The 2022-2023 flu season that the Centers for Disease Control and Prevention (CDC) says began early and is already the worst in the US in more than a decade accelerated during the Thanksgiving holiday week, offering a potential preview of trends for the US holiday season now underway.
According to CDC Director Rochelle P. Walensky, MD, MPH, who spoke at a news conference on Monday, levels of flu-like illness tracked by the agency that account for medical visits with respiratory symptoms were high or very high in 47 jurisdictions during Thanksgiving week, an increase from 36 just the week before. Hospitalizations for influenza during the holiday week reached nearly 20 000—approximately doubling the previous week’s admissions.
According to CDC records there have been at least 8.7 million illnesses, 78 000 hospitalizations, and 4500 fatalities caused by influenza since October. Thanksgiving week also brought 2 new pediatric deaths, bringing fatalities among children thus far to 14.
“Hospitalizations for flu continue to be the highest we have seen at this time of year in a decade,” said Walensky during the media call, a clear signal of the season's early arrival. “I want to emphasize that flu vaccines can be lifesaving and importantly, there's still time to get vaccinated to be protected against flu this season, and its potentially serious consequences,” she added.
Sandra Fryhofer, MD, MACP, FRCP, chair of the American Medical Association Board of Trustees and an adjunct associate professor of medicine at Emory University School of Medicine, agreed with Walensky during the call and said this year’s influenza season was “off to a rough start.”
“Flu is here, it started early,” Fryhofer said. “With COVID and RSV also circulating, it's a perfect storm for a terrible holiday season. Over the last few years, COVID protective measures also prevented [the] spread of flu and other respiratory infections, but we're really no longer in that bubble. And that's why it's so important to get vaccinated for both flu and COVID.”
COVID-19 hospitalizations have also begun to tick up, Walensky noted, a rise that was not unexpected based on the family and other gatherings during the Thanksgiving holiday. She cautions that the increase in cases and hospital admissions does not bode well as winter gets closer and people move indoors again where ventilation may not be optimal and “as we approach the holiday season where many are gathering with loved ones across multiple generations.”
“Booster fatigue” is real, Fryhofer acknowledged, but so is the threat of severe illness this year. She emphasized getting a flu and COVID vaccine at the same time and urged the public to do it soon, pointing out that it can take up to 2 weeks for protective antibodies to develop.
Fryhofer added that this year’s quadrivalent influenza vaccines include two strains apiece of influenzas A and B.
“Different flu strains can circulate within the same flu season,” Fryhofer said. “Right now, we're seeing outbreaks of influenza type A, and the only thing worse than getting flu once in a season is getting it again. So even if you've already had flu this season, you should still get vaccinated once you recover from the acute illness to keep you from getting it again, with a different flu strain.”
Respiratory syncytial virus (RSV), like influenza, appeared early this year and caused a surge of pediatric hospitalizations that overwhelmed capacity at children’s hospitals across the country. Walensky said on Monday that waves of that infection may now have peaked in the southern and southeastern US and seem to be leveling off in the mid-West, mid-Atlantic, and New England.
While any abatement in case rates right now is good news, Walensky reports that even in areas where RSV may be decreasing, health care systems “continue to be stretched with high numbers of patients with other respiratory illnesses.” As all seasonal respiratory viruses continue to spread at high levels, the CDC director advises any one experiencing symptoms to consult a health care practitioner right away. Antiviral medications prescribed early in the course of infection can significantly reduce the risk of severe illness, she points out.
Currently no major jurisdiction has issued a mask mandate in an effort to quell transmission of the circulating respiratory viruses, making vaccination against influenza and COVID-19 an even greater public health priority.
The CDC cannot mandate masking, but it can make recommendations and Walensky on Monday said the agency does recommend masking on public transportation at this time. She also said that 5% of US counties are experiencing high COVID-19 community levels right now and that wearing a “high quality, tight-fitting mask to help prevent the spread of respiratory illness” will help reduce strain on the health care system everywhere and particularly in those counties now most vulnerable.
For anyone concerned about the 2022-2023 triple viral threat, act now to protect yourself, advises Walensky. “One need not wait for CDC action in order to put a mask on,” she said.