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We are seeing an uptick in RSV and the flu in the Northern Hemisphere and particularly in the United States. Given an anticipated uptick in COVID-19, the media is coining this the “triple threat.” Here is the current state of affairs and what it means for you.

Respiratory Syncytial Virus (RSV)

RSV is a common virus that typically circulates during the fall, winter, and spring. Before the pandemic, everyone could count on being infected at least once before they reached the age of 2. Thereafter, people are typically infected multiple times throughout their lifetime.

Most people recover in a week or two, but it can be serious for two groups:

• Young children. Before the pandemic, we saw ~2,300 per 100,000 children under the age of 1 hospitalized. (In comparison, the estimated hospitalizations rate is 30-40 per 100,000 children for flu and 48 per 100,000 children for COVID-19, pre-vaccine.) RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs).
• Older adults. Just like COVID-19, RSV is rough on older adults because their immune systems are weaker and they are more likely to have underlying health conditions, like heart or lung disease. In the U.S. an estimated 177,000 older adults are hospitalized for RSV each year and 14,000 of them die.

Overall, RSV is on the rise. As shown below, the percent positivity rate is above 10-15% in the U.S.—this means RSV is spreading faster than we can test for it and is causing an exponential growth in cases. However, we aren’t at record numbers yet. In fact, we are still below our very unusual 2021 summer surge. Almost all states are showing the same general trend.

Respiratory Syncytial Virus (RSV) Trends United States. Source Here.

There is quite a bit of discussion regarding how RSV is transmitted. The standard precaution for healthcare workers is hand washing, hospital gowns, and gloves. (Notice masks are not recommended.) These precautions stemmed from older studies showing the main mode of RSV transmission is primarily through large particles in the eye or nose or directly touching contaminated surfaces. RSV does have small particles that travel far, but this doesn’t seem to be a main mode given this older research.

There is currently no vaccine for RSV. However, last week we received very good news from two manufacturers (GSK and Pfizer) that vaccines in development for adults were highly effective: 82% efficacy rate for GSK and 86% for Pfizer. We can’t expect a vaccine for this season, but maybe next year.

Influenza (Flu)

The official “flu season” started two weeks ago and case numbers are higher and earlier compared to the past two pandemic years and compared to before the pandemic. (See red triangles in the graph below.)

(CDC)

Flu rates are highest among 0-4 year olds, but cases in every age group are increasing. We are seeing regional trends with the flu, as the South has the most activity but East Coast states are starting to increase, too, particularly New York.

(CDC)

Flu viruses can be detected up to 5-7 days after becoming sick, but people are most contagious in the first 3-4 days after symptoms begin. Symptoms typically begin about 2 days (but can range from 1-4 days) after flu viruses infect a person’s respiratory tract. Some people can be infected with flu viruses and have no symptoms but still spread the virus.

There is a flu vaccine. We won’t know how well the flu vaccine works until next year (we collect real world data in real time), but lab data is indicating the vaccine is a good match this year. Unfortunately, flu vaccine uptake dropped during the pandemic.

COVID-19

Then there is COVID-19, which is calming down in Europe, even in Germany. We are also getting good news from Singapore, where the Omicron subvariant XBB took hold and caused an infection wave. Thankfully their XBB infection wave was smaller than the BA.5 wave. (We expected the opposite.)

In the U.S., wastewater is stalling, while the Omicron subvariants, and particularly BQ.1.1, take hold. BQ.1.1 has now grown to 16% of reported cases. We typically see a variant’s impact at around 50%, so we still have some time.

SARS-CoV-2 wastewater trends during pandemic. Source: Biobot Analytics

However, hospitalizations have started to rise for those over the age of 65, which is not a welcoming trend given that subvariants have yet to take over.

COVID19 daily admissions per 100K, by age group (NYT)

What does this all mean?

It’s becoming a petri dish out there. The triple threat specifically, though, isn’t in full throttle yet. This is clearly displayed in Chicago’s weekly surveillance report below where some viruses are rising but not all.

Respiratory Virus Laboratory Surveillance in Chicago

Will a triple threat come? This is one of the biggest debates among epidemiologists— the concept of whether we are witnessing virus-virus interaction. We know very little about how well viruses co-circulate with each other. For example, is flu spiking early because COVID-19 isn’t spiking yet? Maybe. Could RSV spike, then decline, then COVID-19 take over, then decline, then flu spike, and then decline? Maybe. Or, could they all spike at the same time? Maybe. We just don’t know what will happen, but a resurgence is expected.

