation, the third virus in that trifecta. What is the state of COVID this fall and winter?

It's a little bit different than when we've talked about COVID the last couple of winters. You know, it's not as serious, at least it looks like right now, because when you think about it, pretty much everybody in the country has either been infected multiple times or has had many, many shots. And so we all have a pretty thick layer of immunity against COVID. What is different this year, though, is that there are a couple of variants that are really picking up steam that are very good at getting around that immunity. And so a lot of us will probably get infected, even if we don't get really sick. Well, how will the variants of this winter likely compare with those of, say, Omicron? We have come to see COVID over time as less and less lethal and, frankly, less and less

of a serious health threat for healthy people. Should we keep viewing COVID this way this winter? It seems like it at the moment. I mean, so the new variants, there are two, are still versions of Omicron, which is the one that was circulating last winter. But that version, BA1, was somewhat immune-invasive, which is why a lot of us got infected. But as we've gone on through the year, the variants of Omicron that have been coming up

have been increasingly immune-invasive. And these two, the ones that we're looking at now, BQ1 and BQ1.1 is what they're called, they are incredibly immune evasive. So there was just a study where scientists looked at exactly how much and they said it's five times as able to get around the immune system as BA5, which is the most recent one in the summer, and 175 times more so than the very first coronavirus that we saw back in January 2020. Hmm. So all of that makes me wonder about vaccines because you keep describing these variants as extremely evasive of immunity, does that immunity include the immunity conferred by vaccines? How good is the current COVID booster when it comes to the variants you're talking about? Unfortunately, yes. It does mean that the boosters that we have right

now are probably not going to prevent you from getting infected with the coronavirus. That's depressing. It is depressing. We were hoping for a good match. And, you know, the Biden administration was trying to guess by having an Omicron-specific booster available. But it turned out to be a match for BA.5, which is the variant that was around in the summer when they were making this decision.

And that's on its way out. Hmm. I mean, are we now in a phase of the pandemic where boosters, vaccines for COVID are just going to inevitably struggle to keep up with the speed with which COVID changes? We will unless we change our strategy. There are ways to get around this. You know, we could try to develop what's called, you know, a universal coronavirus vaccine that would be good against lots and lots of different versions of the virus. So you wouldn't have to play this guessing game. So why aren't we doing that?

That's a good question. There are efforts to do that, but it's hard to do. And so I think we'll probably see one in two to three years, if that. There is one really important caveat, which is that older people and immunocompromised people and pregnant women should all go get a booster. Even if it's not that great against these new variants, it will give them a boost in antibodies in general, and they need that in order to fight off severe disease and death and bad outcomes. So they should still go get this booster. I want to ask you a final COVID question. I think it's a question that agonizes a lot of us who are making decisions every day

about getting on the subway or going to the theater. We're doing those increasingly without masks and everyone's telling us that that's okay. But I am curious if given the situation you're outlining with COVID for this winter, if we're doing it wrong. Ideally, yeah, we would all still be wearing masks because that would take care of RSV and flu and COVID and everything we've been talking about. But since we're not doing that, I would say still to try

and avoid crowded indoor spaces. Wear a mask if you can, at least in those situations. Wash your hands. Stay home if you're sick, all the things that we know to do to protect other people and ourselves from getting sick. Got it. So paint a picture of what the dead of winter is going to look like when all three of these viruses we're talking about, RSV, the flu, these COVID variants,

really start to intersect. I really don't like making predictions, which we've talked about before, in part, if you remember. Thanksgiving last year is when we found out about Omicron and that completely transformed what we were facing as a country.

So you're saying you don't want to make a prediction that could be upended by something in four days. Sure. Exactly. But I can give you sort of a range of what we might expect. So the worst case is if all of these viruses

continue to increase, the flu continues to pick up, RSV continues to pick up, COVID really picks up, then we're looking at a pretty bad winter with the healthcare system completely buckled under, lots and lots of people sick. Best case scenario, viral interference theory, which we talked about, is real. And all of these viruses will take their turn politely, as you said. Right. And our system won't buckle. It'll just be a rough winner, not an awful winner. That's a good way to put it.

Well, Purva, as always, thank you very much. I am going to get my flu vaccine, truly. I'll check back in with you next week. Please don't. Thanks, Apoorva. Sure. We'll be right back. Here's what else you need to know today.

Was there any, like, do you remember any conscious thought of, like, I've got to do something or should I run? No. No. When I got oriented and I saw him with people in front of him, I just went. I didn't ask. I didn't fucking think about it. You just do. On Monday, my colleague Dave Phillips interviewed the man who ended the rampage inside an LGBTQ club in Colorado Springs by confronting the gunman who ultimately killed at least five people there on Saturday night. And it was pop, pop, pop, pop. All I saw was the flash of the muzzle.

The man, a U.S. Army veteran named Richard Fierro, told Dave that he was at the club with his wife, daughter, and their friends when he saw the gunman enter and open fire. I don't know if this gun was loaded. I don't know if he was trying to shoot me. I know I was going to take this dude down. Fierro said he charged across the room, tackled the gunman, seized his gun, and began to beat him with the weapon. I grabbed him, I pulled him down, jumped on his back, I'm banging all over him because I didn't want him to get up.

Minutes later, police arrived and arrested the gunman, a 22-year-old who now faces charges of murder and hate crimes. After the shooting, local officials, including the mayor of Colorado Springs, credited Fierro with saving countless lives. I'm a fat old vet, and I went over there and I had to do something. That was it. Yeah. That was it. Yeah. That was it. Today's episode was produced by Sydney Harper, Rachel Quester, and Aastha Chaturvedi.

It was edited by MJ Davis-Lynn and Lexi Diao, with help from Mark George. It was fact-checked by Susan Lee, contains original music by Dan Powell, Marian Lozano, and Rowan Emisto, and was engineered by Brad Fisher. Our theme music is by Jim Brunberg and

Ben Landsberg of Wonderly. That's it for The Daily. I'm Michael Bilboro. See you tomorrow.