Barbara Taylor, MD: Likelihood of a Triple-Demic this Autumn Season with RSV, COVID-19, Flu

Respiratory syncytial virus (RSV) is currently one of the most relevant topics in the field of pulmonology, and the new autumn season brings with it the common questions for clinicians such as which vaccines to choose for influenza and RSV and what concerns might be for patients regarding other illnesses such as COVID-19.

Given that the onset of the autumn season has led to a new vaccine designed to prevent lower respiratory tract diseases caused by RSV for adults aged 60 and older, new questions emerge regarding RSV diagnosis and the potential for a so-called ‘triple-demic’ of RSV, influenza, and COVID-19.

In the latest episode of Lungcast, American Lung Association (ALA) chief medical officer and HCPLive Editorial Advisory Board member Al Rizzo, MD, spoke with Barbara S. Taylor, MD, MS, associate professor of infectious diseases and assistant dean for the MD/MPH program at UT Health San Antonio, on these very subjects.

“It is highly transmissible but fortunately, for the vast majority of people, it causes a mild cold or an upper respiratory infection,” Taylor said. “However, it's also really common in young children and, as you mentioned, is the most common cause for hospitalization of young children.”

Taylor explained that for certain populations, particularly infants under 12 months, older adults, and those who are immunocompromised, RSV can cause a more severe lower respiratory tract infection. It may then present as viral pneumonia which can rapidly progress to hypoxia and death.

“So it does have a lot of potential long term consequences, although for most people, it's just a cold test that usually begins with a nasal swab in grownups or a wash in infants,” Taylor said. “There are really outstanding PCR-based or nucleic acid amplification based tests that can give you a result as quickly as 3 hours. And sometimes those are combined with tests for other respiratory pathogens here locally, I know we have one that's RSV, influenza and COVID.”

Taylor added that there are also rapid antigen tests, some of which Taylor noted are actually available over the counter and can take 30 minutes. Later, Taylor was asked about the potential for a triple-demic of COVID-19, flu, and RSV during the autumn season.

“If anything has very much humbled infectious disease doctors, it's trying to predict what's happening with respiratory pathogens these days,” Taylor said. “But if we learned anything from last year, which as you mentioned was the triple-demic season…battling simultaneous surges of RSV influenza and COVID and particularly in pediatric populations, it’s that this can happen and it's a real challenge in terms of morbidity and mortality for our patients, but also in terms of extreme stress on our hospital systems.”

The previous year was a bit of an anomaly, according to Taylor, given that many of the infants and toddlers had not had pre-existing immunity to RSV because of the very important nonpharmaceutical interventions of 2020 and 2021.

“That kept everybody from having COVID all at once,” she said. “So we won't be facing that same challenge. But in the current context, it's really hard to predict what the RSV season is going to look like and how it will intersect with COVID and with the flu. The CDC Centers for Disease Control and Prevention just released a statement literally this week that they are worried about a repeat triple epidemic and current data suggests that, at least in Texas, both flu and RSV are on the rise.”

Better awareness, vigilance, and better preparation were stressed as the overall message by Taylor with regard to the autumn season’s potential for respiratory diseases.

Lungcast is a monthly respiratory health podcast series from the ALA produced by HCPLive.

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