This winter also depends on the strength of our healthcare system. The combination of our usual viruses co-circulating with COVID-19, burnt out healthcare workers, understaffed hospitals (in 2021, over 330,000 workers left healthcare), and staff being out for illnesses themselves, does not paint a pretty picture.

Bottom line

Lots of viruses are spreading right now and it’s a bit earlier than normal. We don’t have a triple threat yet, but I don’t think we want to see one, as I’m concerned for our healthcare systems. Do your part by getting vaccinated, staying at home while you’re sick, and other measures like washing hands, wearing a mask, and getting that airflow moving.

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WPCNR SCHOOL DAYS. From the Westchester County Department of Communications. October 20, 2022:

Last week, WPCNR asked for details on the Westchester County program to distribute over 3,600 air purifiers to 29 Westchester school districts. Carolyn Fortino, Deputy Director of the Department of Communications furnished further background in response to these WPCNR queries in this written statement:

WPCNR:    Why did the county feel it was important to provide the air purifiers to 29 school districts of Westchester’s 41 districts?

Ms. Fortino: The County had remaining funds from the ELC Reopening Schools grant (meant to help districts stay safe and open for learning during the COVID-19 pandemic) and one of the allowable costs for that grant is portable air purifiers for classrooms.

While these machines eliminate 99.99% of COVID-19 particles from the air, the benefits of cleaning the air extend far beyond that. The units help to eliminate other virus, bacteria, mold, allergens, dust and VOCs from the air, thus improving air quality overall. The air purifiers are a sound investment to help keep classrooms safe and teachers and students healthy through COVID and beyond.

WPCNR: Were all school districts polled/analyzed by county, as to which districts needed the purifiers, and why did they need them — (i.e., failure to equip all their  buildings with air purifiers for all rooms?

Ms. Fortino: Yes, this opportunity was made available to ALL public K-12 school districts. A memo outlining the program and a survey to opt into (or out of) the program was sent to all school districts, and follow up calls were attempted to any districts that had not responded to the survey by the deadline. The districts that are not receiving purifiers either opted out or did not respond to our communications.

WPCNR:      Is the County Health Department directing all school districts in Westchester to report new covid cases among students, teachers, staff? 

Ms. FORTINO: Reporting of suspected or confirmed communicable diseases is mandated under the New York State Sanitary Code (10NYCRR 2.10,2.14). COVID is one of the communicable diseases required to be reported to local health departments by school nurses.

WPCNR:  (The State Education Dept in August said school districts  no longer had to report new cases to the state as they did last year ). But does the County Health Department still require districts to do so?

 Ms. Fortino: Yes.

WPCNR: If the County Health Department is collecting the new case data, when will they release the first figures on school district numbers of new infections compared to last year?

Ms. FORTINO: The County Health Department will not be creating a school dashboard.  Since labs are a mandated reporter, lab confirmed cases of COVID will still be reflected in the NYS COVID tracker. In addition the widespread availability of OTC antigen tests, will make tracking COVID more challenging.  

WPCNR: When will the purifiers be delivered? 

Ms. Fortino: The vendor is working with each district one-on-one to arrange delivery dates. Almost 3,000 units have already shipped and will be delivered in the coming days. Another ~1,500 are expected to ship before the end of this week, and the remaining ~1,000 will likely ship the following week.

WPCNR:     Are the purifiers installed in class rooms and self-contained, plug ins  (easy to install) ?

Yes, these are floor units that are simply plugged into a regular outlet. The control buttons are behind a locked panel to avoid accidental tampering, and the machine has sensors to automatically adjust based on room occupancy, air quality, etc.

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Today, the Randall’s Island “Humanitarian Emergency Response and Relief Center” opened to house new asylum seekers arriving in New York City.

The New York Immigration Coalition strongly denounces the decision to house asylum seekers in tent encampments in this mass transit desert, and demands Mayor Adams utilize alternative housing options to meaningfully protect new arrivals.  

Murad Awawdeh, Executive Director, New York Immigration Coalition said:

“The decision to open the Randall’s Island tent camp today is a stain on our city’s rich history of welcoming immigrants and morally reprehensible.

