Tri-demic? Time to increase protections against surging respiratory viruses

We’ve been hearing talk of a potential triple threat of viruses or a “tri-demic” this winter – a rise in multiple types of respiratory viruses. We sat down with Dr. Eric Chow, who leads our Communicable Disease and Epidemiology Section, to learn more about what’s happening and what we can do to stay safer. 

Slides are available in the following languages: አማርኛ (Amharic), العربية (Arabic), 简体字 (Chinese – Simplified), 繁體字 (Chinese – Traditional), دری (Dari), English, Français (French), 日本語 (Japanese), ភាសាខ្មែរ (Khmer), 한국어 (Korean), Kajin M̧ajeļ (Marshallese), ਪੰਜਾਬੀ (Punjabi), Русский (Russian), Af Soomaali (Somali), Español (Spanish), Wikang Tagalog/Filipino (Tagalog/Filipino), ትግርኛ (Tigrinya), Українська (Ukrainian), Tiếng Việt (Vietnamese)

Dr. Eric, we’ve heard concerns about a potential “tri-demic” this winter – high cases of COVID-19, flu, and RSV. Is this something Public Health is worried about? 

Yes, both locally and nationally we’re seeing a rise in these respiratory viruses. This is concerning both for the health of our most vulnerable residents, such as young children, older adults, and for people with underlying conditions. It’s also concerning for our healthcare system, which for many months has been experiencing staffing shortages and limited available hospital beds for new patients. 

We’re seeing more cases of RSV this winter than we have in the last four years, and the numbers are rising sharply. This is resulting in many very young children needing to be hospitalized. Seattle Children’s Hospital Emergency Department is reporting seeing twice as many patients as they typically do during this time of the year, with about half these patients arriving with some type of respiratory concern. They anticipate these volumes will only increase in the coming months. 

In addition, although it’s not possible to predict the ultimate severity and duration of any flu season, it looks like this winter could be a particularly bad one. Nationally, hospitalization rates for flu this early in the season are higher than they have been at this time of the year for the last 10 years.  

And finally, we’re concerned about a possible surge in COVID-19 cases and hospitalizations this winter as people gather indoors more frequently and new variants become more widespread. 

Whether these outbreaks occur simultaneously or sequentially, they can make a lot of children and adults sick and we should take steps to protect ourselves, our families and our community by preventing as many illnesses as possible. 

What’s behind the concern about a potential “tri-demic?” 

Our last two flu and RSV seasons were historically mild in large part because of mask wearing, social distancing, and people staying home when ill to prevent serious COVID-19 infections. Now that most of these protective measures aren’t in place, we’re seeing a lot more spread of respiratory viruses. 

In addition, because flu and RSV transmission has been so low in recent seasons, population immunity is likely lower now than it would be if we’d had more typical RSV and flu seasons recently. In particular, more young children than usual may be more likely to get infected since they have never been exposed to the flu or RSV. 

And, while the volume of COVID-19 hospitalizations and deaths is currently much lower than in prior fall/winter seasons – thanks primarily to COVID-19 vaccines – new variants continue to evolve. In addition, many people who are at high-risk and eligible for an updated booster shot have still not received it, leaving them more vulnerable to serious infections, even if they were previously vaccinated or infected. 

In short – if you’re feeling sick, even if you test negative for COVID-19, please stay home! It could be the flu or RSV, and you could pass it on to people who are more vulnerable. This is especially important for folks who will be around infants or older adults, who are particularly susceptible to serious illness from flu and RSV. 

Tell us more about RSV. Is this a new virus? 

RSV stands for respiratory syncytial virus. It’s a common respiratory virus that comes up every winter, but this year we’re seeing a very high volume of cases, particularly in young children.  

Anyone can get RSV – for adults and older children, it can feel like a cold. But it can be a very serious illness – causing pneumonia or bronchiolitis – for babies and older adults, including requiring hospitalization or even leading to death. Those with underlying medical conditions such as asthma and COPD may also be at increased risk for complications with RSV infections. 

What symptoms should people look for with RSV?  

In both children and adults, RSV symptoms include: 

  • Runny nose 
  • Decrease in appetite 
  • Coughing 
  • Fever 

In very young infants with RSV, the only symptoms may be irritability, decreased activity and appetite, and breathing difficulties.  

If you or your child is having difficulty breathing, not drinking enough fluids, or experiencing worsening symptoms, call your doctor. Seattle Children’s has more information about RSV symptoms to look for in young children on their website.    

How do these three viruses spread? 

The viruses that cause RSV and influenza are thought to spread primarily by droplets from people who are infected. They can spread when an infected person coughs or sneezes and the droplets land in your eyes, nose or mouth, or if you touch a surface that has the virus on it, like a doorknob, and then touch your face before washing your hands. 

The virus that causes COVID-19 spreads similarly, though it is more easily able to spread through the air and is less likely to live for long periods of time on surfaces, like the viruses that cause RSV and influenza. 

It’s important to know that wearing a high quality, well-fitting mask in indoor public settings and washing your hands regularly can help protect against all three of these respiratory illnesses – RSV, flu, and COVID-19. 

Aside from staying home when we’re sick, what else should we do to fight this potential “tri-demic”? 

While there’s no vaccination to protect against RSV at this time, getting your seasonal flu shot and updated COVID-19 booster is important to protect against serious complications from those viruses.  

Our local healthcare and hospital system is already fragile, and we’re worried about capacity during a potential “tri-demic.” Getting your flu shot and COVID-19 booster will help protect yourself and those around you from serious illness and hospitalization, and in turn help protect hospital capacity to treat all other illnesses that need hospital care, including RSV.  

You’re a parent to a new baby (congrats!). What are you doing to help protect your little one from respiratory viruses? 

Thank you! Yes, having a new baby is so exciting, but can also be scary when hearing about things like a “tri-demic.”  

To help keep our son safer from respiratory illness, my partner and I are both up to date on our flu shots and updated COVID-19 booster, and we make sure that anyone who has close contact with our son (baby-sitters and family and friends who visit) are also up to date on all their vaccinations. As soon as our son turns 6 months old, we’ll be getting his flu and COVID-19 vaccines, since he’s so susceptible to serious illness. 

In addition, we’re clear with visitors that if they’re not feeling well – even if they’ve tested negative for COVID-19 – that they wait to visit with our family until their symptoms have cleared. 

Finally, my family is avoiding large indoor gatherings right now to help prevent one of us picking up a virus we could pass to our son. When we do go into indoor spaces, we wear a well-fitting face mask, like a N95 or KN-95 and try to improve ventilation where possible. 

In addition to protecting new babies, it’s important for people who are pregnant to make sure they’re up to date on their flu and pertussis vaccines, and to ensure that anyone who will be around the infant is also fully up to date on their vaccinations.

Great reminder about the new COVID-19 booster and flu shot. Who’s eligible and where can we go to get them? 

Everyone ages 5 years and older who’s gotten a COVID-19 shot (booster or primary series) at least two months ago should get the updated booster. So, even if you got a COVID-19 booster before, you should still get this updated booster!  

Families should ensure that children ages 6 months to 4 years have completed their primary COVID-19 vaccine series. For more information about where to get a free COVID-19 shot (including the updated booster), visit: 

Everyone ages 6 months and older should get a flu shot every year. More information about where to get a free flu shot is available on our Find a Vaccine Clinic webpage. Flu activity is starting to increase locally at this time, so don’t delay getting your flu shot any longer! 

Lastly, just a reminder that it’s safe and effective to get the flu shot and the COVID-19 shot at the same time.  

More information: 

Originally published November 8, 2022.