Michigan could be pummeled with RSV, flu, COVID-19, health leaders warn

This article appeared in Detroit Free Press. Read more here.

It’s been dubbed the “tripledemic,” the threat of three viral infections — influenza, RSV (respiratory syncytial virus) and coronavirus — pummeling the state all at once.

Both Michigan and national health leaders say they’re concerned that the triple whammy could converge upon us in the weeks ahead as new coronavirus variants gain ground, spreading along with other seasonal viruses.

“We have not only flu, RSV and COVID, which have all the attention right now, but we have rhinovirus and parainfluenza and other coronaviruses,” said Dr. Natasha Bagdasarian, chief medical executive of the Michigan Department of Health and Human Services.

The U.S. Centers for Disease Control and Prevention announced Friday it will issue an alert to thousands of health care providers nationally about the huge spike in cases of RSV, along with a rise in flu cases amid an underlying coronavirus pandemic.

Hospitals, short on staff already, struggling with viral wave

It’s a recipe for overwhelmed hospitals.

Statewide, pediatric intensive care hospital beds are now 89% full, according to data from the Michigan Health and Hospital Association and the state health department. Many of them are being used to care for children sick with RSV, which can cause severe illness and, rarely, death in young children, people who are immunocompromised and people age 65 and older.

“Hospitals are here for Michiganders, particularly in emergencies,” Dr. Gary Roth, chief medical officer of the hospital association, said in a statement. “But our capacity to provide pediatric hospital care is extremely strained. Right now, the staffing challenges we have been sounding the alarms about all year combined with rapid spread of respiratory illnesses are impacting our hospitals’ ability to care for our sickest children in a timely manner.”

Corewell Health East, the new name for Beaumont Health, announced it will enforce new visitor restrictions starting Monday to limit the spread of RSV, influenza, coronavirus and other respiratory illnesses at its eight southeastern Michigan hospitals. Children ages 5 and younger will not be permitted to visit, though exceptions can be made in extraordinary circumstances.

“What we are seeing with the trends right now is that not only are RSV surveillance numbers in terms of positive tests going up, but the number of patients who are presenting to urgent cares and emergency departments with RSV are also going up, and this is primarily in the under 4 age group,” Bagdasarian said.

A wintertime COVID uptick?

It’s not just RSV. Coronavirus hospitalizations in Michigan also have risen slightly since last week, the state health department reported. As of Friday, about 1,200 Michiganders were hospitalized with confirmed or suspected cases of COVID-19. Of them, 43 were children.

The state’s wastewater surveillance sites are reporting that the levels of coronavirus they’re finding in samples are at their highest point in seven weeks — 20% above baseline thresholds.

“We’ve always talked about the likelihood of a COVID-19 uptick in the winter,” Bagdasarian told the Free Press. “We have always talked about the fact that this is a virus that likes to transmit in cold, dry conditions. It likes to transmit during indoor gatherings and so the likelihood of that happening around the holidays, in December, in January, is high.”

The news isn’t much better when it comes to flu, either.

Over the last two weeks, the percentage of positive influenza tests has more than doubled nationally, CDC data shows. Though Michigan has yet to see a huge uptick in flu cases this season, flu hospitalizations are climbing in other parts of the U.S.

Federal officials monitoring cases and supply needs

Dawn O’Connell, assistant secretary for the Administration for Strategic Preparedness and Response, said Friday that the federal government is working with state and local health care providers to assess hospital capacity problems.

“We are monitoring capacity across the country, sharing best practices to reduce the strain on systems, and standing by to deploy additional personnel and supplies as needed,” O’Connell said during a news briefing.

“We are tracking trends and the number of cases of respiratory viruses, the number of emergency department visits, the number of inpatient admissions and the number of intensive care unit admissions. This allows us to anticipate surges, peaks and valleys in hospital bed capacity. We are also closely monitoring the supply chain for any potential shortages.”

The federal agency can deploy supplies such as masks, surgical gloves, gowns and ventilators from the Strategic National Stockpile to struggling hospitals, O’Connell said. National Disaster Medical System teams could be deployed to hard-hit areas as well.

“To date, no state has requested this level of support and additional personnel or supplies,” O’Connell said, “but we stand ready … to work with them should these resources be needed.

“With increased RSV infections, a rising number of flu cases and the ongoing burden of COVID-19 in our communities, there’s no doubt that we will face some challenges this winter. But it’s important to remember … that RSV and flu are not new.”

She and other health leaders urged all eligible Americans to get a flu vaccine and to ensure they’re up to date on COVID-19 vaccines and boosters to reduce the stress on hospitals.

Doctors disappointed in flu, COVID vaccine rates

Michigan still hasn’t hit the targets it had hoped to reach for flu and COVID-19 immunizations.

The goal is to provide 4 million flu shots to Michiganders this fall and winter. As of Oct. 22, the most recent date for which data was available, 43.4% of the state’s residents had gotten a dose of the flu vaccine. This year’s quadrivalent formulation of the flu shot contains an H3N2 strain, which is dominant in the U.S. right now.

The numbers are even lower when it comes to the latest bivalent COVID-19 vaccine booster.

About 10% of the state’s population — 981,659 people — had taken the newly formulated coronavirus booster shot as of Nov. 1, state data shows. The bivalent booster was made using the omicron variant as a target, which means it’s likely to offer good protection against hospitalization and death when people are infected with the subvariants now gaining traction in the U.S. — B.4.6, BQ.1 and BQ.1.1.

“The problem I see in a national way is that there has not been very much uptake of the booster,” said Dr. Arnold Monto, a University of Michigan professor emeritus of epidemiology and global public health who also is acting chairman of the U.S. Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee.

“It’s really unfortunate, especially given the fact that the elderly and other groups are still at risk of having a severe infection.”

Bagdasarian called the low rate of vaccine uptake “troubling.”

“It’s not that people have completely stopped getting vaccinated, but it has not been as robust as I had hoped it would be,” she said.

The crystal ball is broken when it comes to predicting what awaits with COVID-19, said Monto, who worked at U-M for more than 50 years and helped vaccinate schoolchildren to bring herd immunity to Tecumseh during the 1968 influenza pandemic. He also worked in Beijing, China, during another coronavirus outbreak, the 2002-03 SARS outbreak.

“Making predictions has been rather difficult in the past and is even more difficult now,” Monto said.

“We thought we’d be out of the woods with the first series inoculations. We know now that we need to keep up vaccines. We’re going to be getting data on how well boosters are working, and that’s going to take a little while if we don’t have that many people who are getting vaccinated.

“What we don’t know — and this is why I think it is difficult more than usual to predict — is that we have had a lot of natural (COVID) infection and how that is going to affect the spikes that would have occurred otherwise, is hard to say.”

Worry that antibody treatments won’t work on subvariants

While there’s hope that the new COVID-19 bivalent vaccine will offer good protection, epidemiologists, including Bagdasarian, are concerned that the subvariants B.4.6, BQ.1 and BQ.1.1, have the ability to evade current monoclonal antibody treatments.

“We have variants of concern where if they continue to spread at the rate they’re spreading now, we will lose some of our therapeutic tools,” Bagdasarian said.

One such tool is Evusheld, a monoclonal antibody that’s authorized for use in people who are immunocompromised. It works as a preventive treatment for transplant recipients, people with HIV, those who are on chemotherapy and people who take immunosuppressing drugs and may not build up enough antibodies from vaccines to protect them.

The B.4.6 subvariant appears to be able to evade Evusheld, Bagdasarian said.

“Those individuals who have weakened immune systems and who have been counting on Evusheld to keep them safe, they will not have the same level of protection,” she said.

And the BQ.1 and BQ.1.1 subvariants that are beginning to gain in dominance in the U.S. also are likely to be resistant to Evusheld, along with bebtelovimab, the only other monoclonal antibody treatment available now for use against COVID-19 after a person has been infected with the virus, according to the National Institutes of Health.

“Losing those two medications is a big hit,” Bagdasarian said.

While the antiviral drug Paxlovid is still a treatment option for some Americans at high risk for severe disease from the coronavirus, it isn’t a drug that can be used universally.

That’s because Paxlovid interacts with a lot of other commonly used medications and can’t be given to anyone who has severe kidney or liver disease. If you take blood thinners or heart rhythm medication like flecainide or amiodarone, you shouldn’t take Paxlovid. Cholesterol-lowering drugs also can interact with Paxlovid, so people who take those medications may need to talk to their doctors about whether they should go off their cholesterol drugs for a short time to take Paxlovid instead. Paxlovid also is a risk if you have HIV because it can make the medicines used to treat HIV less effective.

“We are heading into the winter with an already strained health care system,” Bagdasarian said. “We’re already hearing that our pediatric ICUs and … pediatric emergency departments are really strained. So if we add on top of that an uptick in COVID … that is not responsive to monoclonal antibodies and … an uptick in influenza A … that is going to make for a very difficult cold and flu season.

“We’re really asking people to just use commonsense strategies, use the tools that we have to keep health care systems functioning and … available for those who need urgent medical care. We want to ensure that if someone has a heart attack or a stroke or … is in a motor vehicle accident, that they have access to the excellent health care that they that they normally would have access to. And that means using the tools.”

Those suggestions include:

  • Making sure you’re up to date on COVID-19 vaccines and the bivalent booster.
  • Getting a flu shot.
  • Having a supply of COVID-19 tests at home to use in case you develop symptoms.
  • Staying home when you’re sick: “We have to remember that what might be a mild infection for someone in their 20s and 30s could be a life-threatening infection for a newborn or someone who’s elderly or immunocompromised,” Bagdasarian said.
  • Keeping a supply of masks at home and wearing them if you must go out or be around others when you feel ill.
  • Talking to your doctor before you get sick so you’re aware of the treatment options and can access them quickly should you contract coronavirus or influenza.

“It is a very tricky virus,” Monto said. “We would never have thought that a viral infection of the respiratory tract would be an emergency for years — for several years.”

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