RSV may be leveling off, but flu cases are still soaring. Here’s the latest on respiratory viruses slamming hospitals.

An unusually early respiratory virus season continues to pummel the U.S., with a trifecta of RSV, flu and COVID-19 cases overwhelming hospitals.

“This year’s flu season is off to a rough start,” Dr. Sandra Fryhofer, board chair of the American Medical Association, said during a Centers for Disease Control and Prevention press briefing on Monday. “Flu’s here, it started early, and with COVID and RSV also circulating, it’s a perfect storm for a terrible holiday season.”

But while levels of flulike illness are at “high or very high levels” in 47 jurisdictions — up from 36 last week — there may be hope on the RSV front.

RSV

The CDC said Monday that there are signs that RSV, or respiratory syncytial virus, may have peaked in some areas of the U.S., like the South and Southeast, and may be leveling off in the mid-Atlantic, New England and Midwest. This is welcome news after a higher than usual spike in cases for this time of year, with RSV patients overwhelming children’s hospitals nationwide. Last month, the Children's Hospital Association and the American Academy of Pediatrics sent a letter to President Biden and Department of Health and Human Services Secretary Xavier Becerra urging them to “declare an emergency to support the national response to the alarming surge of pediatric hospitalizations” from RSV and influenza.

CDC Director Rochelle Walensky said that while these new RSV stats are “encouraging,” hospitals are still swamped by other respiratory viruses. Over 77% of inpatient beds nationwide are currently in use, according to HHS.

“Respiratory viruses continue to spread at high levels nationwide,” Walensky said. “And even in areas where RSV may be decreasing, our hospital systems continue to be stretched, with high numbers of patients with other respiratory illnesses.”

Almost all children will have an RSV infection by their second birthday, according to the CDC, with such symptoms as runny nose, coughing and wheezing, RSV is usually mild and goes away on its own in 1 or 2 weeks. But RSV can also lead to more severe infections and is the most common cause of bronchiolitis and pneumonia in children younger than 1 year old.

Influenza

Although RSV cases may be leveling off, influenza hospitalizations continue to be the highest we’ve seen for this time of year in a decade. The CDC estimates that since the beginning of October, there have been at least 8.7 million illnesses, 78,000 hospitalizations and 4,500 deaths from flu, with hospitalizations for the week ending Nov. 26 nearly double what they were the previous week.

“Over the last two years with the COVID protective measures — wearing masks, washing our hands, staying isolated — we really had almost nonexistent flu seasons, and so I think there’s probably a sense of complacency,” Fryhofer said. “We’ve forgotten how bad flu can be. But this year’s season [shows] that it can get really bad, and it’s here, so people need to get vaccinated.”

This year, all flu vaccinations are quadrivalent, meaning they cover four strains of influenza, and this year’s formulation “seems to be a good match to circulating viruses,” according to the CDC.

Those at higher risk of severe flu illness include children younger than 5 years old, adults older than 65, pregnant people and those with underlying health conditions. But among these higher-risk groups, the CDC said they are seeing lower flu vaccination rates this year compared to last year.

Fourteen pediatric deaths from flu have been reported so far this season, and the CDC said Monday that while they don’t have information on the vaccination status of these deaths, “very consistently, year to year, approximately 80% of pediatric deaths are unvaccinated.”

COVID-19

Over the last week, there’s been a rise in hospitalization from COVID-19, “up about 15%-20% week over week,” according to the CDC, with much of that increase among older people and those with comorbidities.

“We’ve started to see the unfortunate and expected rise of COVID-19 cases and hospitalizations nationally after the Thanksgiving holiday,” Walensky said. “This rise in cases and hospitalizations is especially worrisome as we move into the winter months, when more people are assembling indoors with less ventilation, and as we approach the holiday season, when many are gathering with loved ones across multiple generations.”

Walensky said CDC surveillance shows that people who received their updated COVID-19 vaccine this year were nearly 15 times less likely to die from COVID-19 compared to people who were not vaccinated, and were less likely to die than those who were vaccinated but had not received an updated booster shot. So far, however, the number of Americans opting to get the new bivalent COVID-19 booster has remained low, with 12.7% of eligible Americans currently boosted.

Other infections to look out for this season

On Friday, the U.K. Health Security Agency issued a warning about Strep A — or Group A Strep (GAS), which is responsible for diseases like strep throat and scarlet fever — after the bacterial infection was linked to the deaths of six children. Cases in the U.K. are higher than usual for this time of year, but so far in the U.S. the CDC said they haven’t observed a notable increase nationwide.

Fryhofer said to stay vigilant and don’t be shocked if you have respiratory symptoms but your RSV, flu and COVID-19 tests all come back negative — because they’re not the only viruses we’re contending with this season.

“People who are testing negative for flu, COVID and RSV should be very glad, but understand those aren’t the only respiratory infections that are out there,” Fryhofer said. “People can still have regular colds.”