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Parents brace for the next turn on a roller coaster of viruses

Data: CDC; Note: All data subject to reporting delays and likely undercounted; RSV cases are a five-week moving average; Chart: Kavya Beheraj/Axios

An ominous rise in COVID cases has parents bracing for another wave of illness — even as flu season appears to be peaking and RSV is on the decline.

Why it matters: We're in a season of back-to-back-to-back sucker punches from respiratory viruses that are hitting young children earlier — and harder — than usual.

  • This season has already swamped pediatricians' offices, emergency departments and children's hospitals; caused shortages of common antibiotics and children's medication; and led pharmacies to limit sales of pain and fever meds.

State of play: COVID cases are up 16% since mid-October, fulfilling predictions of a wintertime surge just as an early flu season — which has already caused more than 9,300 deaths — is showing signs of abating.

  • "This year what you're seeing is a true rebound of flu-like illnesses," said Manoj Gandhi, senior medical director at Thermo Fisher Scientific. "It's certainly bad."
  • While much has been made of the so-called tripledemic of flu, RSV and COVID, but there's actually more of a "septo-demic," said Peter Hotez, dean at the National School of Tropical Medicine at Baylor College of Medicine, in an interview posted last week with the American Medical Association.
  • That counts para influenza, rhinovirus, metapneumovirus and pneumococcus as part of the mix, he said.
  • "They're working in different combinations and causing a lot of kids to be admitted to the hospital, as well as seniors. This is accounting for a big surge in hospitalizations," Hotez said.
  • It's a marked contrast to early in the pandemic, when lockdowns and school closings spared kids from the worst of the crisis. Those who did get sick often experienced milder symptoms.

The big picture: Now a rise in COVID infections is being driven by newer variants.

  • Most children are protected against the worst outcomes, either because they've been vaccinated or have some immunity from a prior infection, said Peter Marks, director of the FDA's Center for Biologics Evaluation and Research in an event on children's vaccines Tuesday.

Yes, but: Many still aren't current on their vaccines, and the return to pre-pandemic life is exposing them to simultaneous threats.

  • "Unfortunately, we probably will be seeing a fair amount of flu and COVID-19 among kids, particularly because COVID-19 vaccination rates are not very high," Marks said.
  • "The type of COVID-19 with Omicron B.A.1 that kids got last January, February is probably not highly protective against the variants that are now circulating," Marks said, urging parents to consider boosters.

The bottom line: Hold on for the ride and employ the mitigation strategies we all know well, like washing hands, social distancing and masking when possible.

  • Hotez' advice for parents heading into the holidays: Make sure everyone is up to date on their vaccines, including the new bivalent COVID boosters for kids as well as shots for flu and pneumococcus. "Take as many of those pathogens off the table as you can," he said.
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