Healthcare system dealing with trio of COVID, flu, RSV

According to Munson Healthcare officials, the current combination of three respiratory diseases – COVID-19, influenza, and RSV – is leading to more people seeking healthcare services and increased wait times at clinics and emergency departments.

Munson Healthcare offered an “overview of the status of COVID-19 but also flu and RSV and the impact that it’s having on our communities as well as the healthcare system itself” during an online press conference on Tuesday, January 10. 

Dr. Christine Nefcy, Munson Healthcare Chief Medical Officer, said COVID-19 numbers are up in the region.

“We have definitely after the holidays seen an uptick in our numbers,” Dr. Nefcy said.

Dr. Nefcy said the 14-day test percent positivity average for Michigan is 13.4 but the average in the region is 18.3 percent.

“Typically through this pandemic we have lagged behind the state as far as our positivity but for the last two weeks we are actually above the state average at 18.3 percent positivity and 140 cases per 100,000,” Dr. Nefcy said.

Dr. Nefcy said RSV numbers have been “stable” but influenza numbers are increasing. According to Munson Healthcare, the system had 55 flu inpatients in early January compared to 18 in mid-December. Munson Healthcare reported an increase from 38 COVID-19 inpatients in mid-December to 55 in early January.

“We’ve got several respiratory illnesses that are going on now. One would be COVID, and in addition we’re seeing RSV patients, typically pediatric patients that are hospitalized, and then we’ve got some influenza patients that are being hospitalized as well,” Dr. Nefcy said. “So a slower uptick from a percentage wise in our COVID numbers. We are stable on our RSV now, but we are seeing quite a bit of flu activity of late.”

Munson Healthcare officials said there are some basic things people can do to avoid illness: “Get vaccinated or get your booster. Avoid close contact with people who are sick. If you are sick, limit contact with others as much as possible. Masking can help prevent the spread of flu, RSV, and COVID-19. Avoid large gatherings if possible. Wash hands frequently. Continue your regular screenings and preventive care schedule.”

“We know what will prevent things from spreading from a respiratory perspective. We’ve learned over the past two to three years that masking can help prevent the spread of all of those illnesses of flu, RSV, and COVID-19, all of which we are seeing in the community,” Dr. Nefcy said.

Munson Healthcare officials said it is possible to have one, two, or all three of those illnesses at the same time.

Dr. Christopher Ledtke, Infectious Disease Munson Healthcare, said “new (COVID-19) cases, hospitalizations, and deaths are slowly trending up” nationally, “which is not surprising after indoor holiday gatherings.”

“We do want to remind everyone that the pandemic is still ongoing, though it looks different than it has for the first few years. We’re still losing about 500 Americans every day from COVID-19, almost all of which are 65 and older, which remains the highest risk group,” Dr. Ledtke said.

Dr. Ledtke said COVID-19 omicron variant “offshoots” or “subvariants” are the current dominant versions of the virus, with the XBB.1.5 variant currently prevalent in the northest part of the country. Dr. Ledtke said he expects XBB.1.5 to be “dominant” in the midwest soon.

“We can expect the newly dominant subvariants will be more transmissible or more able to avoid our immune system,” Dr. Ledtke said. “These new subvariants, including XBB.1.5, will be more transmissible, otherwise they would not become dominant, but no evidence exists thus far that they will produce more severe disease.”

Dr. Ledtke said people can “expect new subvariants every few months” and it’s “too soon to tell” how effective the latest omicron-specific vaccines will be against the “new subvariants.”

According to Munson Healthcare, “COVID-19 treatment options remain limited.” Dr. Ledtke said monoclonal antibody therapy is not effective against the latest variants and is “no longer being administered” through Munson Healthcare.

“Paxlovid is the #1 preferred oral therapy for patients at high risk of severe disease. High risk patients include those who are elderly, overweight, diabetic, chronic lung or heart disease among other risk factors. This is free to patients and readily available at local pharmacies. Remdesivir is an alternative but can only be given in the hospital setting at this time,” according to Munson Healthcare.

“Your best bet to stay safe would be ensuring that you are up to date with a most recent booster. Getting appropriate treatment if you meet criteria is also important. Consider masking in high risk situations, which in particular would be crowded indoor settings, especially if you are at risk for severe disease,” Dr. Ledtke said.

Bonnie Kruszka, Munson Healthcare Vice President and Chief Nursing Officer Ambulatory Services, said emergency room visits, ER wait times, and urgent care/walk-in clinic visits have been increasing.

“We are seeing a rise in COVID-19, influenza, and RSV cases across the healthcare system, especially in emergency departments,” Kruszka said.

“With this more contagious variant we are seeing an uptick in the number of cases,” Dr. Nefcy said. “We aren’t seeing a big uptick like we saw in the past with our inpatient numbers, so while the three viruses all together has certainly made an impact over what we were seeing as far as inpatients go. We aren’t seeing the numbers that we saw before that were really significantly impacting our operations. We are having an impact obviously from some employees that are getting ill. The bigger impact is actually in our urgent cares and emergency departments of people seeking care trying to figure out what illness they have and what treatment options are available.”

RSV, respiratory syncytia virus, is “a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age in the United States,” according to the Centers for Disease Control and Prevention.