Well, we are officially in full-on “epidemic” mode for our fall and winter respiratory season. RSV, Covid-19, and flu are increasing across the nation.

Here is your State of Affairs.

Influenza-like illnesses

The climate of respiratory health in the United States (coined “influenza-like illnesses by CDC) reached the “epidemic” level threshold this week. This year continues to land somewhere between pre-pandemic years and last year.

We’ll start with the star of the show…

RSV: Very high

We have a bad RSV season.

RSV moves through the nation like a wave, starting in the South and spreading outwards nationally. So, on a national level, positive RSV tests are exponentially increasing but not yet as high as last year.

In Southern states, hospitalizations are as high (or higher) than last year. For example, Georgia hospitalizations below have exceeded the past two years. It looks like it’s starting to peak in the South.

This is surprising. We had such an intense RSV season last year that we thought things would be calmer this year. Mainly because RSV immunity lasts longer than, for example, Covid-19 or flu. Two possible explanations:

1. Georgia and Tennessee are anomalies, and the other states won’t be as bad.
2. We haven’t fully re-synchronized immunity dynamics. In other words, last year’s bad season wasn’t enough to get “back on track” after immunity largely disappeared during the pandemic.

Unfortunately, the new RSV vaccines and monoclonal antibodies also aren’t impacting the population-level viral transmission because coverage is poor (see more below).

Covid: Increasing

Covid-19 wastewater—the earliest transmission indicator—is slowly creeping up nationwide. ED visits remain plateaued for now.

Covid-19 hospitalizations are decreasing but lag cases by about 3-4 weeks, so this will change soon. Covid-19 hospitalizations today are lower than last year but remain the leader compared to other respiratory viruses.

The NYT published some pretty jarring graphs showing an increase in young adults having “serious difficulty” remembering, concentrating, or making decisions. This is undoubtedly long Covid, but I think various other factors, like managing full-time childcare on top of full-time work, could also drive this. It’s worth probing (as some have); this is concerning.

Flu: Increasing

Flu is increasing, too. The number of positive tests and the percent positivity rate are increasing exponentially. Hospitalizations remain low for now.

Vaccination rates

Vaccine uptake for respiratory diseases is not great, to say the least. The latest data shows Covid-19 (among those 18+) and RSV vaccination (among those 60+) remain significantly lower than flu (among those 18+). Rates are tracking last year’s.

There are significant sociodemographic disparities—more so than during the pandemic—due to suboptimal access and cost. Data will be coming out very soon.

Bottom line

Respiratory season is officially in full throttle. It’s not too late to get your vaccines. I have also started wearing a KN95 mask again in crowded indoor areas, like airports. As a working mom, I just don’t have time to get sick. Risk reduction is the name of the game.

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH Ph.D.—an epidemiologist, wife. During the day, she is a senior scientific consultant to several organizations. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well-equipped to make evidence-based decisions. This newsletter is free, thanks to the generous support of fellow YLE community members. To support this effort, subscribe below: