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November 22, 2022

'This is a crisis': How hospitals are responding to the 'tripledemic'

Daily Briefing

    With Covid-19, flu, and respiratory syncytial virus (RSV) surging across the United States, many hospitals are overwhelmed. And as the "tripledemic" continues to grow, health experts are encouraging people to get vaccinated and practice safety precautions during the upcoming holidays.

    'We are in the midst of a true tripledemic'

    Currently, cases of Covid-19, flu, and RSV are high across the United States, with RSV and flu in particular seeing sharp increases in recent weeks.

    CDC data shows that more than 26,000 RSV tests came back positive between Oct. 30 and Nov. 12—a significantly higher number than what was recorded at the same time last year. In addition, HHS reported last week that 78% of pediatric hospitals nationwide were filled, with seven sates reporting capacity levels of more than 90%.

    Flu activity in the United States also remains elevated. For the week ending Nov. 12, 15 states and the District of Columbia had very high rates of influenza-like illnesses. There were also 8,707 patients hospitalized with influenza that week, up from 6,465 patients the week before.

    "We are in the midst of a true triple-demic," said Jacob Lemieux, an infectious disease specialist at Massachusetts General Hospital.

    Across the country, many hospitals are close to or at capacity, leading to a limited availability of hospital beds and hours-long wait times in the ED. To help manage the influx of new patients, several hospitals have enacted new policies and restrictions.

    For example, Boston Children's Hospital has postponed elective surgeries, and Johns Hopkins Children's Center has reopened Covid-19 triage tents to help manage overflow.

    In North Carolina, several hospitals, including Atrium Health, CaroMont Health, and Novant Health, have implemented visitor restrictions earlier than usual for those 12 and under. Typically, visitor restrictions are implemented around January, when the flu season peaks.

    "We were afraid this might happen," said Katie Passaretti, VP and enterprise chief epidemiologist at Atrium Health. "We're seeing the flu very early this year. Usually, in the past, we've implemented visitor restrictions around January so we're a couple of months earlier than that. And the rate of increase is very, very steep so we're seeing more cases earlier than we tend to see."

    According to Anne Klibanski, president and CEO of Mass General Brigham, "This is not just an issue. This is a crisis."

    "We are caring for patients in the hallways of our emergency departments," she said. "There is a huge capacity crisis, and it's becoming more and more impossible to take care of patients correctly and provide the best care that we all need to be providing."

    Experts recommend precautions ahead of the holidays

    With these respiratory viruses circulating widely and cases continuing to rise, health experts are recommending people take precautions as Thanksgiving and other holidays approach.

    According to Kathryn Stephenson, director of the clinical trials unit at the Center for Virology and Vaccine Research at Beth Israel Deaconess Medical Center, people should "get back to the basics" by staying home when they're sick and wearing a high-quality mask if they visit someone at high risk of infection.

    Other experts also recommend getting tested for Covid-19 before a gathering and changing plans as needed if testing positive.

    "People need to make a risk benefit assessment and be open to dynamically changing plans," Lemieux said. "People need to understand that there's a risk with any human interaction, and that the more density you have and the more indoor poor [air] circulation, the higher the risk."

    "I don't want to say, 'Cancel Thanksgiving,'" he added. "I also don't want to say, 'Don't worry about respiratory viruses.'"

    To reduce the risk of infection and severe illness, the Biden administration has also encouraged people to get a flu shot, as well as an updated Covid-19 booster.

    Many health care organizations have also reached out to the Biden administration for help with ED staffing shortages and burnout, which is likely exacerbating capacity issues amid the current viral surges.

    This month, the American College of Emergency Physicians and 35 other health care organizations sent a letter to President Biden, urging the administration to do more to address these issues. "Shift work, scheduling, risk of exposure to infectious-disease, and violence in the emergency department can all affect the mental health and well-being of the physicians and nurses," they wrote.

    "[T]here is no more normal," Klibanski said. "Everything has changed, and now all those issues at the forefront are only getting more exacerbated over time." (Malhi, Washington Post, 11/20; Alba et al., NBC News, 11/17; Freyer et al., Boston Globe, 11/17; Vargas, KOMO News, 11/17; Santiago, Charlotte Observer, 11/18; Innes, Arizona Republic, 11/17)

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