By confining new asylum seekers to isolated tents, vulnerable to inclement weather and removed from critical social services, the Adams administration has failed in its duties to protect and integrate the newest arrivals to our city.

To continue ignoring the calls from advocates and other city officials to utilize alternative and more appropriate housing options, and instead begin implementing this dangerous plan, Mayor Adams has compromised New York City’s status as a beacon of hope.

Mayor Adams must immediately halt any future plans to use or expand tents around our city, instead prioritize the use of underutilized buildings to house new asylum seekers and intensely work to decompress the NYC Shelter system by providing permanent housing to our unhoused neighbors.”

Background: The New York Immigration Coalition’s Welcoming New York Campaign is advocating for a coordinated City, State and Federal response to asylum seekers being sent by bus from Texas to New York.

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GOVERNOR HOCHUL AND ATTORNEY GENERAL JAMES RELEASE REPORT ON THE ROLE OF ONLINE PLATFORMS IN THE BUFFALO SHOOTING

Report Details Shooter’s Radicalization on Fringe Websites, Use of Mainstream Platforms To Livestream Violence

Governor Hochul, Attorney General James Call for Federal and State Legislative Reforms To Combat Online Extremism and Violence

Governor Kathy Hochul and New York Attorney General Letitia James today released a report on the role of online platforms in the tragic Buffalo mass shooting at a Tops grocery store where 10 Black individuals were killed and three others were injured.

The Office of the Attorney General reviewed thousands of pages of documents and social media content to examine how the alleged shooter used online platforms to plan, prepare, and publicize his attack.

This investigation and subsequent report were completed in accordance with a referral from Governor Hochul. During the course of the investigation, OAG obtained and reviewed external and internal content and policies of several of the online platforms used by the shooter.

The report concludes that fringe online platforms, like 4chan, radicalized the shooter; livestreaming platforms, like Twitch, were weaponized to publicize and encourage copycat violent attacks; and a lack of oversight, transparency, and accountability of these platforms allowed hateful and extremist views to proliferate online, leading to radicalization and violence.

In the wake of these findings, Governor Hochul and Attorney General James are calling for federal and state reforms to combat online extremism and violence, including state legislation that would criminalize graphic images or videos created by a perpetrator of a homicide and penalize individuals who reshare or repost those same images or videos.

In addition, Governor Hochul and Attorney General James are recommending changes to Section 230 of the federal Communications Decency Act to increase accountability of online platforms and require companies take reasonable steps to prevent unlawful violent criminal content from appearing on their platforms.

“For too long, hate and division have been spreading rampant on online platforms — and as we saw in my hometown of Buffalo, the consequences are devastating,” Governor Hochul said. “In the wake of the horrific white supremacist shooting this year, I issued a referral asking the Office of the Attorney General to study the role online platforms played in this massacre. This report offers a chilling account of factors that contributed to this incident and, importantly, a road map toward greater accountability.”

“The tragic shooting in Buffalo exposed the real dangers of unmoderated online platforms that have become breeding grounds for white supremacy,” said Attorney General James. “Today I met with the victims’ families to share the findings of this report. This report is further proof that online radicalization and extremism is a serious threat to our communities, especially communities of color.

We saw this happen in Christchurch, Charlottesville, El Paso, and Buffalo, and we cannot wait for another tragedy before we take action. Online platforms should be held accountable for allowing hateful and dangerous content to spread on their platforms.

Extremist content is flourishing online, and we must all work together to confront this crisis and protect our children and communities.”

The OAG report examined several online platforms used by the shooter, including 4chan, 8kun, Reddit, Discord, Twitch, and YouTube, and other online platforms where OAG found graphic content of the shooting or the shooter’s manifesto, including Facebook, Instagram, Twitter, TikTok, and Rumble.

The OAG subpoenaed these companies and reviewed thousands of pages of documents. Investigators looked at how platforms have been used to distribute and promote racist and antisemitic memes and messages and share graphic media of previous racially motivated violence, both of which contributed to the alleged shooter’s radicalization.

The report also details how several more mainstream platforms were used to livestream the shooting with the goal of inciting additional violent acts, and how graphic video of the shooting has proliferated online.

