Winter months bring the trifecta of illness — will 2023 have high numbers of flu, RSV and COVID?

Health officials weigh in

Thelma Grimes
Posted 9/5/23

With colder months just around the corner, it’s time to start thinking about and preparing for the trifecta of illnesses that come with winter. In 2022, the trifecta was a word used to describe …

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Winter months bring the trifecta of illness — will 2023 have high numbers of flu, RSV and COVID?

Health officials weigh in


With colder months just around the corner, it’s time to start thinking about and preparing for the trifecta of illnesses that come with winter. In 2022, the trifecta was a word used to describe the unseasonably high number of cases of COVID, influenza and, on the rise in recent years, RSV, also known as a respiratory syncytial virus.

Not only has the increased number of RSV cases caused worries for health officials across the Front Range, but the early onset of when they start seeing patients fill hospital rooms is a concern.

In 2021, from Sky Ridge Medical Center in Lone Tree to Children’s Hospital Colorado campuses across the metro area, doctors said they were seeing RSV cases in August and September, which is uncommon for a respiratory virus that is more common during what is considered flu season.

Flu season generally runs between October and February, with the height of cases popping up between December and February.

RSV, usually a respiratory issue that affects children, is also being seen in more adults over the last few years.

Dr. Ben Usatch, UCHealth emergency-room director at Highlands Ranch Hospital, said there is an RSV vaccine available this year. While noting it is not new, Usatch said attention to the vaccine has increased as more adults, especially senior citizens, are coming down with RSV.

Symptoms of RSV include runny nose, decreased appetite, coughing, sneezing, fever, and wheezing. More severe cases require hospitalization, especially for infants and toddlers.

According to the Colorado Department of Health and Wellness, since October 2022 there have been 2,597 RSV hospital admissions in Douglas, Jefferson, Arapahoe and Adams counties.

There have been 4,174 COVID hospital admissions in the four-county stretch along the Front Range. In flu cases, the state health department has tracked 1,502 admissions.

Usatch said that while he does not have any real studies to back it up, he believes when schools and society shut down during the pandemic, immune systems were weakened

Usatch said once the masks came off, immune systems were put back to work, and that could be the reason for more cases of flu, COVID-19 and RSV in 2021 and 2022.

Agreeing with Usatch, Dr. Matt Mendenhall, chief medical officer at AdventHealth Littleton, said unmasking invited cold seasons to return. During the stretch of the pandemic when nearly everyone wore masks, colds, RSV and the flu were almost nonexistent.

“Last year was a bit overwhelming since it all returned and caught like wildfire,” Mendenhall said. “I have never seen an RSV season like last year. The worry this year is if RSV will overwhelm our healthcare systems again.”

Still, Mendenhall said he is optimistic about RSV in 2023, given there have been approved vaccinations for older adults, while the FDA approved Beyfortus for infants.

Beyfortus, a monoclonal antibody, is approved for infants and toddlers 24 months and younger, who are the most vulnerable to RSV.

Dr. Sam Dominguez, medical director and infectious disease expert at Children’s Hospital Colorado, said it is hard to “predict the unpredictable,” but they have been conducting internal surveillance for all viruses and looking at what is circulating around the country to understand what might happening this year.

“We expect to see all three of these viruses (RSV, flu and COVID) circulate again this year. Due to the extraordinary high numbers of RSV cases we saw last year, we do not anticipate as huge of a surge in RSV cases this year, but still anticipate a significant RSV season that looks similar to pre-pandemic seasons.”

In the upcoming season, Usatch said he believes things could be better than the last two years because disease resistance has increased as people have returned to ordinary living.

Usatch said the increase in tracking cases is also because doctors learned a lot more during the pandemic, meaning they are more vigilant in checking for everything. Doctors now check for COVID, flu and RSV.

“Our box has become much bigger for what we are looking for,” he said.

Usatch said while the general public has seemingly moved on from COVID, cases exist and the virus still spreads quicker than other illnesses.

“With COVID continually mutating, we have to watch out,” he said. “We have to see what other health issues come with it. Is the (new mutation) more spreadable? Is it more contagious?”

COVID continues to create issues for health officials worldwide, as the omicron variant was more prevalent in 2022.

In March, the World Health Organization, or WHO, said the omicron viruses account for over 98% of COVID cases since February 2022.

There are now two new COVID variants worrying health officials, with the EG.5 variant being the most dominant strain in the U.S. In August, the Centers for Disease Control estimated that the EG.5 strain makes up about 20.6% of all new COVID infections.

On Aug. 9, WHO reported that the EG.5 variant poses a low public health risk, saying it is similar to past variants.

However, EG.5, and other new variants, can be just as contagious as past variants. Globally, WHO reported that there have been over 1 million new COVID-19 cases and more than 3,100 deaths reported since July.

Since 2020, WHO reported that there have been 768 million confirmed COVID cases and 6.9 million deaths.

When it comes to flu season, Mendenhall said he is less optimistic. Each year, U.S. health officials try to gauge flu season during the summer months when it’s wintertime in Australia.

In July, Australian health officials said this year’s flu season is worse than pre-pandemic numbers in 2019 and one of the worst on record.

Mendenhall said like the U.S., Australian vaccination numbers have decreased since the pandemic, with fewer residents getting the flu shot.

The controversy surrounding COVID has hurt vaccinations in other areas, Mendenhall said, stressing that politics in healthcare has created some hardships since 2020.

Usatch said the flu vaccination is vital to decreasing hospital admissions during winter months. While the vaccine is not 100% effective, it does decrease a person’s chances of catching flu or risking complications from it.

“It’s not about being a good or bad vaccine,” Usatch said. “(Those making the vaccine) consider recent strains and work to make the best guess for the new vaccine and hope that it covers a lot of strains. Vaccines are just great tools for people to take advantage of.”

Mendenhall said it's important for residents to listen to their physicians and follow the science when it comes to preparing for the upcoming season.

“The science is clear — vaccines protect from illness,” he said.

Both COVID and flu vaccinations are expected in September this year.

Mendenhall said for COVID vaccinations this year, it’s important to remember that the government is no longer paying for shots. This year, residents will have to rely on insurance or themselves to pay for them.

Usatch said vaccinations are the best option to decrease cases in the upcoming season.

“You really got to start vaxing up in September and October,” Usatch said. “There is a new COVID vaccination this year, there is more access to RSV vaccinations, and for those who qualify, there is a pneumococcal vaccine.”

The pneumococcal vaccine is usually available to vulnerable citizens aged 65 and older. The vaccine prevents pneumococcal pneumonia. According to the American Lung Association website, pneumococcal pneumonia is the most common type of bacterial pneumonia, with the risk increasing with a person’s age and certain chronic conditions.

Pneumococcal pneumonia can develop after a person has been infected with a viral cold or flu.

Besides getting vaccinated, Usatch said the best way to combat the trifecta of viruses that can spread in and beyond the metro area is to be vigilant.

“Pay attention to your environment,” he said. “Pay attention to yourself. If you are sick, you need to respect your coworkers and stay home. We have tools and tests to do surveillance and understand what’s out there, but most importantly, you need to keep yourself protected. Keep yourself healthy.”

Mendenhall also advised parents to be cautious with children going to school. School-aged children showing symptoms of RSV, flu, COVID or a cold should be kept home.

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