In sum, the report confirms that several online platforms played an undeniable role in this racist attack, first by radicalizing the shooter as he consumed voluminous amounts of racist and violent content, helping him prepare for the attack, and finally allowing him to broadcast it. The report notes these takeaways:

• Fringe Platforms Fuel Radicalization: By his own account, the Buffalo shooter was radicalized by virulent racist and antisemitic content on anonymous, virtually unmoderated websites and platforms that operate outside of the mainstream internet, most notably 4chan. In the wake of the Buffalo shooting, graphic video of the shooting recorded by a viewer of the shooter’s livestream proliferated on fringe sites. The anonymity offered by 4chan and platforms like it, and their refusal to moderate content in any meaningful way, ensures that these platforms continue to be breeding grounds for racist hate speech and radicalization.
• Livestreaming Has Become a Tool for Mass Shooters: Livestreaming has become a tool of mass shooters to instantaneously publicize their crime, further terrorizing the community targeted by the shooter and serving as a mechanism to incite and solicit additional violent acts. The Buffalo shooter was galvanized by his belief that others would be watching him commit violence in real-time. Although the platform he used to livestream his atrocities disabled the livestream within two minutes of the onset of violence, two minutes is still too much.
• Mainstream Platforms’ Moderation Policies Are Inconsistent and Opaque: Many large, established platforms improved on their response time for identifying and removing problematic content related to the Buffalo shooting, including graphic video of the shooting and the shooter’s manifesto, as compared to past events. However, the platforms’ responses were uneven, with one platform unable to identify posts that linked to off-site copies of the shooting video even after those posts were flagged through user reports. Many platforms also do not fully disclose how they moderate hateful, extremist, or racist content.\
• Online Platforms Lack Accountability: Online platforms enjoy too much legal immunity. Section 230 of the Communications Decency Act largely insulates platforms from liability for their content moderation decisions, even when a platform allows users to post and share unlawful content.

In response to the findings in the report, Governor Hochul and Attorney General James recommend a variety of reforms to tackle online extremism and increase accountability of online platforms. These recommendations include:

• Create Liability for the Creation and Distribution of Videos of Homicides: New York and other states should pass legislation imposing criminal liability for the creation, by the perpetrator, of images or videos depicting a homicide. New York should explore establishing civil liability for anyone who transmits or distributes a perpetrator’s images or videos depicting the homicide they commit. In concert with appropriate revisions to Section 230, this liability would extend to online platforms, including social media and livestreaming platforms, that do not take reasonable steps to prevent such content from appearing.
• Add Restrictions to Livestreaming: Livestreaming was used as a tool by the Buffalo shooter, like previous hate-fueled attacks, to instantaneously document and broadcast his violent acts to secure a measure of fame and radicalize others. Livestreaming on platforms should be subject to restrictions—including verification requirements and tape delays—tailored to identify first-person violence before it can be widely disseminated.
• Reform Section 230: Currently, Section 230 of the federal Communications Decency Act protects online platforms from liability for third-party content that they host, regardless of those platforms’ moderation practices. Congress should rethink the ready availability of Section 230 as a complete defense for online platforms’ content moderation practices.
• Instead, the law should be reformed to require an online platform that wishes to retain Section 230’s protections to take reasonable steps to prevent unlawful violent criminal content from appearing on the platform. This proposal would change the default. Instead of simply being able to assert protection under Section 230, an online platform has the initial burden of establishing that its policies and practices were reasonably designed to address unlawful content.
• Increase Transparency and Strengthen Moderation: Online platforms should provide better transparency into their content moderation policies and how those policies are applied in practice, including those that are aimed at addressing hateful, extremist, and racist content. They should also invest in improving industry-wide processes and procedures for reducing the prevalence of such content, including by expanding the types of content that can be analyzed for violations of their policies, improving detection technology, and providing even more efficient means to share information.
• Call on Industry Service Providers to Do More: Online service providers, like domain registrars and hosting companies, stand in between fringe sites and users. These companies should take a closer look at the websites that repeatedly traffic in violent, hateful content, and refuse to service sites that perpetuate the cycle of white supremacist violence.

In May 2022, Governor Hochul provided a referral to OAG under New York Executive Law Section 63(8) to investigate the role of online platforms in the Buffalo shooting.

The investigation and subsequent report were conducted by the Bureau of Internet and Technology and the Hate Crimes Unit of the Bureau of Civil Rights, with special assistance from the Research and Analytics Division and the Criminal Justice Division.